Neuropsychological Assessment (9) Flashcards
An applied science concerned with the behavioural expression of brain dysfunction
Clinical neuropsychology
What were four reasons that WW1 provided the first push for the development of clinical neuropsychology?
Pre-screening
Diagnosis for injured soldiers
Monitoring “behaviourally disturbed” servicemen
Rehabilitation
What were grounding contributions to the origins of the field of clinical neuropsychology?
Neuroscience
Educational psychologists
Experimental studies on behaviour and cognitive function i both humans and animals
Imaging techniques such as X-rays, CT, MRI
Static
Imaging techniques such as EEG, PET, fMRI
Dynamic
Who are assessments given to?
Anyone interested in the identification, assessment, care and treatment/rehabilitation of brain-injured patients
What are the five different purposes that may prompt a neuropsychological examination?
Diagnosis, patient care and planning, treatment, research, forensic questions
What are the four uses of diagnosis?
Discriminate between psychiatric and neurological symptoms
Distinguish between neurological conditions
Early detection and prediction
Behavioural data for localizing the site or side of the damage
Why has the use of neuropsychological assessments as a diagnostic tool declined over time?
Development of sensitive, reliable and noninvasive imaging techniques
Despite advances in imaging techniques, why are neuropsychological assessments still used?
Images cannot identify nature/degree of behavioural deficits
Document the cognitive abilities of those with inconsistent anatomical findings
What are some ways in which neuropsychological assessments help patient care?
Answer questions regarding a patient’s capacity for self-care, likelihood of following treatment plans, and likelihood that they can function independently
Follow the course of neurological conditions over time
Provide information to the patient about their functioning
What aspects of treatment are neuropsychological assessments relevant to?
Treatment planning, evaluating treatment effectiveness
What relevance do neuropsychological assessments have to forensic psychology?
Legal proceedings and criminal cases
What does the collateral information component of NP assessment pertain to?
Chart reviews
Radiological investigations/diagnostic tools
Psychiatric history and diagnoses
Neurological examinations
Previous NP assessment results
Interview with family members
Cultural issues
Legal history (if forensic case)
What are key considerations of the clinical interview component of NP assessments?
Basic personal information
Current medications
Languages
Subjective cognitive complaints
Psychological/emotional issues
Medical history
Developmental history
Substance use history
What are the two key things to consider before testing?
When to examine the patient
What tests should be used
What are the three ways that behaviours of interest can be thought of ?
Cognition (memory, language, etc)
Emotionality (feelings and motivations)
Executive functions (How behaviour is expressed)
Drawing conclusions based on the scores obtained using standardized test
Quantitative
What is the drawback of quantitative methods?
Doesn’t consider how the individual performed the task
Behavioural observations/how the person went about the task
Qualitative
What is the drawback of qualitative methods?
Lacks objective standardization
Which 8 cognitive domains are assessed?
Orientation (optional), pre-morbid intellectual functioning, attention and information processing speed (IPS), language, visual perceptual abilities, learning and memory, executive functions, malingering
The awareness of oneself in relation to one’s surroundings in time and space
Orientation
In which circumstances does impaired orientation usually arise?
Recent injury or injuries with widespread cortical involvement
Which test is usually given to assess orientation?
WMS-111
A ”rough guess” measure of general cognitive ability reflective of the individual’s level of functioning prior to the onset of the disease/illness/etc
Pre-morbid intellectual functioning
Which 4 components are considered for testing pre-morbid intellectual functioning?
Vocabulary, phonetically atypical word reading, general knowledge, visual reasoning
Which test is typically given for assessment of phonetically atypical word reading?
NAART
Why is it difficult to test just for attention or IPS?
They underlie all other domains
What are 6 ways in which attention and IPS can be assessed?
Reaction time, attention span, working memory, sustained attention, divided attention, neglect
What is a common test for attention span?
Digit span (Forwards/backwards)
What is a common test for working memory?
Letter-number sequencing
Impairments in language functioning or the inability to comprehend and/or formulate language due to damage in specific brain regions
Aphasia
Difficulties in language comprehension
Wernicke’s (receptive) aphasia
Can comprehend language, but has difficulty with production
Broca’s (expressive) aphasia
What are 8 considerations when assessing language?
Spontaneous speech/free conversation, repetition of words, comprehension, reading (alexia), writing (agraphia), naming (anomia), verbal fluency, semantic fluency
What is a common test to assess comprehension?
Token test
What is a common test to assess naming?
Boston naming test
What is a common verbal fluency test?
FAS
Difficulty with naming pictures or objects, categorizing, or knowing the uses and features of object
Semantic dementia
The difficulty in articulation of speech sounds due to weakness, paralysis, or poor coordination of the muscles of the vocal cords, tongue, lips, etc
Dysarthria
Measures of perception along with a motor and spatial component
Visual perceptual abilities
What are 4 considerations when assessing visual perceptual abilities?
Visuoconstruction, visual organization, spatial ability, neglect
What is a common test to assess visuoconstruction?
Cube/House drawing
What is a common test to assess spatial ability?
JOLO (line orientation)
What is a common test to assess neglect?
Cross Out Lines
The inability of an individual to perceive more than a single object at a time
Simultagnosia
What are three considerations when assessing leraning and memory?
Verbal memory, visual memory, narrative recall
What is a common test to assess verbal memory?
CVLT
What is a common test to assess visual memory?
BVMT
What is a common test to assess narrative recall?
Logical memory task
What are ten considerations when assessing executive functioning?
Problem solving, multi-tasking, conceptual abilities, response inhibition, initiation, sequencing, abstraction, reasoning, self-awareness, organization
What are three common tests to assess executive functioning?
Sorting, colour-word, concepts
The fabricating of symptoms of cognitive impairment for a variety of reasons (typically some sort of personal gain)
Malingering
Which statistical test is typically used to examine the results of NP assessments?
Z-scores
What is the typical z-score cutoff for impairment?
-1.5 SD on two or more tests
