Neuropsychological Testing

Question 1

What are NP assessments?

Answer 1

Performance-based measures used to assess cognitive functioning

Question 2

What format are NP assessments typically administered in?

Answer 2

They are often employed in a traditional battery approach, with a few tests per domain of interest. They are typically paper and pencil tasks completed with a trained examiner.

Question 3

How are NP assessment results interpreted?

Answer 3

The results are compared to a standard score to determine performance.

Question 4

What are some reasons to conduct NP testing?

Answer 4

○ To aid in diagnosis.
○ To establish a baseline before surgery or at the time of diagnosis of a condition or disease.
○ To monitor cognitive change over time.
○ To inform treatment by identifying areas of difficulty.
○ To determine cognitive strengths & weaknesses.
○ For legal reasons, such as determining if someone has the capacity to make decisions.
○ To identify learning disabilities and recommend accommodations.
○ To help differentiate between psychiatric disorders.

Question 5

What are some situations that might prompt a referral for NP testing?

Answer 5

Changes in short term memory.
○ Difficulty with language.
○ Frequently getting lost or misplacing items.
○ Confusion and poor attention/concentration.
○ Difficulty recognizing objects or familiar people.
○ Impaired judgment and decision making.
○ An unexplained change in personality.
○ Difficulty managing finances.

Question 6

What kind of tasks are included in memory tests?

Answer 6

○ Immediately repeating a series of numbers, letters, or words.
○ Repeating the same information after a delay.
○ Immediately reproducing drawings from memory.
○ Reproducing drawings from memory after a delay.

Question 7

What kind of tasks are included in language tests?

Answer 7

○ Naming a series of pictures.
○ Naming as many words as possible that begin with a certain letter or belong to a certain category (fluency).
○ Pointing to a picture that matches a word or is semantically related to another object.

Question 8

What are some examples of tasks used to assess executive functioning?

Answer 8

○ Sorting cards by color or shape.
○ Filling in numbers that correspond to symbols (coding).
○ Connecting a series of numbers and/or letters (trail making).

Question 9

What aspects of executive functioning do these tests assess?

Answer 9

○ Cognitive flexibility
○ Set-shifting
○ Problem-solving
○ Inhibition
○ Attention
○ Processing speed
○ Working memory

Question 10

What is the difference between working memory and short-term memory?

Answer 10

Short-term memory involves holding information in mind, while working memory involves holding information in mind and manipulating it.

Question 11

What does an assessment of global cognition entail?

Answer 11

It involves a comprehensive evaluation of cognitive functioning across multiple domains, such as language, memory, and executive functioning

Question 12

What is the purpose of assessing global cognition?

Answer 12

○ Provides a comprehensive understanding of strengths and weaknesses.
○ May involve a single test or a composite score from multiple tests

Question 13

What is an example of a test of global cognition?

Answer 13

The Montreal Cognitive Assessment (MoCA)

Assesses cognitive abilities, including:
- short-term memory
- EF
- orientation
- animal naming
- abstraction
- attention

Question 14

What are 6 key applications of NP testing?

Answer 14

○ Diagnosis
○ Differential diagnosis
○ Understanding the relationship between clinical tests and real-world functioning.
○ Assessing individual differences
○ Measuring treatment response
○ Investigating the relationship between NP test performance and neuroimaging findings.

Question 15

How is NP testing used in diagnosis?

Answer 15

○ It can help differentiate between conditions.
○ Important: NP testing alone cannot definitively confirm a diagnosis.
○ Cognitive deficits may be present in some conditions, even if they are not included in the diagnostic criteria.

Question 16

How is NP testing used in differential diagnosis?

Answer 16

○ Cognitive symptoms can overlap across different conditions.
○ There can be significant overlap in cognitive performance between individuals with certain conditions and healthy controls.

Question 17

What is the relationship between NP test performance and functional status?

Answer 17

○ Global cognition scores have one of the strongest relationships to functional status.
○ Individuals with neuropsychiatric conditions whose cognitive abilities resemble those of healthy controls are less likely to have functional limitations

Question 18

Can you provide some examples of the relationship between NP testing and functional outcomes?

Answer 18

○ Less cognitive impairment after traumatic brain injury (TBI) is associated with a greater likelihood of functional recovery.
○ Progression of cognitive impairments in Alzheimer’s disease is linked to functional decline.
○ Cognitive impairments in schizophrenia are predictive of functional deficits in everyday life.
○ The relationship between cognitive impairment and everyday functioning is very similar in schizophrenia and bipolar disorder.
○ Cognitive impairments in Parkinson’s disease are associated with functional deficits that are characteristic of dementia.

Question 19

What are some individual difference factors that can influence NP test scores?

Answer 19

○ Cultural factors, as not all tests are appropriate for all individuals
○ Education, as lower levels of education tend to be associated with lower scores
○ Time of year, with individuals tested during the winter months generally performing worse than those tested during the summer

Question 20

How can NP tests be used to measure the effectiveness of treatments?

Answer 20

○ Administer a pre-treatment NP test battery.
○ Provide the treatment.
○ Administer a post-treatment NP test battery.
○ Important: Different versions of the same test should be used pre- and post-treatment to minimize practice effects.

Question 21

What is the relationship between NP test performance and neuroimaging findings?

Answer 21

○ Studies are investigating the relationship between structural brain imaging and cognitive performance, including structural MRI in living individuals and post-mortem analysis.
○ Lesion studies can help identify the brain areas associated with specific cognitive domains.