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PSYCH > Neuropsychology Metrics > Flashcards

Neuropsychology Metrics Flashcards

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1
Q

What are the advantages of using a test such as the MMSE to screen cognitive abilities?

Disadvantages?

A
  • Advantages
    • brief, objective, quantitative
    • some info patient’s general abilities
  • Disadvantages
    • false-positive results from older people or with < 9 yr education
    • low “ceilling” so those who perform well are not necessarily cognitively intact
    • research suggests not a thorough cognitive assessment
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2
Q

What was the intended use of the MMS?

A
  • differentiate “organic” vs functional psychatric patient
  • to screen for cognitive impairment/dementia
  • monitor for change over time
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3
Q

What is the range of scoring for the MMSE?

What is normal for relative education level?

A
  • Range
    • 24-30: no cognitive impairment
    • 18-23: mild cognitive impairment
    • 0-17: severe cognitie impairment
  • Education
    • <8th grade: <21 is abnormal
    • <12th grade: <24 is abnormal
    • college: <25 is abnormal
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4
Q

What are the ranges of scores for the MoCA?

A
  • 30 max
  • 18-26: mild cognitive impairment
  • 10-17: moderate cognitie impairment
  • <10 severe cognitive impairment

+1 point for education <12 yrs

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5
Q

What cognitive tasts are assessed in MoCA but not in MMSE? (5)

A
  • executive function
  • attention
  • fluency tasks - two item & phonemic
  • verbal abstraction - two item
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6
Q

What cognitive tasts are assessed in both MoCA and MMSE? (6)

A
  • visuospatial
  • language
  • concentration
  • working memory
  • memory recall
  • orientation
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7
Q

What assessment component is seen in SLUMS and not in MMSE or MoCA?

A

short story

(may add additionaly memory assessment)

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8
Q

What are the ranges of scores for the SLUMS?

A
  • >12 yr education
    • 27-30: normal
    • 21-16: mild cognitive impairment
    • 1-20: dementia
  • <12 years school
    • 25-30: normal
    • 20-24: mild cognitive impairment
    • 1-19: dementia
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9
Q

What content is assessed both by MoCA and SLUMS?

A
  • orientation/time
  • registration/recall
  • praxis / visuospatial
  • attention
  • executive function
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10
Q

What content is assessed by MoCA but not by SLUMS?

What content is assessed by SLUMS but not MoCA?

A
  • MoCA:
    • aphasia, verbal fluency
  • SLUMS
    • remote memory
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11
Q

Comparative validity of MoCA & SLUMS?

A

similary validity

(equivalent sensitivity, specificity, PPV & NPV)

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12
Q

What is the term for:

if a person has a disease, how often will the test be positive (true positive)?

A

Sensitivity

if a test is highly sensitive & the test is negative, you can be nearly certain that they don’t have the disease

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13
Q

What is the term for:

if a person does not have the disease how often will the test be negative (true negative rate)?

A

specificity

if the test result for a highly specific test is positive, you can be nearly certain that they actually have the disease

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14
Q

List the order of highest sensitivity to lowest sensitivity for SLUMS, MoCA & MMSE?

A
  • Sensitivity:
    • 92% - SLUMS (100% dementia)
    • 90% - MoCA (100% dementia)
    • 18% - MMSE (78% dementia)
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15
Q

Which cognitive screening tools have 100% sensitivity for dementia?

A

MoCA & SLUMS

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16
Q

List the order of highest specificity to lowest specificity for SLUMS, MoCA & MMSE?

A
  • Specificity
    • 100% - MMSE
    • 87% - MoCA
    • 81% - SLUMS
17
Q

Which cognitive screening tools have 100% specificity?

A

MMSE

18
Q

What are the indications to performa neuropsychological assessment?

A
  • changes in memory
  • poor attention and concentration
  • changes in language functioning
  • changes in visuospatial abilities
  • impaired executive function
  • changes in emotional functioning
  • fluctuations in mental status
19
Q

Frequently, cognitive impairment accompanies what issue?

A

brain dysfunction

it is a disagnostically significant feature of many neuropsychiatric disorders

20
Q

Why is a “summation score” for a cognitive test not as reliable?

A

the undelying variability is what mght be indicative of brain dysfunction, and this variablility is lost when only a single score is assessed

21
Q

What is the first step in establishing a deficit measurement?

A

estimate the patient’s premorbid performance level for various fuctions being assessed

22
Q

What needs to be considered when establishing test norms?

A

demographic variables

(age, education, gender)

23
Q

What is a major limitaiton of norm comparisons?

A

real change can only be defined by comparing present with prior functioning

24
Q

What is the difference between indirect & direct deficit measurements?

A
  • Direct
    • the behavior in quesiton can be compared against n_ormative standards_
  • Indirect
    • compare present performance with an estimate of the patient’s original ability level, i.e.,
      • historical data
      • observational data
25
Q

Describe the process of deficit measurement

A
  • present performance is compared to expected level (comparison standard)
  • discrepancies are evaluated for statistical significance
    • this indicates a probability of a cognitive deficit
    • if this occurs for more than one test - a pattern of deficit may emerge
    • this is compared to patters known to be associated with specific neurologicla or psychological conditions
      • implications for etiological and/or remedial intervention
26
Q

Test selectio nis influenced by what test psychometrics?

A

validity

reliability

sensitivity

specificity

27
Q

What are the examination questions?

A

differential diagnosis

descriptive questions

(I have no idea what he is talking about here)

28
Q

What term refers to where the test is measureing what is is intending to measure (brain-behavior functions in question)?

A

validity

29
Q

What term refers to the consistency with which the test generates the same score under similar retest conditions?

A

reliability

30
Q

What are are the “spetial populations” to consider when giving neurophychological tests?

A
  • sensory & motor deficits
  • mental or physical disabilties
  • severly brain damaged patients
  • elderly persons
  • language & cultural differences (translators & interpreters)
31
Q

What are variables that need to be addressed when working with people who have brain disorders?

A
  • attentional deficit & slow processing
  • fatigue
  • medication
  • pain
  • performance inconsistency “good days” & “bad days”
  • motivation
  • anxiety, stress, & depression
  • litigation
32
Q

What are the common interpretation errors?

A
  • overgeneralization of findings
  • false negatives (if the function is not examined, its status will remain unknown)
  • confirmatory bias
  • underutilization or misutilization of base rates
  • effort effects
33
Q

What is a “z-score”?

A

mean of 0 and a standard deviation of 1

34
Q

What is a “t-score”?

A

mean of 50 and a standard deviation of 10

PSYCH (7 decks)

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