Neuropsychology Metrics Flashcards
What are the advantages of using a test such as the MMSE to screen cognitive abilities?
Disadvantages?
- 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
What was the intended use of the MMS?
- differentiate “organic” vs functional psychatric patient
- to screen for cognitive impairment/dementia
- monitor for change over time
What is the range of scoring for the MMSE?
What is normal for relative education level?
- 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
What are the ranges of scores for the MoCA?
- 30 max
- 18-26: mild cognitive impairment
- 10-17: moderate cognitie impairment
- <10 severe cognitive impairment
+1 point for education <12 yrs
What cognitive tasts are assessed in MoCA but not in MMSE? (5)
- executive function
- attention
- fluency tasks - two item & phonemic
- verbal abstraction - two item
What cognitive tasts are assessed in both MoCA and MMSE? (6)
- visuospatial
- language
- concentration
- working memory
- memory recall
- orientation
What assessment component is seen in SLUMS and not in MMSE or MoCA?
short story
(may add additionaly memory assessment)
What are the ranges of scores for the SLUMS?
- >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
What content is assessed both by MoCA and SLUMS?
- orientation/time
- registration/recall
- praxis / visuospatial
- attention
- executive function
What content is assessed by MoCA but not by SLUMS?
What content is assessed by SLUMS but not MoCA?
- MoCA:
- aphasia, verbal fluency
- SLUMS
- remote memory
Comparative validity of MoCA & SLUMS?
similary validity
(equivalent sensitivity, specificity, PPV & NPV)
What is the term for:
if a person has a disease, how often will the test be positive (true positive)?
Sensitivity
if a test is highly sensitive & the test is negative, you can be nearly certain that they don’t have the disease
What is the term for:
if a person does not have the disease how often will the test be negative (true negative rate)?
specificity
if the test result for a highly specific test is positive, you can be nearly certain that they actually have the disease
List the order of highest sensitivity to lowest sensitivity for SLUMS, MoCA & MMSE?
- Sensitivity:
- 92% - SLUMS (100% dementia)
- 90% - MoCA (100% dementia)
- 18% - MMSE (78% dementia)
Which cognitive screening tools have 100% sensitivity for dementia?
MoCA & SLUMS
List the order of highest specificity to lowest specificity for SLUMS, MoCA & MMSE?
- Specificity
- 100% - MMSE
- 87% - MoCA
- 81% - SLUMS
Which cognitive screening tools have 100% specificity?
MMSE
What are the indications to performa neuropsychological assessment?
- 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
Frequently, cognitive impairment accompanies what issue?
brain dysfunction
it is a disagnostically significant feature of many neuropsychiatric disorders
Why is a “summation score” for a cognitive test not as reliable?
the undelying variability is what mght be indicative of brain dysfunction, and this variablility is lost when only a single score is assessed
What is the first step in establishing a deficit measurement?
estimate the patient’s premorbid performance level for various fuctions being assessed
What needs to be considered when establishing test norms?
demographic variables
(age, education, gender)
What is a major limitaiton of norm comparisons?
real change can only be defined by comparing present with prior functioning
What is the difference between indirect & direct deficit measurements?
- 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
- compare present performance with an estimate of the patient’s original ability level, i.e.,
Describe the process of deficit measurement
- 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
Test selectio nis influenced by what test psychometrics?
validity
reliability
sensitivity
specificity
What are the examination questions?
differential diagnosis
descriptive questions
(I have no idea what he is talking about here)
What term refers to where the test is measureing what is is intending to measure (brain-behavior functions in question)?
validity
What term refers to the consistency with which the test generates the same score under similar retest conditions?
reliability
What are are the “spetial populations” to consider when giving neurophychological tests?
- sensory & motor deficits
- mental or physical disabilties
- severly brain damaged patients
- elderly persons
- language & cultural differences (translators & interpreters)
What are variables that need to be addressed when working with people who have brain disorders?
- attentional deficit & slow processing
- fatigue
- medication
- pain
- performance inconsistency “good days” & “bad days”
- motivation
- anxiety, stress, & depression
- litigation
What are the common interpretation errors?
- 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
What is a “z-score”?
mean of 0 and a standard deviation of 1
What is a “t-score”?
mean of 50 and a standard deviation of 10
