PSYC3003 - Introduction to Clinical Psychology - Neuropsychology P1: Evaluations and general knowledge Flashcards
What does a neuropsychologist study?
The brain -behaviour relationship.
What does a neuropsychologist ‘do’? (i.e work)
- Evaluation & diagnsosis (neuropsychological evalution, brain imaging techniques)
- Rehabilitiation
- Teaching
- Research
- Mediolegal (compensation litigation, diminished criminal responsibility)
What types of patients does a neuropsychologist deal with/see?
- Traumatic head injury
- Strokes
- Brain tumours
- Dementing conditions
- Learning diabilities
- Pervasive develomental disorders
- Attention deficit disorder
- Seizure disorder
- Effects of toxic chemical or chronic substance abuse
What is a neuropsychological evaluation?
Assessment of behaviour using standardised tests that are sensitive to breain-behaviour relationships.
Recommended when brain-based impairment is suspected.
As in all psychometrics, tests should be standardised, reliable and valid.
What does a neuropsychological evaluation involve and how long does it take?
Usually involves a number of tasks (a ‘battery’ of tests) which are non-invasive, flexible to to the situation (e.g table or bedside) and taileored to the individual patient’s needs based on the nature of the presenting problem.
They can take 6-8 hours of face-to-face time, this can be in a single session or spread over a series of appointments.
What is the purpose of neuropsychological evaluation?
- Profile patient strengths and weaknesses
- Differentiate between functional and organic disorder
- Document impact of brain dysfunction on a patients life
- Monitor progress in rehabilitation
- Disability determination for froensic/legal purposes.
What others pieces of patient imformation compliment neuropsychological evaluation?
(i.e integral approach)
- Patient backgroun (persnal history, description of illness, medical history, family history of brain disorder)
- Neurological examination
- Data from neuroimaging techniques (e.g., EEg, MRI, CT & PET
Briefly, what is ‘standardisation’ and ‘test norms’?
Standardisation: administer test and intepret results in the same way
Test-norms: data with which to compare the test result to, making it possible to determine the relative standing of an individual who has taken a test, thus, giving the results meaning.
What is reliability?
What are the 4 types of reliability?
Reliability: the stability/dependability/consistency of a test on repeated measures of the same person. Includes:
- Test-retest reliability - consistency between scores of an individual measured more than once.
- Inter-rater reliability - reliability between different people’s use of the measure to score the same individual
- Split-half reliability - the correlation between two halfs of a test
- Internal reliability/consistency - the degree to which items of a scale measure the same thing, also known as ‘cronbach’s alpha)
What is validity?
What are the 3 types of validity?
A test is valid when it measures what it purports to measure. The validity of a test is the meanifulness of specific inference made from the test scores.
An unreliable test cannot be valid, but a non-valid test can be reliable.
- Construct validity - does the test score measure the abstract psychological charactersitic or construct of interest (e.g memory or intelligence etc.)
- Content validity - do the items or tasks that make up your test make conceptual sense. Various items of teh test should correspond to the behavior te test is designed to measure or predict.
- Criterion validity - demonstrates that scores relate systematicaly to one or more outcome criteria. has two components:
- Concurrent validity - relates to outcomes now (important for testing capacities now)
- Predictive validity - relates to outcomes in the future (e.g predicting improvements or decline in recovary)
Neuropsychological testing focuses on what functional areas? (from the most basic to the most complex)
- Orientation
- Sensation/perception
- Attention
- Motor skills
- Language
- Visuospatial
- Memory
- Executive functioning (abstract reasoning/conceptualisation, emotional/psychological distress, activities of daily living)
What are the 4 lobes of the brain and where are they?
Where is the cerebellum, spinal cord and cerebrum?
See diagram!
Where is the hindbrain, midbrain and forebrain?
See diagram!
What is ‘orientation’ and why is it one of the first test administered?
what factors does it include?
Orientation is an awareness of oneself to the surrounding world.
It is a most basic level of functioning upon which other higher functions are built. It represents the capacity of the patient to actually undergo formal neuropsychological testing. (if they don’t know who they are, where they are or when they are…some further testing won’t yield much)
Three main types:
Orientation to person (who are you?)
Orientation to time (what date is it?)
Orientation to place (where are you?)
But also:
Arousal, degree of confusion, awareness of change
What part of the brain is (predominately) responsible for orientation?
Where is it in the brain?
Reticular formation.
The reticular formation is a group of nerve fibers located inside the brainstem.
What neuropsychologial items are used to test a persons ‘orientation’?
Assessment instrument: Galveston Orientation and Amnedai Test (GOAT) (or Glasgow Come Scale (GSC))
BOTH Assesses the extent and duration of confusion and amnesia after traumatic brain injury.
GOAT - Yields a score from 0-100 with a suggested cut-off of 75 or better indicating relatively intact orientation.
Also more generally:
- Orientation evaluation questions (what is your full name?, where do you live?, how old are you? where are you now? Who is the current president? who was the president before them?)
What is sensation?
What is perception?
What overal brain system does it use?
Perception = processing and intepretation of sensory input
Sensation = stimulation of sensory organs. (touch, vision, hearing, taste, smell)
Sensorymotor system (organised contralatterally) made up of many areas of the brain
Where are the two parts of the brain that deal with TOUCH sensation, what are they called and what do they do?
- Primary somatosensory cortex - basic awareness of touch - in the parietal lobee
- Secondary system - Intepretation - parietal lobe
The primary somatosensory cortex (SI) is across the central sulcus and behind the primary motor cortex configured to generally correspond with the arrangement of nearby motor cells related to specific body parts. The area includes gray matter along the central gyrus and its extension into the postcentral gyrus.
Goes across both brain hemispheres.
Where are the two parts of the brain that deal with VISION sensation, what are they called and what do they do?
- Primary visual cortex - the occipital lobe
- Secondary area of the visual cortex - two systems: ‘what’ system (faces, objects), ‘where’ system (where in space) - the occupital lobe
“The visual area known as V1, striate cortex, or (primary visual cortex, Brodmann area 17) is located on the calcarine sulcus deep within the inside folds of the occipital lobe.”
Where are the three ares of the brain that deal with HEARING sensation, what are they called and what do they do?
- Primary auditory cortex - frequency volume length
- Secondary area 1 - Wernickes area (Temporal lobe) - Understanding speech
- Secondary area 2 - Brocha’s area (Frontal lobe) - produce speech
What factors are assessed in sensation/perception?
- Recognition
- Familiarity of stimuli
- Relationship among features
- visual acuity
- Auditory
- Taste/smell
- Tactile/prioprioceptive
- Internal/environmental
- Awareness
What methods and instruments are used in the assessment of perception/intepretation?
Assessment instruments: Halstead-Reiten Neuropsychological Battery (visual, auditory & tactile modalities)
Also,
- Visual field examination: testing for interactions of the patients right and left hempispheres.
What is ‘Attention/Concentration’?
What areas of the brain are involved in attention/concentration?
Attending to the environment, maintaining attention.
- Sustained attention - paying attention to something over a prolonger period.
- Selective attention - Paying attention to more than one thing at a time.
Frontal lobe and Parietal Lobe
What methods and instruments are used to assess attention/concentration?
Instruments:
- Symbol Digit Modalities Test i.e., SDMT (see picture) - assesses complex scanning, visual tracking and sustained attention
- ‘d2 test’ - test of selection attention were one crosses out all the d’s with a “ above, below or both the letter. (BUT NOT any other combination) - also measures processing speed, rule compliance and quality of performance; allowing estimation of individual attention and concetration performance.
Methods:
- Maintaining attention - Easy tasks that require attention (count from 1-20 quickly, recite the alphabet, count in 3s till you reach 22)
- Attention span - attend to various verbal stimuli and then repeat them, becoming progressively more complex. e.g repeating numbers (589, 9275, 71632) and then also do it backwards.
- Sustained attention - tap on he table when you hear me say the number 4
What would the following methods be used to test?
- Count from 1-20 quickly, recite the alphabet, count in 3s till you reach 22
- neuropsychologist says some verbal stimuli, becoming progressively more complex, patient repeats each set e.g repeating numbers (589, 9275, 71632) and then also do it backwards.
- Patient has to tap on the table when they hear the psychologist says the number 4
Attention/Concetration
What is the Symbol Digit Modalities Test (SDMT) and ‘d2’ test, used to test?
Attention/Concentration
What is the Halstead-Reiten Neuropsychological Battery designed to assess?
Visual, Auditory & tactile modalities.
i.e., Sensory and Perception
What is the Galveston Orientation and Amnesia Test (GOAT) used to assess?
Orientation
What are motor skills?
Ability to demonstrate movement control in the upper and lower extremities.
What methods and instuments are used to assess motor skills?
Instruments:
Subtests of the Halstead-Reitan Neuropsychological Battery:
- Finger-tapping test - tap index finger as fast as possible.
- Grip strength test - measure with a hand-dynamometer - 3 goes with each hand averaged.
Methods:
- Gross motor movement - raise your right hand, left hand, move left leg
- Motor speed - touch your thumb to your forefinger as quickly as you can.
- Fine-motor ability - touch your thumb to each finger, one after the other
- Inhibit motor behaviour - “If i clap twice, you clap once”; “if you clap once, you clap twice”
- Visual pereption input and complex motor response output - copy a design (scored via correct shape, size, symmetry and integration).
- Motor apraxia - show me how to make a telephone call from beginning to end
What is ‘apraxia’?
The inability to perform purposeful sequences of motor behaviours.
What do the following subtests of the Halstead-Reitan Neuropsychological Battery assess?
Finger-tapping test - tap index finger as fast as possible.
Grip strength test - measure with a hand-dynamometer - 3 goes with each hand averaged.
Motor skills
What systems deal with motor skills and what areas of the brain are they in?
Organised contrallatraly
Primary motor cortex - initiate movement and some finer movements posterior portion of the frontal lobe.
a number of secondary areas:
- Frontal lobe area - planning sequencing (i.e., higher order)
- Cerebellum and basal ganglia (midbrain)- co-ordination and balance
Primary motor cortex works in association with other motor areas including premotor cortex, the supplementary motor area, posterior parietal cortex, and several subcortical brain regions, to plan and execute movements.
What aspects of motor function is dealt with by the frontal lobe and basal ganglia/cerebellum respectively?
Frontal lobe = Planning/sequencing
Basal ganglia/cerebellum = coordination and balance
What two components make up ‘language’?
Receptive language
Expressive language
What part of the brain handles understanding language? (i.e., receptive language) and where is it on the brain?
Wernikes area
Traditionally thought to be located posterior section of the superior temporal gyrus (STG) in the dominant cerebral hemisphere (which is the left hemisphere in about 97% of people).
Which hemisphere is broca’s area and Wernickes area situatied in?
The left hemisphere in about 97% of people, but it is in the right hemisphere for some people.
What part of the brain handles producing language? (i.e., expressive language) and where is it on the brain?
Broca’s area
Broca’s area is a region in the frontal lobe of the left hemisphere
What methods and instruments are used to assess ‘Language’?
Instruments:
- Token test -receptive language
- COWA - Controlled Oral Word Association test - expressive language
- Boston Naming Test
What is the Token test used to test, how is it administered?
Token test - used to test receptive language - commands regarding shapes in a picture e.g show me a pink shape, show me a blue square, show me a small blue shape,show me the green sqaure etc.)
What is the Controlled Oral Word Association (COWA) test used to assess? How is it administered?
COWA - Controlled Oral Word Association test - expressive language - come up with words beginning with # (a letter) letter in 1-minutes, must be more than four letters long and not names or partial repitions.
Why are the letters F, A and S often used in the Controlled Oral Word Association (COWA) test
F = lowest digital frequency
A = vowel
S = Highest digital frequency
Descrive the administration of the Boston Naming Test, what is it designed to asses?
Boston Naming Test - Language - simple line drawing of common objects, if they can’t name what the object is they are given a stimulus (e.g for ‘seahore’ might say ‘it’s an ocean creature’). if they still have trouble they are given a phonetic cue (e.g it starts with a ‘c’ sound)
what is receptive and expressive language?
Receptive: The patients ability to comprehend simple spoken commands (e.g., ‘say hello’)
Expressive: vocabulary knowledge and recognition of concepts and objects (e.g., please tell me wheat ‘happiness’ means or ‘make up a sentance using the word ‘vacation’)
What is dysgraphia?
Deficits in the motor component of writing
What is ‘visual-spatial organisation’ and what factors does it include?
Involes a range of cognitive processes e.g., map reading, route finding, visual perception, constructional ability & facial expressions)
- Construction
- Route Finding
- Spatial orientation
- Facial recognition
What methods and instruments are used to assess visual-spatial organisation?
Assessment instruments:
Clock drawing test = draw 12:00 etc
Rey Figure tes = complex figure, replicate while looking at it, then replication and original are removed and patient must draw again from memory.
Methods:
- directional skills, mazes, clock drawing, motor-free constructional tasks
- Facial recognition (e.g recognise familiar face or ‘show me the happy face, sad face and angry face’)
- Visual sequencing (higher order) - putting pictures of a story in the correct/logical order.
What is malingering (according to DSM-IV)?
The intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives such as avoiding military duty, avoiding work, obtaining financial compensation, evading criminal procecution, or obtaining drugs.
What are the two approaches to neurospychological intepretation?
Standard battery approach (Realiance on standardised tests)
Process Approach (aka hypothesis approach) the idea that the neuropsychologist should adapt each examination to the individual patient rather than use a standard battery of tests. The neuropsychologist selects the tests and procedures for each examination, using hypotheses he or she has made from impressions of the patient and from information available about the patient.
What are the advantages of the standard Battery approach to neuropsychological intepretation?
- Comprehensive evaluation of abilities
- Objective interpretation based on normative data
- Facilitates teaching because of standard rules/norms
- Useful for empirical studies
What are the disadvantages of the standard Battery approach to neuropsychological intepretation?
- Time demanding and labor intensive
- Tests only as good as standardisation
- Relatively infelxible approach to testing
- Scores may not reflect a single cogitive process
What are the advantages of the ‘Process Approach’ to neuropsychological intepretation?
- Acknowledges the individuality of the patient
- Examination focuses on most important deficits
- Emphasizes how a task is failed or solved
- Useful for clinical case studies
What are the disadvantages of the ‘Process Approach’ to neuropsychological intepretation?
- Test procedures may be biased by clinician
- Opinion of the clinician is subjective
- Difficult to teach, because it requires experience
- Does not lend itself to large-scale research
What is the difference between a focal and a diffuse neurological disorder of the brain?
Focal have a prticular focus or site. (E.g., tumour, stroke or brain bleed
Diffuse are more generalized, affecting the brain as a whole. (e.g., closed head injurys [CHI], toxic conditions, degenrative disorders)
What is type of memory deals with factual information?
Explicit/declarative memory
What component of memory does explicit/declarative memory deal with?
Factual information
What type of memory deals with action or “doing” memory?
Implicit/procedural
What is Implicit/procedural memory?
Memory for action or “doing”
What are the three processes of memory?
- Encoding
- Storage
- Retrieval
What 3 main areas of the brain are involved in memory? and what aspects of memory are they associated with?
Where in the brain is the the basal ganglia and the cerebellum?
- Hippocampus (middle of the temporal lobe) - encoding and cognitive maos
- Basal Gaglia (mid-brain) - motor memory
- Cerebellum - learning of procedural memory and motor learning
What test is this from? what does it assess?
Wisconsin card sorting test
Assesses executive functioning - shfting between sorting categories and ignoring irrelevent information.
