Session Two (The Neuropsychological Assessment) Flashcards
What is the purpose of clinical neuropsychology?
The idea that all abnormal psychology has a physical cause somewhere in the brain, and the search to find and treat that cause.
Broadly what are the 5 purposes of the neuropsychological assessment?
- Diagnosis. Can identify a specific disorder (e.g. Alzheimer’s) or the location of a lesion or disorder (e.g. epilepsy or a stroke).
- Patient Care. Helps with outcomes and quality of life by monitoring disease progression.
- Treatment Planning and Evaluation. Track someones recovery and plan their rehab, focuses on daily function and depression/anxiety symptoms.
- Research. Allows us to look into the organisation of the brain and how it translates into behaviour, looking to inform future treatments.
- Forensic and Legal. Mainly judging someones fitness to work (and therefore disability status) and criminal responsibility (and therefore conviction).
What can be gathered by comparing scores on different sorts of tests e.g. Language vs Cognition vs Visuospatial arrangement?
- Which part of the brain is affected (by epilepsy or a stroke) as different regions of the brain are responsible for different functions, all of which are testable.
- Can determine levels of cognitive decline following a brain injury or stroke by comparing scores on a test that would be affected (e.g. cognitive reasoning) vs something that would not be affected (e.g. vocabulary).
What are the two types of measures in NP assessments?
Quantitative: Normally scores on a standardised test. More common in research
Qualitative: Usually a series of interviews with the patient and their families. More common clinically.
How and Why do we use Psych assessments to Measure Deficit in a person’s functioning?
We do this to judge if someone has some sort of cognitive impairment, either from birth or resulting from injury/illness.
Can be done by comparing to a baseline they set (e.g. through vocabulary testing) or that a population sets (e.g. work against a baseline, normally matched for demographic).
- Can use Cohen’s D testing.
What are the two things that make up Reliability?
- Test-Retest Reliability, are the results CONSISTENT across time?
- Inter-Rater Reliability, are the results REPLICABLE between two different raters, do they produce the same results?
What are the two things that make up Validity?
Construct Validity, does the test measure what it claims it measures?
- Ecological Validity, are the results from the test applicable to the real world? E.g. How do tests of cognitive function related to the patients activities of daily living.
Distinguish Sensitivity and Specificity?
Sensitivity = How likely is it that someone with the condition is picked up by this test. Specificity = How likely is it that someone who is picked up by the test actually has the condition?
Combine to influence how VALID an experiment is.
How can we compensate for issues of specificity and sensitivity when testing a patient for a condition?
First give them a high sensitivity, low specificity test (picking up many cases but also many false positives) and then give them the low sensitivity high specificity test (weeding out the false positives).
What are some commonly seen issues around Neuropsychology testing?
- Anxiety, depression, worry, confusion and fear can all significantly affect a person’s score on these tests, and must be bared in mind.
- There is significant cultural variety in how people view and perform on these tests (e.g. certain Asian cultures are more likely to view these as a ‘test’ and therefore take them more seriously, IQ tests are designed pretty much just for white society, image based tests usually use images relevant to the culture they were developed in.
How would you get around issues with the patient in regards to these tests (e.g. if they were blind/foreign..)
Essentially there are many different tests you can use to the same effect, the important thing to know as clinicians is several different options to suggest.
E.g. if they’re blind you can do audio tests, if they can’t read English you can do image based tests, if you’re worried about the cultural setting of the images you can do pattern based tests.
What are the 5 key steps to the assessment process?
- Review referral question (turn a fuzzy, open question into a specific manageable one)
- Planning, hypothesis, test selection (choose a hypothesis with a clear idea of what you are predicting, select a test with appropriate validity…)
- History taking (gain information by taking collateral histories and regular histories)
- Testing
- Interpretation, reporting, feedback
What are some examples of language tests and why are these clinically useful?
NART, FSIQ, WTAR (gives patients a list of 40 words, of increasingly difficult and awkward pronunciation, tests to see which they know well enough to know how to pronounce).
Vocabulary correlates to intelligence and is resilient to deterioration when other cognitive areas would (e.g. during a stroke).
What are some examples of memory and visual-spatial assessments?
- Wechsler Memory Scale, a comprehensive look into all components of memory (verbal, visual, immediate recall, delayed recall).
- ROCF (abstract image drawing)
- Doors and People Test
What are some examples of language assessment tests?
- Comprehension (the Token test)
- Naming (Boston naming test)
- Fluency (2 types; semantic (words with similar meanings e.g. animals) and phonetic (words with a similar sound e.g. an S) fluency
- Repetition testing
- Reading and Writing tests
