Week 1 lecture 1- Intro & assessment

Question 1

Role of clinical neuropsychologist

Answer 1

-Children, adolescents, adults, elderly people
-Individuals with intracranial mass lesions (e.g. brain tumors)
-Individuals with epilepsy
-Individuals with cerebrovascular accidents (CVA; e.g. stroke and aneurysm ruptures)
-Individuals with traumatic brain injury (TBI)
-Individuals with substance use disorders (e.g. alcoholism)
-Individuals following toxic or hazardous exposures (e.g.radioactive radiations)
-Individuals with mental diseases (e.g. depression, schizophrenia)
-ndividuals with neurodegenerative disorders / Dementias
(e.g. Alzheimer’s disease, Parkinson‘s disease, Huntington‘s
disease, Pick‘s disease)
-Individuals with neurodegenerative disorders / Dementias (e.g. Alzheimer’s disease, Parkinson‘s disease, Huntington‘s disease, Pick‘s disease)
-Individuals with infectious and inflammatory brain disorders (e.g. AIDS)
-Individuals with developmental disorders (e.g. attention deficit hyperactivity disorder (ADHD), autism, Tourette’s syndrome, learning disabilities)

Question 2

What is CNP

Answer 2

-The study of brain-behaviour relationships
-Understand functioning of the normal brain
-Understand impairments resulting from a damaged brain
-Develop better methods for assessment & treatment

Question 3

Causes of cognitive impairments

Answer 3

Focal damage: (Damage depends on which area of the brain)
›Cerebrovascular accidents (stroke)
› Open head injury
› Virus
› Brain tumors (benign/malignant)

Diffuse damage: (Widespread brain damage- General cognitive disorders)
› Neurodegenerative disorders
› Closed head injury
› Psychiatric disorders
› Neurotoxicity

Often mix of both focal and diffuse damage

Question 4

Neuropsychological assessment

Answer 4

-A method of studying the brain by studying its behavioural outputs
-A performance based method to assess cognitive functioning
Used to examine the consequences of brain damage, brain disease and severe mental illness

Question 5

Why are neuropsychological assessments used

Answer 5

-Collect differential diagnostic info
-Assessment of treatment response
-Prediction of functional potential (in daily life for patient)
-Prediction of functional recovery
-Determine cognitive strengths & weaknesses to aid rehabilitation

Question 6

Consequences of neuropsychological impairment

Answer 6

› Daily life activities (e.g. Getting dressed, shopping)
› Traffic participation
› Social functioning
› Work/education
› Leisure
› Depending on individual context

Question 7

Steps in conducting a neuropsychological assessment

Answer 7

› Patient history (incl. referral question & clinical & laboratory examinations)
› Interview with patient and relatives
› Deciding upon and administering tests (What is your hypothesis)
› Observing behaviour during assessment (Not just results but how they got those results)
› Comparison with norm data
› Diagnostic conclusions (Answer research question)
› Referrals and advice
› Sometimes: rehabilitation treatment

Question 8

Steps when taking the patients history

Answer 8

-Who is the patient? (Childhood, education, family etc)
-What are the complaints?
-When did complaints start?
-How did complaints start (suddenly or gradually)?
-What course have complaints taken?
-Which situations trigger or relieve complaints?
-What treatment has been tried? (And effects)

Question 9

Limitations to a neuropsychological assessment

Answer 9

› Impact of mood (disorders)
› Limitations of frequently used tests / test familiarity
› Need to expand the range of neuropsychological tests
› Ecological validity (Tests don’t resemble daily life activities)
› Language and cultural considerations

Question 10

Impact of personal & contextual factors

Answer 10

› Intrapersonal factors:
▪ premorbid traits/characteristics
▪ Factors related to disease (coping & beliefs
about illness, self-stigma)
› Interpersonal factors:
▪Lifestyle (also intrapersonal)
▪ Family and social support systems
▪ School/work related personal factors
(attitudes toward illness, stigma, support)
▪ Cultural attitudes
› Socio-cultural factors
▪ Socio-demographic factors
▪ Healthcare systems in place
› Environmental factors
▪ Physical characteristics (Noise, lighting,
structured environment)

Question 11

Evidence based practice

Answer 11

Triangle of patient, professional and science
Does not mean that you only apply proven effective treatments

Question 12

PICO- Important parts of a well built clinical question

Answer 12

Patient/ population- Description of the person your question is about
Intervention- The intervention of your interest
Control- The intervention you want to compare to
Outcome- The main outcome you are interested in

Question 13

Quantitative method of neuropsychological assessment

Answer 13

-Standardised use of a set group, or battery of tests
-Scored quantitatively
-Resulting data is compared with normative data from a group of non-brain damaged people:
Age
Sex
Socioeconomic group
Culture
Years of formal education
-Comparisons with the scores of groups of patients with similar disorders or lesions in a similar area of the brain can be made to see whether a patients scores are typical

Question 14

Advantage of quantitative method

Answer 14

Assessment can be conducted by a trained technician (psychometrist) who does not necessarily need to understand the concepts underlying the tests or their interpretation
o Computer can score the tests and interpret them according to the most likely pathology based on the best fit with normative and research data eg. Halstead-Reitan Battery

Question 15

Disadvantage of quantitative method

Answer 15

o Does not allow for individual differences in brain-behaviour relations
o Considerably restricts the possible interpretations
o A deficit may be missed because there is no test that covers it
o Time may be wasted assessing many functions that are clearly intact
o Lots of qualitative info is lost that could be essential to the correct interpretation of the data
Eg. if a patient is tired and cannot concentrate this will be ignored and interpreted as an impairment

Question 16

Qualitative method to neuropsychological testing

Answer 16

-Introduced by Aleksander Luria
-Emphasises uniqueness of every case
-Follows a hypothesis-testing approach
-Patient is given increasingly more specific tests depending on results of previous tests
-Done until pattern of impaired functions is clear
-Contextual factors taken into account:
Emotional state
Learning history
Medical and physical problems

Question 17

Disadvantage of qualitative method

Answer 17

 Relies on the training and experience of the neuropsychologist
 To an extent the results achieved by such a method cant be repeated exactly, especially by another neuropsychologist
 “The only person who can carry out an assessment by the Luria method is Luria!”

Question 18

Flexible assessment method (Qualitative- Flexible approach)

Answer 18

• Kaplan, Lezak & Walsh
  -Flexible battery or range of tests that often includes many of the subsets of a standard quantitative test battery Eg, Weschler Intelligence Scales

Question 19

Changes in a subtest

Answer 19

• Changing subtest items
• Adding or deleting whole subtests to improve the validity and sensitivity of the tests to the abilities they are aiming to measure
• Improving the scoring
• Introducing new ways of interpreting patterns of scores and updating normative data

Question 20

Each new addition of a subtest takes a few years to be the most used due to the factors:

Answer 20

o Cost
o Clinical neuropsychologist may have built up a great amount of knowledge based on their administration, scoring and interpretation of the old edition
o Lack of research published on new version
o Belief that some of the new subsets are not as useful as the older versions

Question 21

Weschler Intelligence Scales

Answer 21

WAIS-III (Adult intelligence scale)
WIS (Children)
Weschler memory scale- Assesses verbal and visual memory functions

Question 22

Referral question should specify the aim of the assessment:

Answer 22

o To aid with diagnosis- As in the case of suspected dementia
o To provide an up-to-date picture of the patient’s impairments and deficits so that the therapist or rehabilitation team can better plan a rehabilitation program
o To monitor a patients recover or progression of disease
o To provide a baseline measure of cognitive functioning before neurosurgery or drug treatment and a follow-up assessment
 As in the case of temporal lobectomy for epilepsy
o To provide an assessment of disability that can be used for insurance or compensation purposes
o To assist in preparing a legal case
 In a case where a person with frontal-lobe damage is raped or is charged with neglecting her children

Question 23

Aim of psychological assessment

Answer 23

o To aid with diagnosis
 As in the case of suspected dementia
o To provide an up-to-date picture of the patient’s impairments and deficits so that the therapist or rehabilitation team can better plan a rehabilitation program
o To monitor a patients recover or progression of disease
o To provide a baseline measure of cognitive functioning before neurosurgery or drug treatment and a follow-up assessment
 As in the case of temporal lobectomy for epilepsy
o To provide an assessment of disability that can be used for insurance or compensation purposes
o To assist in preparing a legal case
 In a case where a person with frontal-lobe damage is raped or is charged with neglecting her children

Question 24

If a comprehension deficit is suspected in neuropsychological testing:

Answer 24

o Patients can be tested with special aphasia batteries to assess his language abilities
o Should not be given a general test battery if it becomes clear that he is unable to understand the test instructions
o There are special techniques and tests to assess patients with a minimal ability to comprehend or respond
-Its important to assess basic auditory comprehension before carrying out any further neuropsychological tests

Question 25

To assess basic auditory comorehension

Answer 25

Short Token Test- Patient is asked to use coloured tokens to carry out commands of increasing length and complexity

Question 26

Aphasia batteries to evaluate language abilities

Answer 26

o Boston Diagnostic Aphasia Examination (BDAE)
o Neurosensory Center Comprehensive Examination for Aphasia (NCCEA)
o Communicative Abilities in Daily Living (CADL)

Question 27

Communicative abilities in daily living test

Answer 27

 Assesses the patients problems in trying to communicate in normal living situations
 Assessment of the patients ability to communicate nonverbally

Question 28

Tests of visuospatial perceptual abilities

Answer 28

WIS subtests
Copy of the complex figure

Question 29

Tests of executive and control abilities

Answer 29

Subtests of WIS
-Comprehension subtest, Block design, object assembly and picture arrangement
Tests that involve sorting objects into categories according to rules that the individual must discover by attending to his errors
- Wisconsin card sorting test
Halstead Category test
Trail Making Test
Controlled oral word fluency tests

Question 30

Neurology

Answer 30

Study of the medial aspects of CNS disorders and treatments

Question 31

Cognitive psychology aim

Answer 31

To understand the workings of the human mind by analyzing higher cognitive functions and their components
Participants in experiments are unimpaired people

Question 32

Cognitive neuropsychology

Answer 32

Detailed analysis of higher cognitive functions
Studies brain damaged patients

Question 33

3 major divisions in the brain

Answer 33

Cerebral hemispheres
Cerebellum
Brain stem- 4 parts:
-Medulla oblongata, pons, midbrain, diencephalon
-Controls respiration, cardiovascular function, gastrointestinal function