Week 1 lecture 1- Intro & assessment Flashcards
Role of clinical neuropsychologist
-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)
What is CNP
-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
Causes of cognitive impairments
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
Neuropsychological assessment
-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
Why are neuropsychological assessments used
-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
Consequences of neuropsychological impairment
› Daily life activities (e.g. Getting dressed, shopping)
› Traffic participation
› Social functioning
› Work/education
› Leisure
› Depending on individual context
Steps in conducting a neuropsychological assessment
› 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
Steps when taking the patients history
-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)
Limitations to a neuropsychological assessment
› 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
Impact of personal & contextual factors
› 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)
Evidence based practice
Triangle of patient, professional and science
Does not mean that you only apply proven effective treatments
PICO- Important parts of a well built clinical question
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
Quantitative method of neuropsychological assessment
-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
Advantage of quantitative method
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
Disadvantage of quantitative method
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
Qualitative method to neuropsychological testing
-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
Disadvantage of qualitative method
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!”
Flexible assessment method (Qualitative- Flexible approach)
- 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
Changes in a subtest
- 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
Each new addition of a subtest takes a few years to be the most used due to the factors:
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
Weschler Intelligence Scales
WAIS-III (Adult intelligence scale)
WIS (Children)
Weschler memory scale- Assesses verbal and visual memory functions
Referral question should specify the aim of the assessment:
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
Aim of psychological assessment
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
If a comprehension deficit is suspected in neuropsychological testing:
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
