Week 2: Neuropsychological assessment Flashcards

1
Q

What is the most important reason to conduct an assessment?

A

To diagnose

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2
Q

What other reasons, other than diagnosis, is there to do assessments?

A
To classify the severity 
Differential diagnosis 
To gain clarity 
Target treatment and evaluate if treatment has been effective 
Performance evaluation 
Medicolegal evidence
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3
Q

What initiates a psychological assessment?

A

The referral

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4
Q

What is a referral for assessment?

A

Letter or note

  • Basic patient info
  • Some type of question (very specific) that needs to be answered
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5
Q

What, in particular, should you research about the condition your referral relates to?

A

Behaviours

Physical limitations (may need to alter assessment type to accommodate these)

Cognitive profile (select tests on this basis)

Everyday function (need to understand how they are impacted in everyday life)

Support services - can refer them on to get help

Treatment services

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6
Q

What kind of information should you gather about the person themselves?

A

School behavior
Prior medical history
Employment history
Information from family members (deeper insight away from self-report)
Prior mental health conditions
Prior neuropsychological assessment reports

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7
Q

Does all personal information come from interviews?

A

Typically interviews are self-report which is not super reliable, can get some objective interview as well where possible (eg. school, medical history)

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8
Q

What other information may be incredibly valuable to obtain if available?

A

If there are any past radiology reports (CT or MRI)

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9
Q

What are T1 weighted images in MRI

A

Tissues comprising water and fluid appear to be dark and the tissues containing fat are bright in colour

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10
Q

What are T2 weighted images in MRI

A

Tissues comprising water and fluid appear to be bright and the tissues containing fat are dark in colour

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11
Q

What does the clinical interview involve?

A

A reconstruction of clinical issues and history
Data to understand
What they were like beforehand (allows us to understand decline)
Observe their behaviour (restless, fidgeting, disinhibited etc) - may give you a good indication of how they are functioning in everyday life

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12
Q

If people are honest they are….

A

a good source of information

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13
Q

The goal of an assessment is to…

A

Predict or decide on a clinical category

E.g. diagnosis vs. no diagnosis, impaired vs. not impaired

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14
Q

Additional information is important why?

A

It can increase the sensitivity and specificity of the testing you do

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15
Q

What is sensitivity in neuropsychological assessment?

A

The probability that a test correctly identifies a clinical category given they actually do have it

E.g what is the ability of a memory test to detect AD given that a person actually has it

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16
Q

What is specificity in neuropsychological assessment?

A

The probability that the test correctly detects or classifies a normal performance

E.g. correctly detects that they do not have the condition

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17
Q

What is the first thing you should ask in the interview?

A

Whether or not the person knows why they are there

Allows us to see their level of insight into their difficulties

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18
Q

Insight is…

A

a catalyst for change

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19
Q

If someone suggests they have difficulties in certain domains, you should

A

Clarify scenarios with them on when this difficulty occurs

Because cognition is very multidimensional eg. different types of memory

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20
Q

Steps for obtaining self-report information?

A

Start with broad questioning

If not offered, prompt by asking to think about difficulties in certain domains

If still not offered, ask even more specific situational questions to prompt

When difficulties are identified, be inquisitive about it - aim to develop a clear understanding

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21
Q

What factors do we need to consider when trying to optimise performance in assessments?

A

Internal factors eg. anxiety
Should establish a rapport

External factors eg. the environment in which the person is tested

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22
Q

How does motivation influence neuropsychological assessments?

A
  • Good idea to ask why they are there

E.g. For workers compensation, they may be motivated to perform more poorly

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23
Q

When do you write notes?

A

As it is happening
- Otherwise may forget

Can also go through at the end of the session and expand on your notes so you don’t forget things

May also have permission to make a recording

24
Q

Tests that you use, need to have good….

A

Normative data

Extracted from population

Data you can refer to to compare our patient to

25
Q

What does a standardized test mean?

A

These are published tests that have been normed

The same instructions are given to everyone - we know we can accurately make comparison to the normative group

26
Q

What if patients have trouble understanding standardised instructions?

A

You can simplify them
Or tell in a way that patients will best understand.

Where possible they need to be administered in the standardised way

27
Q

Why do you need to put on a poker face during testing?

A

Need to be mindful of how much feedback you give

This can make them feel anxious or give them an inflated sense that they are right

28
Q

You need a poker face during assessment but what do you still need to do?

A

Give them some level of encouragement

Can lift their motivation to keep going and keep trying hard on the test

29
Q

When do you score the test?

A

Score as much as possible as it is being administered because there can be discontinuation rules that apply and may need to stop the patient.

30
Q

Can the patient see how you are scoring them?

A

No, make sure it is completely out of view

31
Q

Scoring procedures can be…

A

Quite complicated but you need to make sure they are accurate otherwise it can lead to misdiagnosis

32
Q

What about standardised tests for those with special needs?

A

There are some alternative tests for those with special needs (for those that are the most commonly used)

Tests are designed as if motor and sensory systems are intact but this is obviously not always the case

33
Q

What makes a testing conditional optimal?

A
Quiet - no foot traffic 
Sufficient artificial light - no glare 
Comfortable temp 
Should be welcoming and friendly 
Should be organised so that the patient does not have enough time waiting around to get bored
34
Q

What if optimal testing conditions are unattainable?

A

Sometimes has to be done in less than optimal conditions, try best to make it better
- need to ensure you note down conditions

35
Q

How do you know if someone is trying to fail?

A

May be shown through overt signs of distractibility, excessive slowness or carelessness

Errors may not reflect brain pathology of any kind

Although this is difficult to determine through observation alone

36
Q

If someone is obviously not trying, what do you do?

A

The clinician can choose to terminate the session because it is unlikely to produce data that can reliably support clinical inferences
- need to report what lead you to this decision

37
Q

When you are record taking in real time, you need to be careful not to…

A

Seem disinterested in the patient

38
Q

What do you need to follow to adhere to standard procedures?

A

Exact wording
Test materials
Time limits
Scoring rules

39
Q

What is premorbid functioning?

A

When people are referred, we don’t know what they were like prior to seeing you
Need to really understand what they were like before the illness or injury and this is premorbid functioning

40
Q

Why do we need to know premorbid functioning?

A

Tells us about their level of decline, or specific areas of decline
Need to make comparisons between what that person was like previously

41
Q

How do we assess premorbid functioning?

A

Self-report
- not reliable, people overestimate achievements and some may lack insight, if depressed they may underrate abilities

School/uni/employment records

  • hard to acquire/obtain
  • GPA may not be correlated with IQ, may be more about motivation

Formal testing
- word pronunciation test

42
Q

How do we assess intellectual functioning?

A

The WAIS-IV

43
Q

What are the main domains of intellectual functioning?

A
  1. Verbal intellectual functioning (verbal comprehension scale)
  2. Non-verbal intellectual functioning (perceptual reasoning scale - block design, matric reasoning)
  3. Working memory scale (digit span and arithmetic)
  4. Processing speed scale (symbol search and coding)
44
Q

What are the core aspects of intelligence that are impacted first when there is an injury to the brain?

A

Processing speed and working memory

45
Q

What intellectual functioning is the most preserved following injury?

A

Verbal

46
Q

What function really affects other cognitive domains when impaired?

A

Processing speed - difficulties taking in and learning new information

Core to cognitive assessments

47
Q

What is confrontation naming?

A

The ability to name everyday objects - impaired in dementia (temporal regions)

48
Q

What are the two different kinds of apraxia?

A

Ideomotor: processing/planning - if motor cortex is impaired, you may understand but not execute (cannot mimic what another person is doing due to motor cortex)

Ideational: processing and planning = damaged, you have lost concepts of how to use objects (need to show how to use object and they cant do it)

49
Q

What are some tests of motor functioning?

A

Finger tapping task (contralateral control)

Grip strength
- dynamometer

Dexterity
- peg board test (for motor impairments)

50
Q

What tests are used for visuospatial construction and problem-solving?

A

Block test
Clock test
Complex figure - reproducing

51
Q

What kind of functioning is becoming more common in psychological assessment?

A

Social cognition

E.g. affect naming is about the ability to perceive emotions in other people, theory of mind ability

52
Q

What is set shifting?

A

Ability to switch between different topics - difficult to do if dementing

Colour-form sort (may sort in shape or colour and then asked to switch and sort to a new category) - shows cognitive flexibility

53
Q

How do we assess idea generation?

A

Controlled oral word association test
- Say as many words as can think of beginning with a particular letter (letter fluency) - frontal
or
- Animals or fruit (semantic fluency) - temporal

Provides insight into location of dementia

54
Q

What is malingering?

A

Knowing if someone is putting in their full effort

E.g. people trying to get compensation may not try at all

May show an atypical pattern of performance, fail easy items, pass hard or miss details in recall that are normally not missed

55
Q

How do we detect malingering?

A

The test of memory malingering

  • In non-malingering adults, will get 49/50 correct even in dementia we get 46/50
  • in malingerers we see a reduced level of performance