Week 2: Neuropsychological assessment Flashcards
What is the most important reason to conduct an assessment?
To diagnose
What other reasons, other than diagnosis, is there to do assessments?
To classify the severity Differential diagnosis To gain clarity Target treatment and evaluate if treatment has been effective Performance evaluation Medicolegal evidence
What initiates a psychological assessment?
The referral
What is a referral for assessment?
Letter or note
- Basic patient info
- Some type of question (very specific) that needs to be answered
What, in particular, should you research about the condition your referral relates to?
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
What kind of information should you gather about the person themselves?
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
Does all personal information come from interviews?
Typically interviews are self-report which is not super reliable, can get some objective interview as well where possible (eg. school, medical history)
What other information may be incredibly valuable to obtain if available?
If there are any past radiology reports (CT or MRI)
What are T1 weighted images in MRI
Tissues comprising water and fluid appear to be dark and the tissues containing fat are bright in colour
What are T2 weighted images in MRI
Tissues comprising water and fluid appear to be bright and the tissues containing fat are dark in colour
What does the clinical interview involve?
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
If people are honest they are….
a good source of information
The goal of an assessment is to…
Predict or decide on a clinical category
E.g. diagnosis vs. no diagnosis, impaired vs. not impaired
Additional information is important why?
It can increase the sensitivity and specificity of the testing you do
What is sensitivity in neuropsychological assessment?
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
What is specificity in neuropsychological assessment?
The probability that the test correctly detects or classifies a normal performance
E.g. correctly detects that they do not have the condition
What is the first thing you should ask in the interview?
Whether or not the person knows why they are there
Allows us to see their level of insight into their difficulties
Insight is…
a catalyst for change
If someone suggests they have difficulties in certain domains, you should
Clarify scenarios with them on when this difficulty occurs
Because cognition is very multidimensional eg. different types of memory
Steps for obtaining self-report information?
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
What factors do we need to consider when trying to optimise performance in assessments?
Internal factors eg. anxiety
Should establish a rapport
External factors eg. the environment in which the person is tested
How does motivation influence neuropsychological assessments?
- Good idea to ask why they are there
E.g. For workers compensation, they may be motivated to perform more poorly