Handout – Neuropsychological Assessment PDF

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NEUROPSYCHOLOGICAL ASSESSMENTNeurology – is a branch of medicine that focuses on the nervous system and its disorderNeuropsychology – is the branch of psychology that focuses on the relationship of the brain functioning and behaviorSubspecialty areas of neuropsychology:  Pediatric neuropsychology ...

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NEUROPSYCHOLOGICAL ASSESSMENT Neurology – is a branch of medicine that focuses on the nervous system and its disorder

Why do we do neurological assessment? –– Plays a critical role in determining the extent of behavioral impairment.

Neuropsychology – is the branch of psychology that focuses on the relationship of the brain functioning and behavior

Technical names for various kinds of sensory and motor deficits:      

Subspecialty areas of neuropsychology:  Pediatric neuropsychology  Geriatric neuropsychology  Forensic neuropsychology  School psychology Neuropsychological assessment – It is defined as the evaluation of brain and nervous functioning as it relates to behavior.

SHORT MEDICAL BACKGROUND Nervous system and behavior Nervous system is composed of various kinds of neurons and can be divided into:  Central Nervous system - brain and spinal cord  Peripheral Nervous System – neurons that conveys messages to and from the rest of the body Brain Parts of the brain:  Temporal lobes – auditory and visual perception  Occipital lobes – visual reception  Parietal lobes – sense of touch  Frontal lobes – ordering information and sorting out stimuli  Thalamus – communication relay station  Hypothalamus – eating, drinking, body temperature, sexual behavior and emotion  Cerebellum – balance, breathing, posture  Reticular Formation – relay center  Limbic system – hormones, expressions of emotions  Spinal cord – reflex, coordination of motor movements Neurological damage – lesion in the brain and any other site within CNS and PNS

Acalculia Acopia Agnosia Agraphia Akinesia Alexia

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Amnesia Amusia Anomia Anopia Anosmia Aphasia

Terms Neurological damage – most inclusive because it covers the damage not only to the brain but also the spinal cord and other components of PNS Brain damage – general reference to physical or functional impairment Organicity – used during post world war I NEUROPSYCHOLOGICAL EVALUATION Conditions evaluation:      

that may prompt a referral to neurological Brain injury Epilepsy AIDS Alzheimer’s disease Attention and learning problems Other significant changes in sensory, motor, and cognitive function

Elements of neuropsychological evaluation:  History  Interview  Neuropsychological mental status examination Physical examination: o Appearance o Unusual enlargements or depressions o Muscle tone o Reflexes Tests used to evaluate muscle coordination:  Walking – running – skipping  Standing still  Nose – finger – test  Finger wiggle Cranial nerve functions:

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CN I – smell CN II – vision CN V – scalp, forehead, nose CN VIII – hearing and balance

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Parkinson’s Disease A progressive neurological disorder characterized by disorders of movement such as tremors, rigidity, slowness and problems with balance and coordination. Substantia nigra Dopamine deficiency Characteristics: o Tremors, Rigidity, Slowness o Difficulties with gait and balance o Difficulties with fine motor skills o Swallowing difficulties, Excessive salivation o Rapid eye movement o Sweating, fatigue, depression

Wisconsin Card-Sorting Test – Consists of sixtyfour cards  Participants deduce from feedback how to sort a series of cards depicting different geometric shapes in various colors and quantities  Cards are sorted to matching rules that must be inferred and that shift as the test progresses TESTS OF EXECUTIVE FUNCTION

1.

Tower of Hanoi – Paris, 1993; La Tour de Hanoi (Pagoda)  Solid form or computerized Administration  (1) Only one ring may be moved at a time; (2) ring is moved from one peg to another; (3) no ring may be placed on a smaller one

2.

Porteus Maze Test – Stanley D. Porteus (as early as 1930s)  This was originally introduced to yield a quantitative estimate of a) prudence, b) forethought, c) mental alertness, d) sustained attention  Identify correct path, then trace a line to the end point  Useful in measuring executive functions in adults but questionable for use in children\

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Clock-Drawing Test  Task is to draw the face of a clock, with hands of the clock indicating a particular time  Has many variations as well as scoring of this test  Some clinicians begin the test with a predrawn circle  Abnormalities in drawings indicate cognitive dysfunction as a result of dementia or other neurological or psychiatric conditions  Poor performance has been associated with visual memory deficits, mild cognitive impairment and losses in function concomitant to aging

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Trail-Making Test  Task is to connect the circles in a logical way  Thought to tap abilities: visuo-perceptual skills, working memory, ability to switch between tasks  Initial performance on this test was able to predict impairments in mobility and even

Interventions: o Medications o Good nutrition o Regular exercise o Psychotherapy

Neuropsychological Assessment Tests TESTS OF GENERAL INTELLECTUAL ABILITY Wechsler Test – is an intelligence test use to measure intellectual and cognitive ability

TESTS TO MEASURE THE ABILITY TO ABSTRACT 1.

Wechsler Similarities – It was isolated from the age-appropriate version of intelligence scale.  Task is to identify how objects are alike.

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Proverbs Test – Designed to test abstraction and related ability. Has two forms:  Write an explanation of a proverb  Multiple-choice

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Weigl’s Test – Object-Sorting and Color-Form Sorting  Sort objects of different shapes and colors  Group a few of the objects together and ask the testtaker to explain why objects go together and which object does not belong with the rest

3 mortality based on a 6-year longitudinal study (Vazzan, et. al., 2010) 5.

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Field of Search  Test-taker is shown a target stimulus (shape or design) and scans a field of a stimuli to match the the sample  Test is timed  Note: people with brain lesions on the right hemisphere may show problems in visual scanning ability Identification Task – also known as “confrontation naming”  Line drawings that appears in Boston Naming Test  Task is to name each stimulus that is presented  Has three components: 1) perceptual–– perceive visual features of the stimulus, 2) semantic––accessing core meaning of whatever is pictured, 3) lexical–– accessing and expressing the appropriate name  Difficulties in this test could be due to deficits in the three components  Patients with Alzheimer’s or dementia typically experience difficulties with naming tasks Picture Absurdity – Similar to absurdity items on the Stanford-Binet intelligence test; also similar also to Wechsler-type Comprehension items  Task is to identify what is wrong or silly about the picture presented  Test-taker must be able to perform executive functions like calling by telephone for help and the like  Helps assess one’s capacity for independent living

 Examinee––who has no speech defect, who doesn’t mutter, and who doesn’t have a heavy accent––determines whether the two words are the same or different  Note: this test has little information about its reliability or validity and fails to outline standardized administration conditions 3.

Bruininks-Oseretsky Test  Designed for children (4.5 to 14.5 years of age)  Has subtests that assess running speed, agility, balance, strength, response speed, and manual dexterity

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Purdue Pegboard Test – Developed in 1940s as aid in employee selection  Task is to insert pegs into holes using first (1) one hand, (2) then the other hand, and (3) then both hands  Each of the three segments has a 30-second limit; score is equal to the number of pegs correctly placed  Note: Women generally perform a little better than men in population without brain injury  Helps answers questions about lesion lateralization in brain-injured subjects

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Bender Visual-Motor Gestalt Test – Lauretta Bender (1896-1987); used by Max Wetheimer in 1923 to study the perception of gestalten (German––configurational wholes; totality; form)  Used to get a record of perceptual motor experience  Originally has nine cards (now with additional seven)  Testtakers are shown each of the cards and are instructed to copy as best as they can  No time limit; scored on a clinical judgement  Published with few scoring guidelines and no normative information

TESTS OF PERCEPTUAL, MOTOR, AND PERCEPTUALMOTOR FUNCTION 1.

Ishihara Test – Shinobu Ishihara (1879–1963); a modified version of the Stilling Color Vision Test  Test for color-blindness  Numbers or letters are formed by dots with colors against a background of dots with varying degrees of brightness of saturation

TESTS OF VERBAL FUNCTIONING 1.

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Wepman Auditory Discrimination  Easy to administer; examiner is required to read a list of 40 pairs of monosyllabic meaningful words (with lips covered––not muffled––by hand or a screen)

Controlled-Word Association Test – known as Verbal Associative Fluency Test  Examiner says a letter of the then, the subject says as many he/she can think of beginning letter

Formerly alphabet; words as with the

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Three (3) trials with three (3) letters as stimulus; each trial lasts one minute Final score is the total number of correct words weighted by gender, age, and education of test-taker The test is related to the prediction of dementia patients’ ability to complete tasks of daily living

Reitan-Indiana Aphasia Screening  Available for child and adult  Part of the Halstead-Reitan Neuropsychological Battery  32-item test; developed to evaluate language, constructional praxis, calculation, and right-left orientation  Tasks include naming common objects, following verbal instructions, writing familiar words TESTS OF MEMORY

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California Verbal Learning Test–II  Task is to repeat a list of words read by the examiner; series of trials are administered  Forced-choice type, useful in detection of malingering  Has short form (fatigue or related factors are taken into consideration); has alternate form for retesting purposes; has child form  Norms from ages 16 to 89

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Wechsler Memory Scale–IV – published 2009; most recent revision; Designed for ages 16 to 90  Provides index scores for auditory, visual, visual working memory, immediate, and delayed memories  Some evidence suggests that WMS–IV may be a more useful measure of auditory and visual memory than WMS–III under certain circumstances (Hoelzleet et. al., 2011)

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[Assessees are asked to fit each of the 10 wooden blocks into the right space in the formboard with each hand separately and then with both hands. Then assessees may be asked to draw the formboard from memory. All responses are timed and scored for accuracy.] HALSTEAD-REITAN NEUROPSYCHOLOGICAL TEST BATTERY Halstead Reitan Neuropsychological Test Battery – Ward C. Halstead (1908-1969), experimental psychologist; Halstead Neurological Test Battery (designed to assess presence or absence of organic brain damage); Ralph M. Reitan, student of Halstead; Manual for Administration of Neuropsychological Test Batteries for Adults and Children, published 1969 (result of two papers in 1955 about the differential intellectual effect of various brain lesions sites)  Requires highly trained examiner conversant with the administration of the subtests  Full-workday to complete  Halstead Impairment Index (score); a score of .5 or above is as indication of neuropsychological problem  Cut-off point of .5 was established using 10,000 data from patients  Normative information was published with respect to special populations  Cultural factors must be considered in the administration of the battery Category

Halstead–Reitan Subtests Measures abstracting ability. Subjects determine what principle ties the stimulus together and indicate their answers among four choices on a simple keyboard.

Tactual performance

Blindfolded subjects complete the Seguin-Goddard Formboard with their dominant, non-dominant hands, and then both hands. Formboard is removed, blindfold taken off and examinees are asked to draw the formboard from memory.

Rhythm

Subject’s task is to discriminate between like and unlike pair of musical beats. Difficulty with this task is associated with right temporal brain damage.

Measurements of Tactile Memory  Tactile Nonsense Figures – (nonrepresentational) used to measure immediate tactile (haptic) memory [Examinees are instructed to feel one of the figures with their right or left hand (or with both hands) and then to locate a matching figure]

Seguin–Goddard Formboard – used to assess tactile memory if examinees were blindfolded and a recall trial added

Speech

Consists of 60 nonsense words by

5 sounds perception

Fingertapping

Time sense

Other tests

means of audiotape adjusted to preferred volume by examinee. Task is to discriminate a spoken syllable, selecting from four alternatives presented on printed form. Performance is related to left hemisphere functioning. Originally called finger oscillation test. Tests manual dexterity by measuring tapping speed of index finger on each hand on a tapping key. Cortical lesions may differently affect finger-tapping rate of two hands. Examinee watches the hand of a clock sweep across the clock and then has the task of reproducing that movement from sight. This test taps visual motor skills as well as ability to estimate time span.  Trail Making test––task is to correctly connect numbered and lettered circles; strength of grip measured informally by handshake or dynamometer  Miles ABC Test of Ocular Dominance; Wechsler Intelligence Test; MMPI; Halstead and Wepman’s (1959) test adapted for work.

Fixed Battery  It is a set of neuropsychological tests defined within a structure or conceptual framework  Comprehensi vely sample a patient’s neurological functioning. One drawback for this test is that the specific disability of a patient may adversely influence performance on the test (visual impairment –– tasks of visual skills

Flexible Battery  It is an assortment of instruments handpicked for some purpose relevant to the unique aspects of the patient and the presenting problem  The clinician has the responsibility of selecting the tests as well as the burden of integrating all the findings from each of the individual tests

OTHER ASSESSMENT BATTERIES Neurosensory Center Comprehensive Examination of Aphasia (NCCEA) – a battery of tests that focuses on communication deficit

Montreal Neurological Institute Battery – used by trained psychologists in locating specific kinds of lesions Southern California Sensory Integration Tests – to assess sensory-integrative and motor functioning (sensory and motor functioning) in children 4 to 9 years of age Severe Impairment Battery – designed for use with assessees who are severly impaired; it is divided into six subscales: Attention, Orientation, Language, Memory, Visuoperception, and Construction Cognitive Behavioral Driver’s Inventory – specifically designed to assist in determining whether individuals with brain damage are capable of driving a motor vehicle OTHER TOOLS OF NEUROPSYCHOLOGICAL ASSESSMENT 1.

X-ray and Cerebral Angiogram – Diagnosis of tumors, lesions, infections and other abnormalities can be made.

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Computerized Axial Tomography Scan (CT Scan) – Superior to traditional X-rays because the structures in the brain may be represented in a systematic series of three-dimensional views, a feature that is extremely important in assessing conditions such as spinal anomalies.

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Positron Emission Tomography Scan (PET) – A tool of nuclear medicine particularly useful in diagnosing biochemical lesions in the brain.

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Single Photon Emission Computed Tomography (SPECT) – A technology that records the course of a radioactive tracer fluid (iodine) and produces exceptionally clear photographs of organs and tissues.

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Electroencephalograph (EEG) – A safe, painless, and noninvasive procedure that can be of significant value in diagnosing and treating seizure and other disorder.

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Electromyograph (EMC) – Records electrical activity of muscles by means of an electrode inserted directly into the muscle. Abnormalities found in the EMG can be used with other clinical and historical data as an aid in making a final diagnosis.

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Echoencephalograph – An adjunct to other procedures in helping the diagnostician to determine the nature and location of certain types of lesions in the brain.

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Lumbar Puncture – Test allows the diagnostician to gauge the normality of the intracranial pressure.

REFERENCE

[1] Cohen, R.J & Swerdlik, M.E. (2018) Psychological Testing and Assessment: An Introduction to Tests and Measurement. 9th ed. McGraw-Hill Companies, Inc., N.Y.Quotations.htm. Web. Accessed: April 9, 2012. [2] VandenBos, G. R. (2015). APA dictionary of psychology. Second edition. Washington, DC: American Psychological Association....