Week 12: Neuropsychological Testing

Satisfied but could be better if there was time

What does a neuropsychologist do?

There is a branch of jobs that neuropsychologists do and even have specialisations—where some studies patients to identify and clarify the underlying processes of human cognition and others might specialise in assessment and treatment

What is neuropsychology?

Neuropsychology is the branch of psychology that focuses on the relationship between brain functioning and behaviour

What do neuropsychologists do?

• conducting neuropsychological assessment on individuals with or suspected to have a brain injury

• providing psycho-education, counselling or psychotherapy for individuals with brain injury (and in some cases, their immediate family members or partners)

• planning, conducting and evaluating neuropsychological rehabilitation for individuals with brain injury based on the results of neuropsychological assessment

• conducting clinical neuropsychology research

What does a neuropsychological assessment entail?

Follows the application of neuropsychological tests and other data-collection techniques to answer referral questions or solve problems for individuals with known or suspected brain injury

What is the process of an assessment?

1. interviewing

2. gathering other relevant information

3. neuropsychological testing

4. interpreting test results and integrating information

5. report writing and providing feedback

What are some conditions that would prompt a neuropsychological assessment?

• BRAIN INJURY—Acquired, Traumatic

• NEUROLOGICAL CONDITIONS—Epilepsy, Hydrocephalus, MS, PD

• MEDICAL—Infectious diseases (acquired immune deficiency syndrome), vascular disease, tumour

• DEMENTIA SYNDROMES—Alzheimer’s Disease, vascular dementia, fronto-temporal dementia

• PSYCHIATRIC—Schizophrenia, major depression

• LEARNING DIFFICULTIES/DEVELOPMENTAL DELAY—Autism Spectrum, ADHD, specific learning disability (e.g., reading)

Why would conducting a neuropsychological assessment be useful?

• diagnosis—important regarding cases where cognitive impairment is subtle and not evident on screening assessments or neuroimaging

• description of neuropsychological functions—provides a detailed profile of the patient’s cognitive strengths and weaknesses

• prognosis (what does it long like in the long term)—results of the assessment can be used to assist with developing individual treatment recommendations or plans; also be used in predicting and enhancing social, educational and vocational outcomes

• treatment planning—especially helpful for people experiencing difficulties with memory, attention, language or other aspects of cognition or behaviour

• monitoring the rate of recovery & evaluating the effects of treatment—neuropsychological conditions can worsen or improve with time and treatment, neuropsychological assessment is valuable as it provides a baseline for future comparison of changes over time

What is the scientist-practitioner model?

A way to deliver a service via use of evidence based research—that all clinical practice (including diagnosis/ intervention/ evaluation) should be informed by the content and methods of science

What are some things to consider when planning your approach in the clinical interview?

Overall the aim is to gather information about the person and the presenting complaint

What are some considerations for an interview?

• What information are you missing?

• What information do you need to help with differential diagnosis (e.g., dementia v depression)

• Are there any areas that need clarification? (e.g., timeline)

• Consider if an informant history is required (e.g., memory complaints)

• Consider the length of the interview in the context of the client’s background and reported complaints

• What are the key areas of focus?

What would a qualitative assessment be important?

How does the patient present during interview? (e.g., affect, language, presentation, motor, behaviour, effort)

What are the two types of batteries that neuropsychologists use?

• fixed

• flexible

What is the type of battery neuropsychologists prefer to use?

Flexible

What are fixed battery of tests?

group of tests used on all clients regardless of referral question designed to comprehensively sample the client’s cognitive functioning

What are flexible battery of tests?

consists of a range of tests selected specifically in the context of the referral question and the client’s presenting problem

Neuropsychologists specialize in brain and behaviour, what are the typical neurological functions they assess?

• Sensory function

• Intellectual ability

• Executive function

• Perceptual and motor function

• Verbal functioning

• Learning and memory

• Language

• Attention and processing speed

• Effort

• Premorbid ability

• Visuospatial

• Premorbid functioning

What are some considerations when administering a test?

• introduce the session—Provide general clear guidelines about the aims and procedures of the assessment to minimise performance anxiety and build rapport

• task order—The first 30 minutes is the most crucial, but don’t bombard them with tough concepts at first; alternative and take breaks

• instructions—Neuropsychological tests are quite sensitive to instructions → use standardised instructions

• record keeping—Ensure to record all relevant qualitative data so you can interpret this later in conjunction with test results; experience of anxiety etc

What is the Halstead-Reitan Neuropsychological Battery (HRNB)?

A battery that provide a comprehensive measurement of neuropsychological functions—under the battery are subtests of functions; takes 6-8 hours to complete

In the Halstead-Reitan Neuropsychological Battery (HRNB): What is measured in the category test?

measures abstract reasoning and complex concept formation—determine the rules for categorising pictures of geometric figures by using feedback based on whether they got the last item

In the Halstead-Reitan Neuropsychological Battery (HRNB): What is measured in the tactual performance test?

measures sensorimotor and kinaesthetic abilities and incidental spatial memory—Blindfolded participants use their dominant, nondominant, and both hands to fit large wooden shapes into matching cut-outs on an upright board. Afterward, without the board or blindfold, they draw the board's outline from memory

In the Halstead-Reitan Neuropsychological Battery (HRNB): What is measured in the speech sounds perception test?

measures the functions in perception of auditory verbal stimuli, auditory-visual synthesis and sustained attention—60 nonsense syllables are presented in this subtest and test takers are required to pick out the presented sound from four choices

In the Halstead-Reitan Neuropsychological Battery (HRNB): What is measured in the seashore rhythm test?

measures functioning in the auditory perception and sustained attention—participants are required to indicate if thirty pairs of rhythmic sounds are the same or different

In the Halstead-Reitan Neuropsychological Battery (HRNB): What is measured in the finger tapping test?

measures gross motor speed—participants are required to tap as rapidly as possible on a telegraph-type key fitted with a mechanical counter

In the Halstead-Reitan Neuropsychological Battery (HRNB): What is measured in the trail making test?

functions measured by this test are simple and complex information-processing speed and cognitive flexibility—a two part test;

1. participants are asked to use a pencil to connect twenty-five numbered circles on a piece of paper as quickly as possible

2. the task is to connect numbered and lettered circles alternately (1-A-2-B etc.)

In the Halstead-Reitan Neuropsychological Battery (HRNB): What is measured in the aphasia screening test?

used to screen receptive and expressive language problems—participants are required to undertake tasks such as repeating short phrases, naming pictures, following instructions and copying pictures

In the Halstead-Reitan Neuropsychological Battery (HRNB): What is measured in the sensory-perceptual examination?

measures a person’s sensory-perceptual abilities—participants are required to respond to a series of simple auditory, tactile and visual stimuli, both unilaterally and bilaterally

What is the main strength of the HRNB?

the use of a standard set of measures on which patients’ performances can be compared

What is the main criticism of the HRNB?

its inflexibility and the amount of time it takes to complete the battery

What are some neuropsychological tests based on perceptual/motor assessment?

• Visual Perception (Visual Discrimination Test, Judgment of Line Orientation Test)

• Visual Construction (Rey Complex Figure –Copy)

• Clock Drawing

• Motor Speed (Finger Tapping)

• Motor Dexterity (Grooved Pegboard)

What are some neuropsychological tests based on language?

• Perception (sound, phonemic)

• Comprehension (rule following tests)

• Production (free speech analysis)

• Repetition

• Reading/Writing

• Semantics (access, concepts)

• Naming

What are some neuropsychological tests based on attention and speed?

• Attentional Span Sustained Attention (Cancellation tests)

• Divided Attention (TMT B)

• Speed (Coding, TMT A)

What are some neuropsychological tests based on memory?

• Episodic memory

• Verbal learning and memory: Word Lists, Logical Memory

• Visual Memory: Complex Figures (but watch perceptual/motor skills)

What are some neuropsychological tests based on executive functions?

• Abstraction (Similarities, Proverbs, 10 Questions)

• Working Memory (Letter Number Sequencing)

• Planning (Tower of London)

• Response Inhibition (Stroop, Hayling)

• Shifting (Wisconsin Card Sorting Test, Trail Making Test)

• Attentional switching/Flexibility (Trail Making TestB)

What is an ecological approach in neuropsychology?

understanding how cognitive functions operate in real-world, everyday settings—considers how a person’s brain functions in natural environments and daily tasks, aiming to create assessments and treatments that reflect real-life challenges and contexts

What are some assessment that follow an ecological approach?

• Rivermead Behavioral Memory Test

• Test of Everyday Attention

• Behavioral Assessment of the Dysexecutive System

• Multitasking

What is the Behavioural Assessment of the Dysecutive System?

A battery of tasks designed to assess everyday problems associated with deficits in executive function—designed to elicit problems with planning and organising behaviour and prioritising between sets of tasks