Clinical Neuropsychology and memory assessment

Flashcards on Clinical Neuropsychology and memory assessment

Clinical cutoffs

Requires comparisons to matched clinical groups, rather than using general population norms.

General population norms

May underestimate deficits in neurologically impaired individuals if used instead of matched clinical groups.

Best practices for using RBMT

Using version specific, demographically adjusted norms.

RBMT-3

UK norms may not be fully appropriate for Hong Kong older adults

Local Norms

Developing normative reference points from a local sample.

Supplementing with Qualitative Observations

Triangulation of data from test performance, clinical history, and real-world function.

Individual Background and Context

Adjusting interactions based on age, education level, and cognitive reserve.

Bilingual Memory Interference

Difficulty in recalling or distinguishing between two languages due to overlapping memory networks.

Implications of Bilingual Memory Interference

Memory tests may yield unreliable results if language switching or dominance isn’t accounted for.

Clinical Application of Bilingual Memory Considerations

Assess language proficiency in both languages and consider administering memory tasks in the dominant language or both.

Attention in Noisy Environments

Adapting testing conditions with cultural context in mind.

Translated and normed neuropsychological batteries

Using tools translated and validated for the client's cultural and linguistic background

Normative Data Considerations

Ensure normative data reflect the client's educational, linguistic, and socioeconomic context.

Liaison with Interpreters

Collaborate with trained medical interpreters.

Culturally Informed Psychoeducation

Frame mental health concepts in culturally relevant terms.

Community Resources

Connect clients with culturally appropriate services.

RBMT-3 Version

Administered in Cantonese, assesses everyday memory.

Ecologically Valid Task

Remembering a name.

RBMT-3 Features

Includes standard and parallel forms to reduce practice effects.

Scoring in RBMT-3

Each subtest contributes to a general memory index (GMI).

Language in Hong Kong Study

Cantonese-translated and culturally adapted version of RBMT-3.

Cultural Considerations

Participants were Cantonese speaking Hong Kong residents.

Standard Instruments

Mini mental state examination

Pilot testing purpose

Using Pilot testing to ensure ecologically validity

Floor effects

Participants with low education or illiteracy may struggle disproportionately on tasks.

Ceiling effects

Common in cognitively healthy, educated individuals, limiting sensitivity in high functioning populations.

Mitigation

adapt instructions, offer examples, and consider oral only formats when necessary

Examiner-Examinee Rapport

Greater trust and cultural sensitivity lead to more accurate performance.

Cultural Considerations in Hong Kong

Respect for authority figures may lead to socially desirable responses or underreporting of difficulties.

Language proficiency

Assess oral comprehension and allow clarifications without leading responses.

Acculturation

Levels of westernization may influence comfort with testing formats

Ecologically validity

Tasks mimic real world memory demands making it more relevant than abstract memory test

Sensitivity to functional impairment

Effective in detecting early memory decline, especially in dementia or MCI

Culturally adaptable

Has been translated and normed for many languages/cultures, including a Cantonese version for Hong Kong.

Quick and practical

Takes 30-45 minutes, making it feasible for use in both clinical and community settings.

Education and literacy bias

Low literate or less educated individuals may score lower due to test unfamiliarity, not true memory deficits.

Ceiling and flood effects

High functioning individuals may max outsources, while low literacy participants may bottom out, limiting discriminatory power.

Cultural specificity

Even translated versions may include cultural assumptions.

Limited insight into underlying mechanisms

RBMT shows functional impairment but not specific cognitive processes.

Matched Clinical Groups

Clinical cutoffs require comparisons to these groups rather than general population norms.

Age Norms

The RBMT-3 includes these norms to improve accuracy.

Local Sample

The process of establishing optimal cut-off scores for differentiating between healthy controls, MCI, and dementia.

Triangulation of Data

The use of multiple data points to ensure that memory test scores are interpreted within the full clinical picture.

Cognitive Reserve

Considering factors like age, education level, and cognitive reserve when interpreting results.

Language Switching

Difficulty in recalling or distinguishing between two languages.

WAIS-IV

A Spanish version of these tools ensures clients have appropriate testing resources.

Family Members

Preserving confidentiality and accuracy by avoiding this type of translator.

Storytelling

Using these in indigenous communities can help explain memory rehabilitation.

Cantonese

Participants of this study spoke this language, making cultural adaptations necessary.

30-45 minutes

This is the amount it takes to administer the RBMT, mkaing it clinically feasible..