14: Neuropsychological Assessment

Neurology

The branch of medicine that focuses on the nervous system and its disorders

Neuropsychology

The branch of psychology that focuses on the relationship between brain functioning and behavior

Neuropsychological Assessment

The evaluation of brain and nervous system functioning as it relates to behavior

Neurons

nerve cells

Central Nervous System

consists of the brain and the spinal cord

Peripheral Nervous System

consists of the neurons that convey messages to and from the rest of the body

Contralateral Control

a phenomenon where the two cerebral hemispheres receives sensory information from the opposite side of the body and also controls motor responses on the opposite side of the body

Corpus Callosum

The meeting ground of the two hemispheres (left and right)

left

Corpus Callosum: The _ hemisphere leads in such activities as reading, writing, arithmetic, and speech

right

Carpos Callosum: The _ hemisphere leads in tasks involving spatial and textural recognition as well as art and music appreciation

complements

In the normal, neurologically intact individual, one hemisphere ___ the other

Temporal Lobes

auditory processing

Occipital Lobes

visual processing

Parietal Lobes

tactile processing

Frontal Lobes

ordering information and sorting out stimuli

Thalamus

communications relay station for all sensory information

Hypothalamus

regulation of bodily functions

Cerebellum

regulation of balance, breathing, and posture, among other functions

Reticular Formation

contains fibers en route to and from the cortex

Limbic System

integral to the expression of emotions

Spinal Cord

integral to the coordination of motor movements and many survival reflexes

Neurological Damage

The damage to the brain, to the spinal cord, and to all the components of the peripheral nervous system

Brain Damage

A general reference to any physical or functional impairment in the central nervous system that results in sensory, motor, cognitive, emotional, or related deficit

Organicity (Organic Brain Syndrome)

The factors differentiating organically impaired from normal individuals and includes the loss of abstraction ability, deficits in reasoning ability, and inflexibility in problem-solving tasks

Lesion

A pathological alteration of tissue, such as that which could result from injury or infection

• Focal damage

• Diffused damage

Lesion may be physical or chemical in nature

Focal damage

Lesion may be physical or chemical in nature

__ - relatively circumscribed at one site

Diffused damage - scattered at various sites

Diffused damage

Lesion may be physical or chemical in nature

Focal damage - relatively circumscribed at one site

__ - scattered at various sites

Neuropsychological Assessment

__ may play a critical role in determining the extent of behavioral impairment that has occurred or can be expected to occur as the result of a neurological disorder or injury

consequences

Such diagnostic information is useful not only in designing remediation programs but also in evaluating the __ of drug treatments, physical training, and other therapy

Psychologists

_ who conduct everyday assessments for a variety of reasons may all include some sort of neuropsychological evaluation as a component of what they do.

definitively diagnose

However, most typically, what these non-specialists are trying to do is screen for the presence of a possible neuropsychological problem, rather than __ such a problem.

referred for

If suspicious neurological signs are discovered in the course of the evaluation, the patient will be __ further and more detailed evaluation.

referral

The occurrence of various events or the existence of some known pathology may prompt a _ for evaluation by a specialist

neurological deficit

Signs of ___ may take the form of troubling episodes that only occur at home, at work, or some other venue.

Hard Sign

an indicator of definite neurological deficit

Soft Sign

merely suggestive of neurological deficit

stimulus-response situations

The objective of the typical neuropsychological evaluation is to draw inferences about the structural and functional characteristics of a person’s brain by evaluating an individual’s behavior in defined __

problems of neuropsychological functioning

Common to all thorough neuropsychological examinations are a history taking, a mental status examination, and the administration of tests and procedures designed to reveal _____

Some Conditions That May Prompt Referral for Neuropsychological Evaluation

• Brain injury resulting from stroke, traumatic brain injury (TBI), concussion, or infection

• Epilepsy, hydrocephaly, or other known neurological conditions

• Acquired immune deficiency syndrome (AIDS)

• Alzheimer's disease and other forms of dementia

• Problems with attention and learning

• Any significant changes from usual sensory, motor, or cognitive functioning

General Elements of Neuropsychological Evaluation

• Case History

• Interview

• Neuropsychological Mental Status Examination

Case History

General Elements of Neuropsychological Evaluation

__ - Neuropsychologists pay careful attention to patients’ histories as told to them by the patients themselves and as revealed in patients’ records

Interview

General Elements of Neuropsychological Evaluation

__ - A variety of structured interviews and rating forms are available as aids to the neuropsychological screening and evaluation process

Neuropsychological Mental Status Examination

General Elements of Neuropsychological Evaluation

____ – This examination overlaps the general mental status examination with respect to questions concerning the assessee’s consciousness, emotional state, thought content and clarity, memory, sensory perception, performance of action, language, speech, handwriting, and handedness

Physical Examination

Most neuropsychologists perform some kind of __ on patients, but the extent of this examination varies widely as a function of the expertise, competence, and confidence of the examiner

Non-invasive Procedures

The Physical Examination

__ - procedures that do not involve any intrusion into the examinee’s body

Reflexes - involuntary motor responses to stimuli

Reflexes

The Physical Examination

Non-invasive Procedures - procedures that do not involve any intrusion into the examinee’s body

_ - involuntary motor responses to stimuli

nerves, muscles, and other organs and systems

The physical examination aspect of the neuropsychological examination is designed to assess not only the functioning of the brain but also aspects of the functioning of the _________ and _

Wechsler tests

Tests of General Intellectual Ability

The most famous diagnostic tool is the __. The varied nature of the tasks on the Wechsler scales and the wide variety of responses required make these tests potentially very useful tools for neuropsychological screening.

Pattern analysis

Tests of General Intellectual Ability

__ – the study of the pattern of test scores

Deterioration Quotient (DQ) - signs of brain damage have various ratios and quotients based on patterns of subtest scores

Tests of General Intellectual Ability

• Deterioration Quotient (DQ)

• Pattern analysis

Deterioration Quotient (DQ)

Tests of General Intellectual Ability

Pattern analysis – the study of the pattern of test scores

__ - signs of brain damage have various ratios and quotients based on patterns of subtest scores

think abstractly

Tests to Measure the Ability to Abstract

One symptom commonly associated with neuropsychological deficit, regardless of the site or exact cause of the problem, is inability or lessened ability to __-

Tests to Measure the Ability to Abstract

Example tests are:

• Wechsler Similarities Subtest

• The Proverbs Test

• Weigl’s Test

• Wisconsin Card Sorting Tests.

Executive Function

Tests of Executive Function

organizing, planning, cognitive flexibility, and inhibition of impulses and related activities associated with the frontal and prefrontal lobes of the brain

Tests of Executive Function

Example tests are:

• Tower of Hanoi

• Porteus Maze

• Clock-Drawing Test

Perceptual Tests

Tests of Perceptual, Motor, and Perceptual-Motor Function

used to evaluate varied aspects of sensory functioning, including aspects of sight, hearing, smell, touch, taste, and balance

Motor Tests

Tests of Perceptual, Motor, and Perceptual-Motor Function

used to evaluate varied aspects of one’s ability and mobility

Perceptual-Motor Tests

Tests of Perceptual, Motor and Perceptual-Motor Function

used to evaluate the integration or coordination of perceptual and motor abilities

Tests of Perceptual, Motor and Perceptual-Motor Function

Example tests are:

• The Ishihara Test

• Wepman Auditory Discrimination Test

• Purdue Pegboard Test

• Bruininks-Oseretsky Test of Motor Proficiency

• the most famous one, the Bender Visual-Motor Gestalt Test

Verbal fluency and fluency in writing

Tests of Verbal Functioning

__ and __are sometimes affected by injury to the brain

Tests of Verbal Functioning

Example tests are:

• Controlled Word Association Test

• Reitan-Indiana Aphasia Screening Test

no one model

Tests of Memory

Different models of memory compete for recognition in the scientific community, and __ has garnered universal acceptance

Tests of Memory

Example tests are:

• California Verbal Learning Test – II

• Wechsler Memory Scale

• Seguin-Goddard Formboard.