ch. 14 neuropsychological assessment

neuropsychological assessment

the evaluation of brain and nervous system functioning as it relates to behaviour

neurological damage

may take the form of lesion in the brain or any other site within the central or peripheral nervous system

lesion

a pathological alteration of tissue such as that which could result from injury or infection
- can be focal (specific location) or diffuse (more than one area)

brain damage

a general reference to any physical or functional impairment in the CNS that results in sensory, motor, cognitive, emotional, or related deficit

organicity

organic brain syndrome

hard sign

an indicator or definite neurological deficit
- e.g., cranial nerve damage as indicated by neuroimaging

soft sign

an indicator that is merely suggestive of neurological deficit
- e.g., an apparent inability to accurately copy a stimulus figure when attempting to draw it

general elements to neuropsychological evaluation

"to draw inferences about the structural and functional characteristics of a person's brain by evaluating an individual's behaviour in defined stimulus-response situations"
- evaluation will vary based on the nature of the referral questions, the capabilities of the patient, and the availability of records

neuropsychological mental status examination

administered for the purpose of evaluating neuropsychological functioning to delve more into specific areas of interest

mini-mental state exam

- most widely used mental status tool with the elderly
- assesses global cognitive functioning

mental status exam

appearance, behaviour, feelings, perception, judgment

behaviour rating scales

observations from persons familiar with the client

neuropsychological physical examination

a physical exam involves looking at the examinee's appearance including scalp and skull; size, strength, and tone of the muscle; and reflexes

parkinson's disease

progressive, neurological illness that may also have several non-motor symptoms associated with it (ranging from depression to dementia)

clock-drawing test (CDT)

a test to quickly screen for certain executive functions

wisconsin card sorting test

abstract thinking, ability to shift set

porteus maze test

measures planning and foresight

trail-making item

a task that is thought to tap many abilities, including visuo-spatial skills, working memory, and the ability ti switch between tasks

field-of-search items

the test taker must scan a field if various stimuli to match a sample
- useful in discovering visual scanning deficits

tests of perceptual, motor, and perceptual-motor function

- jigsaw puzzles tap perceptual-motor ability
- ishihara test (1964) helps screen for colour blindness
- SCAN-3 Tests for Auditory Processing Disorders
- Bruininks-Oseretsky test of Motor Proficiency
- Bender Visual-Motor Gestalt Test

tests of verbal function

- Controlled Word Association Test has the examinee recite as many words beginning with a particular letter as they can
- aphasia: loss of ability to express oneself or understand spoken or written language because of some neurological deficit
- Reitan-Indiana Aphasia Screening Test (AST) contains a variety of tasks such as naming common objects, following verbal instructions, and writing familiar words

tests of memory

- procedural memory
- declarative memory
- semantic memory episodic memory
- episodic memory
- implicit memory
- a widely used test of memory is the California Verbal Learning Test-Two (CVLT-2)
- Wechsler Memory Scale (WMS-4)
- Seguin-Goddard Formboard

neuropsychological test batteries

a neuropsychologist typically administers a battery of tests for clinical study based on the mental status examination, physical examination, and the case history data
- fixed battery
- flexible battery

flexible batter of tests

involves hand-picked instruments relevant to the unique aspects of the patient and the presenting problem

developing a plan for an assessment

- determining 1 or 2 questions (purpose)
- diagnosis; treatment; eligibility for services; life decision (Education, job, parenting plan)
- ethical considerations
- generating multiple hypotheses that need to be examined to address the question
- gathering data to test the hypotheses using a biopsychosocial approach
- keeping ethical issues in mind
- consent
- confidentiality

patient/client factors (threats to validity)

- retrospective recall
- possible biases in self-presentation

clinician factors (threats to validity)

- biases
- potential for scoring errors