Human Neuropsychology - Lecture 7: Neuropsychological Assessment

Neuropsychology

The study of the relationships between brain function and behavior.

Closed Head Injury

A traumatic brain injury (TBI) resulting from mechanical forces (impact or movement) that does not break or open the skull.

Biopsychosocial Model of Assessment

An assessment framework evaluating biological/neurocognitive factors (history of disease, addiction, family medical history), psychological factors (stressors and psychological issues), and socioenvironmental factors (living arrangements, relationships, finances).

Standardized Test Batteries

A set of neuropsychological tests with fixed criteria for organicity used to distinguish behavioral symptoms from those not directly related to brain pathology, exemplified by the Halstead-Reitan and Luria-Nebraska batteries.

Organicity

Atypical behavior that has an organic basis (arising directly from brain pathology).

Individualized Test Batteries

Neuropsychological assessment batteries tailored both to a patient's specific etiology and to the qualitative nature of their performance on each test, requiring specialized knowledge to administer and interpret (e.g., Luria's neurological approach).

Etiology

The root cause or triggering event of a disease.

Composite Test Batteries

A middle-ground assessment approach administered in a formalized way that may use comparison norms while simultaneously evaluating qualitative performance and the overall pattern of test results (e.g., the Boston Process Approach).

Rey Auditory Verbal Learning Test (RAVLT)

A verbal memory test that assesses learning and retention by having the patient listen to and repeatedly recall a standardized list of 15 words across trials.

Wisconsin Card Sorting Task (WCST)

A neuropsychological test assessing abstract reasoning, executive functioning, and cognitive flexibility, where patients sort cards according to an unspoken rule (shape, color, or number) based solely on correct/incorrect feedback until the rule changes without warning.

Boston Naming Test

A language assessment consisting of 60 line drawings of objects that patients are prompted to name, used to help identify anomic aphasia.

Clock Drawing Test

A screening tool where the patient draws an analog clock face as a circle with all numbers and places the hands to indicate a specific time (e.g., '10 past 11'), assessing visuospatial ability, dementia severity, and spatial neglect.

Stroop Task

A cognitive assessment developed by Stroop (1935) that evaluates selective attention and cognitive inhibition by instructing participants to name the ink color of printed color names while ignoring the conflicting word text.

Rey-Osterrieth Complex Figure

A neuropsychological test introduced by Rey and Osterrieth (1941) to evaluate visuospatial perception, construction, and visual memory by having the patient copy and later reproduce an intricate geometric design from memory.

Matrix reasoning test

Non-verbal cognitive assessment - patient presented with a grid of abstract shapes, symbols, or patterns with one missing piece.

Requires mental rotation

Sensitivity

The property of an assessment to correctly detect everyone with a disease or condition by maximizing hits and minimizing misses.

Specificity

The property of an assessment to correctly rule out healthy individuals without the disease or condition by maximizing correct rejections and minimizing false alarms.

Receiver Operating Characteristic (ROC) Curve

A plot of the True Positive Rate (Sensitivity) against the False Positive Rate ($1 - \text{Specificity}$) across varying decision thresholds, where the Area Under the Curve (AUC) measures overall diagnostic accuracy.

Validity

The extent to which an assessment accurately and truthfully measures the theoretical construct it claims to measure.

Reliability

The consistency and precision with which a test produces the same results across repeated administrations.

Testing Interval Requirement

The recommended practice of maintaining adequate intervals ($\ge 1\text{ year}$) between successive neuropsychological assessments to prevent invalid results caused by practice effects.

Malingering

The intentional production of false or grossly exaggerated physical or psychological symptoms motivated by external incentives, such as evading work, seeking financial compensation, evading prosecution, or obtaining drugs.

Symptom Validity Testing (SVT)

Formalized assessment techniques designed to measure whether an individual is putting forth genuine, good-faith effort during neuropsychological testing.

Forced Choice Digit Memory Test

A symptom validity test where patients view a multi-digit number and immediately choose it from a pair alongside a novel number; performance below $90\%$ is suspect because even severely amnestic patients perform near ceiling ($100\%$).

Test of Memory Malingering (ToMM)

A two-alternative forced-choice (2AFC) symptom validity test presenting 50 line drawings for $3\text{ seconds}$ each; because normal adults score near ceiling ($100\%$) and brain-damaged patients score $50\text{--}100\%$, performance below chance ($<50\%$) indicates intentional underperformance.

Goals of neuropsychological assessment

• Determine general level of functioning and localize any identifiable cerebral dysfunction

• Facilitate patient care and rehabilitation by measuring changes in function over time

• Describe mild disturbances in cognitive function that other studies have not clearly identified

• Identify unusual brain organization that may exist in people who are left-handed or who experienced childhood brain injury

• Support an abnormal EEG finding

• Demonstrate recovery of function following a brain injury

• Help the patient and their family expect realistic outcomes

Halstead-Reitan

Example of standardizes battery test

Evaluates brain and nervous system functioning in individuals 15+, detect the presence of brain damage or dysfunction, and help clinicians understand how brain deficits affect a person's thinking, perception, and behavior

Lucia-Nebraska test

Standardize battery test

Evaluate brain-behavior relationships and identify cognitive/neurological deficits; helps detect and locate brain damage, evaluate functional impairments, and differentiate brain injury from functional mental disorders (such as schizophrenia)

Lucia’s neurological approach

Example of individualized test

treats cognitive activity as complex functional systems distributed across the brain rather than localized strictly to static compartments

Benton’s neuropsychological investigation

Composite test batteries

evaluate cognitive, visuospatial, and motor deficits in brain-damaged patients

Boston Process Approach

Composite test battery

to evaluate brain damage, cognitive function, and neurological impairment

10 commonly tested categories

1. Abstract reasoning and conceptualizing (problem solving, executive functioning)

2. Attention ( selective, sustained, shifting, neglect)

3. Daily attention (toileting, dressing, eating)

4. Emotional and psychological distress ( depression, impulsivity)

5. Language (receptive and expressive speech, aphasia)

6. Memory (verbal, visual, working)

7. Motor (dexterity, strength, speed)

8. Orientation (awareness of place, time)

9. Sensation and perception (visual acuity, taste/smell, tactile)

10. Visuospatial (construction, routine finding, recognition)

Intelligence tests

important to obtain/provide baseline level of cognitive function prior to any injury/disease

often using Weschler tests (WISC IV)

Wechsler Intelligence Scale for Children IV

individually administered cognitive assessment tool used to evaluate intelligence and cognitive functioning of children and adolescents 6 years 0 months to 16 years 11month

10 core feature of assessment

1. Collaborative

2. Pre-treatment baseline is essential

3. Individual development history is considered

4. Acknowledge comorbidities (simultaneous issues/syndrome)

5. subject complains (patient and those close) are informative

6. results used to maximize potential ( educational/occupational)

7. Not everyone can/will engage with testing

8. limit based on design of test (intended used)

9. Adequate intervals (>= 1yr) btw assessment (avoid practice/testing effects)

10. patients are informed about process (transparency)