14- Neuropsychological Assessment

neurology

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

neuropsychology

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

neuropsychological assessment

defined as the evaluation of brain and nervous system functioning as it relates to behavior.

behavioral neurology

subspecialty within the medical specialty of neurology that also focuses on brain–behavior relationships (with more biochemical and less behavioral emphasis)

neurotology

branch of medicine that focuses on problems related to hearing, balance, and facial nerves.

contralateral control

Each of 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

neurological damage

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

lesion

pathological alteration of tissue, such

as that which could result from injury or infection

focal

lesion relatively circumscribed at one site

diffuse

lesion scattered at various sites

neurological damage

most inclusive term because it covers not only damage to the brain but also damage to the spinal cord and to all the components of the peripheral nervous system

brain damage

general reference to any physical or functional impairment in the central nervous

Kurt Goldstein

The use of the term organicity derives from the post–World War I research of the German neurologist

organic brain syndrome/ organicity

Goldstein and his colleagues developed psychological tests that tapped these factors and were designed to help in the diagnosis of ____ for short. In general, the tests included tasks designed to evaluate testtakers’ shortterm memory and ability to abstract.

hard sign

defined as an indicator of definite neurological deficit. Abnormal reflex performance is an example of a hard sign.

soft sign

is an indicator that is merely suggestive of neurological deficit. One example is an apparent inability to accurately copy a stimulus figure when attempting to draw it

objective of neuropsycholoigcal evaluation

“to draw inferences about the structural and functional characteristics of a person’s brain by evaluating an individual’s behavior in defined stimulus-response situations”

• History taking, the case history, and case studies

• Interview

• neuropsychological mental status examination

general elements of a neuropsychological evaluation

Short Portable Mental Status Questionnaire

a Neuropsychological screening device completed by an assessor

Neuropsychological Impairment Scale

a Neuropsychological screening device completed by self-report

Mini-Mental State Exam

has a very long history as a clinical and research tool used to screen for cognitive impairment.

7 Minute Screen,

structured interview that was developed to help identify patients

with symptoms characteristic of Alzheimer’s diseas

neuropsychological mental status examination

overlaps the general 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 aspect of the neuropsychological examination

is designed to assess not only the functioning of the brain but also aspects of the functioning of the nerves, muscles, and other organs and systems.

walking-running-skipping

If the examiner has not had a chance to watch the patient walk for any distance, he or she may ask the patient to do so as part of the examination. We tend to take walking for granted, but neurologically speaking it is a highly complex activity that involves proper integration of many varied components of the nervous system.

standing still/ Romberg test

The patient is asked to stand still with feet together, head erect, and eyes open. Whether patients have their arms extended straight out or at their sides and whether or not they are wearing shoes or other clothing will be a matter of the examiner’s preference.

Nose-finger-nose

The patient’s task is to touch her nose with the tip of her index finger, then touch the examiner’s finger, and then touch her own nose again.

assessing CN I (olfactory nerve)

Closing one nostril with a finger, the examiner places some odoriferous substance under the nostril being tested and asks

whether the smell is perceived. Subjects who perceive it are next asked to identify it. Failure to perceive an odor when

one is presented may indicate lesions of the olfactory nerve, a brain tumor, or other medical conditions. Of course, failure

may be due to other factors, such as oppositional tendencies on the part of the patient or intranasal disease, and such

factors must be ruled out as causal.

assessing CN II (optic nerve)

Assessment of the intactness of the second cranial nerve is a highly complicated procedure, for this is a sensory nerve with

functions related to visual acuity and peripheral vision. A Snellen eye chart is one of the tools used by the physician in

assessing optic nerve function. If the subject at a distance of 20 feet from the chart is able to read the small numbers or

letters in the line labeled “20,” then the subject is said to have 20/20 vision in the eye being tested. This is only a standard.

Although many persons can read only the larger print at higher numbers on the chart (or, a person who reads the letters on

line “40” of the chart would be said to have a distance vision of 20/40), some persons have better than 20/20 vision. An

individual who could read the line labeled “11” on the Snellen eye chart would be said to have 20/11 vision.

assessing CN V (trigeminal nerve)

The trigeminal nerve supplies sensory information from the face, and it supplies motor information to and from the muscles

involved in chewing. Information regarding the functioning of this nerve is examined by the use of tests for facial pain

(pinpricks are made by the physician), facial sensitivity to different temperatures, and other sensations. Another part of the

examination entails having the subject clamp his or her jaw shut. The physician will then feel and inspect the facial muscles

for weakness and other abnormalities.

assessing CN VIII (acoustic nerve)

The acoustic nerve has functions related to the sense of hearing and the sense of balance. Hearing is formally assessed with

an audiometer. More frequently, the routine assessment of hearing involves the use of a “dollar watch.” Provided the

examination room is quiet, an individual with normal hearing should be able to hear a dollar watch ticking at a distance of

about 40 inches from each ear (30 inches if the room is not very quiet). Other quick tests of hearing involve placing a

vibrating tuning fork on various portions of the skull. Individuals who complain of dizziness, vertigo, disturbances in

balance, and so forth may have their vestibular system examined by means of specific tests.

Parkinson’s disease (PD)

a progressive, neurological illness that may also have several nonmotor symptoms associated with it (ranging from depression to dementia

Ayurveda

age-old system of natural healing that is believed to have originated with the Vedic culture of India.

substantia nigra

PD results from cell loss in a specific area of the brain called the

idiopathic

the vast majority of diagnoses of PD are characterized

in medical jargon as ___ (of unknown origin)

Rapid eye movement sleep behavior disorder

condition characterized by an “acting out” of dreams with vocalizations or gestures.

dyskinesias

involuntary, jerking-type movements that may result from the long-term use of some of these PD medications.

deep brain stimulation

neurosurgical treatment for use with patients who have advanced PD. The procedure entails the surgical implantation of electrodes at specific sites in the brain

lewy bodies

are clusters of stuck-together proteins that have the effect of depleting available dopamine and other brain substances

lewy body dementia

results from the formation of a number of Lewy bodies in the brain stem and cerebral cortex that cause Parkinsonian-like symptoms, Alzheimer-like symptoms, and other symptoms of dementia.

DaTscan

entails the use of high-tech imaging equipment to visualize the substantia nigra and gauge the amount of dopamine present.

Wechsler tests

Tests of intellectual ability, particularly ____, occupy a prominent position among the diagnostic tools available to the neuropsychologist.

Pattern analysis

Because certain patterns of test response indicate particular deficits, the examiner looks beyond performance on individual tests to a study of the pattern of test scores, a process termed ___

Deterioration quotient

A number of researchers intent on developing a definitive sign of brain damage have devised various ratios and quotients based on patterns of subtest scores. David Wechsler himself referred to one such pattern, called a

Wechsler Similarities subtest

One traditional measure of verbal abstraction ability has been the ____, isolated from the age-appropriate version of the Wechsler intelligence scale.

Proverbs Test

an instrument specifically designed to test abstraction and related ability, contains a number of proverbs along with standardized administration instructions and normative data.

Object Sorting Test and Color-Form Sorting Test (Weigl’s Test)

both of which require testtakers to sort objects of different shapes and colors.

Wisconsin Card Sorting Test- 64 Card Version

requires the testtaker to sort a pack of 64 cards that contain different geometric figures printed in different colors.

Executive function

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

Tower of Hanoi

One test used to measure executive function is ___; It is set up by stacking the rings on one of the pegs, beginning with the largest-diameter ring, with no succeeding ring resting on a smaller one

Stanley D. Porteus

the 1930s, psychologist ___ became enamored with the potential for psychological assessment of the seemingly simple task of identifying the correct path in a maze and then tracing a line to the end point of that maze.

Porteus Maze Test

are used primarily as measures of executive function (

Clock-Drawing test (CDT)

the task in this test is for the patient to draw the face of a clock, usually with the hands of the clock indicating a particular time

Trail-making item

connect the circles in a logical way. This type of task is thought to tap many abilities,

including visuo-perceptual skills, working memory, and the ability to switch between tasks

field-of-search item

Shown a sample or target stimulus (usually some sort of shape or design), the testtaker must scan a field of various stimuli to match the sample

Boston Naming Test

example of a simple line drawing reminiscent of the type of item that appears in instruments such as the

confrontation naming

naming each stimulus presented

perceptual component

perceiving the visual features of the stimulus

semantic component

accessing the underlying conceptual representation or core meaning of whatever is pictured

lexical component

accessing and expressing the appropriate name

Picture absurdity item

The pictorial equivalent of a verbal absurdity item, the task here is to identify what is wrong or silly about the picture. It

Wechsler-type Comprehension items

this type of item can provide insight into the testtaker’s social comprehension and reasoning abilities.

Test of Executive Function in an Emergency (TEFE)

To help in the assessment of one’s capacity for independent living, a performance-based instrument called the

Test of Executive Function in an Emergency (TEFE)

was designed to specifically evaluate the ability of cognitively impaired patients to access assistance in the event of an emergency

perceptual test

is a general reference to any of many instruments and procedures used to evaluate varied aspects of sensory functioning, including aspects of sight, hearing, smell, touch, taste, and balance.

motor test

is a general reference to any of many instruments and procedures used to evaluate varied aspects of one’s ability and mobility, including the ability to move limbs, eyes, or other parts of the body.

perceptual-motor test

is a general reference to any of many instruments and procedures used to evaluate the integration or coordination of perceptual and motor abilities

Ishihara test

is used to screen for color blindness

Wepman Auditory Discrimination Test

This brief, easy-to-administer test requires that the examiner

read a list of 40 pairs of monosyllabic meaningful words (such as muss/much) pronounced with

lips covered (not muffled, please) by either a screen or a hand

Bruininks-Oseretsky Test of Motor Proficiency

A test designed to assess gross and fine motor skills is the

Purdue Pegboard Test

test designed to measure manual dexterity; Originally developed in the late 1940s as an aid in employee selection, the object is to insert pegs into holes using first one hand, then the other hand, and then both hands

Bender Visual-Motor Gestalt Test/ Bender Gestalt

Once widely used neuropsychological test test consisted of nine cards, on each of which was printed one design

Controlled Word Association Test

examiner says a letter of the alphabet and then it is the subject’s task to say as many words as he or she can think of that begin with that letter.

aphasia

refers to a loss of ability to express oneself or to understand spoken or written language because of some neurological deficit.

Reitan-Indiana Aphasia Screening Test (AST),

available in both a child and an adult form, contains a variety of tasks such as naming common objects, following verbal instructions, and writing familiar wor

Procedural memory

is memory for things like driving a car, making entries on a keyboard, or riding a bicycle.

declarative memory

memory of factual material—such

as the differences between procedural and declarative memory

semantic memory

strictly speaking, memory for facts.

episodic memory

memory for facts in a particular context or situation

California Verbal Learning Test–II

A widely used test of memory; The task is to repeat a list of words that are read by the examiner.

fourth edition of the Wechsler Memory Scale (WMS-IV)

the most recent revision of a brand of memory tests that was preceded by the WMS-III, the WMS-R, and the WMS.

fixed battery

Trained neuropsychologists may administer a prepackaged ___

flexible battery

consisting of an assortment of instruments hand-picked for some purpose relevant to the unique aspects of the patient and the presenting problem.

Fixed neuropsychological test batteries

are designed to comprehensively sample the

patient’s neuropsychological functioning

Halstead-Reitan Neuropsychological Battery

classic neuropsychological test battery among the many available for use by

researchers and clinicians is the

Manual for Administration of Neuropsychological Test Batteries for Adults and Children

the forerunner of the Halstead-Reitan

Neuropsychological Test Battery

Neurosensory Center Comprehensive Examination of Aphasia (NCCEA)

is a battery of tests that focuses on communication deficit

Montreal Neurological Institute Battery

particularly useful to trained neuropsychologists in locating specific kinds of lesions

Southern California Sensory Integration Tests

make up a battery designed to assess sensory-integrative and motor functioning in children 4 to 9 years of age

Severe Impairment Battery

A neuropsychological battery is designed for use with

severely impaired assessees who might otherwise perform at

or near the floor of existing tests.

dementia

is a neurological disorder characterized

by deficits in memory, judgment, ability to concentrate, and other cognitive abilities, with

associated changes in personality due to damage to, or disease of brain neurons