Neuropsychological Assessment: Differential Diagnosis, Confounding Factors, and Key Cognitive and Visual Considerations

What is differential diagnosis?

Identifying disorder labels that apply or do not apply to an individual based on evaluation of body structure and function.

What is a confounding factor?

Anything that could lead to invalid results, including aspects of a person's abilities, assessment tools, and the testing context.

List some examples of confounding factors.

Age, intelligence, literacy, education, vision, hearing, motor abilities, reading, writing.

Why is age not considered a diagnosis?

Old age corresponds to brain changes that may lead to symptoms but is not an explanation for impairment.

How does intelligence and education level affect assessments?

Below-average intelligence can influence the validity of assessments normed on average or higher intelligence.

What visual problems should be screened for in assessments?

Visual acuity deficits, visual field cuts, color vision deficits, ocular motor problems, and visual neglect.

What is visual neglect?

A condition where individuals are unaware of their neglect and may not report it, requiring screening.

How may individuals compensate for visual field deficits

Head movements

What are some methods for screening visual neglect?

Line bisection, line cancellation, letter cancellation, clock drawing, copying pictures, and reading aloud.

What issues can arise from hearing problems in assessments?

Hearing problems can affect communication and understanding, impacting assessment outcomes.

Hemi spatial neglect

neglect of one half of space and/or body

t/f: individuals with Hemispatial neglect tend to ignore nonvisual aspects of same hemispace

true

What is acquired alexia?

you once were able to read and you lost that ability (inability to read)

t/f: Acquired alexia is not a confound for assessments

F

dyshraphia

writing problems

t/f: consciousness is a state of present/not present

F: measured on a continuum

What are some signs of lack of awareness deficits?

Inability to accurately describe abilities and disabilities, poor self-prediction of task performance, and difficulty in error detection.

Anosognosia

A condition in which a person with an illness seems unaware of the existence of his or her illness.

How can you assess awareness of deficits?

Ask the person to describe their own abilities and compare, directly observe interactions, etc

How can executive function deficits impact assessments?

They can affect a person's ability to plan, organize, and execute tasks, leading to inaccurate assessment results.

t/f: memory problems can be sequalae of stroke or related to dementia (or both)

true

What are common symptoms of depression in individuals with neurogenic communication disorders?

Persistent sadness, frequent crying, feelings of helplessness, social withdrawal, and associated physical symptoms.

What is emotional lability?

Inconsistent emotional reactions that do not match the situation, often seen in individuals with brain injuries.

What should be done if there are concerns about a mood disorder?

Refer the patient to a psychologist or psychiatrist for further evaluation.

What role does anxiety play in neurogenic communication disorders?

Anxiety can manifest as ongoing worry, fear, restlessness, low energy, and poor concentration.

What is the significance of assessing awareness of deficits?

It helps to understand the individual's perception of their abilities and the potential impact on treatment.

What is the Stroke Aphasic Depression Questionnaire?

A commonly used rating scale to assess depression, which may be difficult for some patients with aphasia to complete.

How can pragmatic deficits affect communication?

Poor use of social language may make it seem that a person's receptive and expressive abilities are weaker than they actually are.

t/f: pragmatic deficits are closely tied to executive function abilities

true

What are some potential confounding factors to consider during language assessment?

Age, intelligence, visual and hearing problems, motor skills, emotional state, and cognitive abilities.

What is the impact of socioeconomic status (SES) on assessments?

SES is often tied to education and literacy levels, which can influence the validity of assessment results.