Chapter 14

PSYC 385 Psychological Test - Fall 2025 Study Notes

Outline of Topics

  • Important terms in neuropsychological assessment

  • Nervous system and behavior

  • Neuropsychological evaluation

  • Interview

  • Mental status examination

  • Executive functioning

  • Intellectual, verbal, perceptual, and motor abilities

  • Memory

  • Neuropsychological test batteries

  • Other methods of neuropsychological assessment

  • Brain structure and activity

Learning Objectives

  • Understand the primary goals and objectives of neuropsychological assessment.

  • Become familiar with the basic functions of the nervous system and how these functions are evaluated.

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.

    • Formerly a specialty area within clinical psychology.

  • Neuropsychological assessment: the evaluation of brain and nervous system functioning as it relates to cognitive, emotional, and behavioral issues.

    • Subspecialty areas include:

    • Pediatric neuropsychology

    • Geriatric neuropsychology

    • Forensic neuropsychology

    • School neuropsychology

    • Other specialized fields.

The Nervous System and Behavior

  • Neuron: a nerve cell, the basic building block of the nervous system.

  • Central Nervous System (CNS): consists of the brain and spinal cord.

  • Peripheral Nervous System (PNS): the neurons that convey messages to and from the rest of the body.

    • Each cerebral hemisphere receives sensory information from the opposite side of the body and controls motor responses on the opposite side (known as contralateral control).

Nervous System Overview

  • Central Nervous System (CNS):

    • Composed of the brain and spinal cord.

  • Peripheral Nervous System (PNS):

    • Divided into:

    • Somatic Nervous System: Controls muscle movement.

    • Autonomic Nervous System:

      • Sympathetic Division: Mobilizes energy, e.g., fight or flight response.

      • Parasympathetic Division: Replenishes energy, e.g., salivation, digestion, etc.

      • Regulates smooth muscle (e.g., organs).

The Brain

  • The brain is protected by a bath of cerebrospinal fluid (CSF) and has the consistency of Jell-O, jelly, or warm butter.

  • Contains structures and systems responsible for:

    • Thinking

    • Reasoning

    • Learning

    • Memory

    • Breathing

    • Sleeping

    • Eating

    • Movement

    • Processing sensory information

    • Experiencing emotion.

Tools for Assessing Neurological Function

  • Researchers utilize tools and procedures, including:

    • MRI (Magnetic Resonance Imaging)

    • fMRI (Functional MRI)

    • PET (Positron Emission Tomography)

    • CT (Computed Tomography) imaging

    • Electrical or chemical stimulation

    • Surgical alterations

    • Laboratory testing

    • Field observation

    • Autopsies.

Neurological Assessment Components

  • Neurological damage and organicity:

    • Lesion: a pathological alteration of tissue that can result from injury, disease, or infection.

    • Lesions can be focal (localized) or diffuse (spread out).

    • Manifest in various behavioral symptoms.

    • Neurological damage: physical or functional impairment in the CNS leading to sensory, motor, cognitive, emotional, or related deficits.

    • Organicity: refers to brain damage of a physical or structural nature.

The Neuropsychological Evaluation

  • When is a neuropsychological evaluation indicated?

    • Patients are often referred by other medical professionals when neurological problems are suspected.

    • A battery of tests is typically conducted, including intelligence tests, personality assessments, and perceptual-motor/memory tests.

    • If signs of neurological issues or history of head trauma are found, further evaluation is recommended.

Conditions Prompting Referral for Evaluation

  • Brain injury from:

    • Stroke

    • Traumatic brain injury (TBI)

    • Concussion

    • Infection

  • Possible reasons for referral include:

    • Differential diagnosis between brain injury and psychiatric disorders (e.g., depression).

    • Assessment of current functioning compared to premorbid levels.

    • Monitoring treatment progress.

  • Other conditions:

    • Epilepsy, hydrocephaly, or neurological conditions to assess cognitive deterioration.

    • Alzheimer's disease and other forms of dementia.

    • Problems with attention and learning, leading to intervention plans.

    • Significant changes in sensory, motor, or cognitive functioning for determining functional vs. organic deficits.

Signs of Neurological Deficits

  • Hard signs: Concrete indicators of neurological deficits (e.g., cranial nerve damage evident through neuroimaging).

  • Soft signs: Suggestive but not definitive indicators of neurological deficits (e.g., difficulty accurately copying a stimulus figure).

General Elements of Evaluation

  • The objective is to infer structural and functional characteristics of the brain based on the individual's behavior in defined contexts (Benton, 1994, p. 1).

  • Evaluation involves:

    • Taking into consideration the referral question, patient capabilities, and records.

    • Ensuring proper assessment tools are used.

    • Adaptation of tests may be necessary if deficits are identified.

    • Typically includes patient history, mental status exams, and test administration.

Patient History

  • Important components include:

    • Medical history of patient and family.

    • Developmental milestones.

    • Psychosocial history (educational achievements, intelligence, personality traits, etc.).

    • Details of disturbances in sense, muscle control, speech, and any changes throughout time.

Interviewing Process

  • Structured interviews and rating forms assist in screening and further evaluation, focusing on key areas.

    • Example tools include the Mini-Mental State Exam (MMSE).

Physical Examination

  • A physical exam assesses various aspects (appearance, muscle tone, reflexes) but does not replace a medical examination.

Tests of Cognitive Functioning

  • General intellectual ability tests: commonly include Wechsler tests, which have diverse tasks to identify deficits through response patterns.

  • Abstract ability tests: assess the capacity for verbal abstraction (e.g., Wechsler Similarities Subtest, proverbs).

    • Nonverbal object sorting tasks are also used for nonverbal abstraction skills.

Tests of Executive Function

  • Executive function: encompasses abilities like organizing, planning, cognitive flexibility, and inhibition of impulses. Functions are associated primarily with the frontal and prefrontal lobes.

    • Tests include the Tower of Hanoi, mazes, and the Clock-drawing test (CDT).

  • Trail-making item: assesses multiple skills, including visuo-perceptual skills and working memory.

  • Field-of-search items: require scanning a stimulus field to identify matches.

Tests of Motor and Perceptual Function

  • Evaluations of perceptual and motor capabilities include:

    • Perceptual tests for aspects of visual processing.

    • Motor tests for physical abilities and control.

    • Perceptual-motor integration tests.

    • Specific tools and tests include jigsaw puzzles, color blindness tests, auditory discrimination, and visual-motor gestalt assessments.

Tests of Verbal Functioning

  • Aphasia: loss of ability to use spoken or written language due to neurological deficits.

    • The Controlled Word Association Test measures verbal fluency.

    • The Reitan-Indiana Aphasia Screening Test identifies symptoms characteristic of aphasia.

Tests of Memory

  • Long-term memory:

    • Procedural memory: skills (e.g., riding a bicycle).

    • Declarative memory: factual memory with two components:

    • Semantic memory: facts.

    • Episodic memory: context-specific facts.

  • Widely used tests include the California Verbal Learning Test-II (CVLT-II), Wechsler Memory Scale (WMS-IV), and Seguin-Goddard Formboard.

Neuropsychological Test Batteries

  • A neuropsychologist administers either a fixed or flexible battery of tests for clinical study.

    • A fixed battery provides a standard sample of neuropsychological functioning:

    • Halstead-Reitan Neuropsychological Battery: widely used, requiring extensive administration time and a skilled evaluator. It provides the Halstead Impairment Index for assessing impairment.

    • Luria-Nebraska Neuropsychological Battery (LNNB): assesses cognitive processes in less time while providing critical data regarding impairment.

    • A flexible battery tailors tests to the unique aspects relevant to the patient's problem, but may lead to overlapping assessments.

Other Tools and Innovations in Neuropsychological Assessment

  • Neuropsychologists must accommodate patients who are vision or hearing impaired or those with other disabilities.

  • Advances in neuropsychology are significantly attributed to high technology and collaboration with medical professionals.

    • Technology includes MRI, fMRI, CT, PET, EMG, EEG, etc.

Brain Structure and Measurements

  • Measurement Techniques:

    • Computed tomography (CT) scans utilize X-ray imaging techniques to visualize brain structures.

    • Magnetic resonance imaging (MRI) employs magnets and radio waves for detailed brain imaging, capturing relative size, weight, and cellular quantity.

Brain Activity Assessment Methods

  • Various methods assess brain activity, including:

    • Cortical Stimulation: involves stimulating parts of the brain and having subjects report changes.

    • Evoked Potentials (EP): measures brain electrical activity in response to sensory stimuli.

    • Transcranial Direct Current Stimulation (TDCS): applies low voltage currents via electrodes on the scalp.

    • Positron Emission Tomography (PET): uses a radioactive glucose-like substance to assess metabolic activity, identifying active brain regions.

    • Electroencephalogram (EEG): detects electrical activity through electrodes placed on the scalp; applicable in severe conditions.

    • fMRI: traces blood oxygen levels over time, indicating active brain regions.

Challenges in fMRI and Other Methods

  • fMRI limitations include:

    • Difficulty in pinpointing specific firing areas.

    • Delay of about 2 seconds in blood oxygen response.

    • Time-consuming with small sample sizes which can bias results.

  • Transcranial Magnetic Stimulation (TMS): can either impair or enhance neuronal function, simulating a brain lesion.

Interpretation of Responses to Stimuli

  • The response to certain stimuli may indicate:

    • The area could be central for specific functions or characteristics.

    • Other areas could also be equally important or have facilitated activation through disinhibition.

    • A response implies necessity but not sufficiency for function; thus, other regions may be required for complete activity.

    • Increased glucose utilization in areas (as measured by PET) may indicate higher neuronal activity or inefficiency requiring more glucose.