Psychological - Lecture 10 - Neuropsychological Assessment (DN)
The two main fields of neuropsychology are Experimental Neuropsychology, which studies brain-behavior relationships through research, and Clinical Neuropsychology, which applies this knowledge to assess and treat individuals with brain injuries or neurological disorders.
What are the two fields of Neuropsychology?
Experimental Neuropsychology
Clinical Neuropsychology
Key Terms
What are the two fields of Neuropsychology?
Experimental Neuropsychology
Clinical Neuropsychology
What is the focus of Experimental Neuropsychology?
the “normal” brain
Method: animal & human models (e.g., lesions)
What is the focus of Clinical Neuropsychology?
“dysfunction” - particularly CNS dysfunction &
its impact on behaviour & quality of life
What are the two main areas of clinical neuropsychology
Assessment
Rehabilitation
What is the (NAN, 2001) definition of a Clinical Neuropsychologist?
8:00
professional within the field of psychology
special expertise in applied science of the brain-behaviour relationships
9:50
What is the difference between treatment & rehabilitation in clinical neuropsychology?
10:50
Treatment engages some technique applied to a client
Rehabilitation applies a dynamic interaction between patient, clinician, fam...
Related Flashcard Decks
Study Tips
- Press F to enter focus mode for distraction-free studying
- Review cards regularly to improve retention
- Try to recall the answer before flipping the card
- Share this deck with friends to study together
| Term | Definition |
|---|---|
What are the two fields of Neuropsychology? |
|
What is the focus of Experimental Neuropsychology? |
Method: animal & human models (e.g., lesions) |
What is the focus of Clinical Neuropsychology? |
|
What are the two main areas of clinical neuropsychology | Assessment Rehabilitation |
What is the (NAN, 2001) definition of a Clinical Neuropsychologist? | 8:00 professional within the field of psychology special expertise in applied science of the brain-behaviour relationships 9:50 they use this knowledge to assess, diagnose, treat &/or rehabilitate patients with neurological, medical, neurodevelopmental & psychiatric conditions as well as other cognitive & learning disorders |
What is the difference between treatment & rehabilitation in clinical neuropsychology? | 10:50 Treatment engages some technique applied to a client Rehabilitation applies a dynamic interaction between patient, clinician, family & community resources to achieve maximum possible recovery (we know that most of CNS will not fully recover) but need to work to maximum possible recovery to improve client’s daily life |
What are the 4 areas of definition required by the American Psych Assoc for a discipline to be recognised? | Type of Problem Populations Settings Services 15:35 |
What type of problems would a Clinical Neuropsychologist attend to? | characterisation of impairment differential diagnosis e.g., between dementia & other conditions measurement of change preliminary baseline measurement e.g., Parkinsons disease to track change applicable to every dysfunction that can be detected early (huntingtons, MS) prediction of functional outcomes e.g., can this person continue to work / drive safely etc) planning rehabilitation rehabilitation 16:05 |
What populations do Clinical Neuropsychologists work with? | Neurological brain injury Psychiatric depression, OCD, schizophrenia General medical & surgical vascular conditions impacting brain Professional sports (brain trauma, post concussional syndrome), occupational (exposed to neurotoxic agents) Children (learning disabilities, developmental disorders) 22:45 |
What settings do Clinical Neuropsychologists work in? | Hospitals Clinics Forensic Private Practise 25:35 |
What services can a Clinical Neuropsychologist provide? | Neuropsychological Assessment Cognitive remediation & intervention Neuropsychological rehabilitation Psychological therapies (for brain dysfunction) e.g., personality problems resulting from brain injury may require specific therapies Counselling to Public Agencies, Private Companies, Educational Centres 25:50 |
What proportion of a Clinical Neuropsychologist’s time is spent in assessment? | 40% |
How do current views of Neuropsychological Assessment differ from old views? | Old Views - relevance to current views locate the lesion - other techniques are better equipped for this (e.g., brain imaging) current priority is to characterise cognitive status determine organicity - do not distinguish between organic & non-organic (psychological) current view is that it is always organic & always psychological provide a reasoned account of cognitive strengths & weaknesses neurological or psychiatric diagnosis - this is for a neurologist or psychiatrist role is to work out how neuropsych system works and what is not working well determine functional (everyday) impact provide a neuropsychological diagnosis 27:25 |
What is the first question one should ask before performing a Neuropsychological Assessment? | Why is this assessment necessary |
What are the two approaches to Neuropsychological Assessment? | Fixed Battery, Pattern Analysis Flexible Approach, Hypothesis Testing assess only particular parts of system that you think are causing the problem |
How does the Fixed Battery differ from the Flexible Approach to Assessment? | Fixed Battery Quantitave gives you numbers - interpreted relative to norms Outcome Focussed scores/performance Matrix Vision Comprehensive Flexible Approach Mixed Quantitative/Qualitative Process Focussed why did the client achieve this outcome, what compensatory processes, what could he have done differently Modular Vision assumes certain systems of brain are specific to certain functions isolated on other systems of the brain so only focus on module which is dysfunctional Hypothesis-driven |
What are the advantages of the Fixed Battery approach to Neuropsychological Assessment? | Systematic always done the same way Comprehensive addresses every possible cognitive determinant Objective Interpretation scores can be trasformed into deficits or strengths Easy to train Easy to replicate 37:15 |
What are the advantages of the flexible approach to Neuropsychological Assessment? | Patient-tailored individuality of each case Focus on relevant domains not whole system Process (WHY) emphasis rather than outcome (WHAT) Time efficient 38:00 |
What are the disadvantages of the Fixed Battery Flexible Approach | Disadvantages of Fixed Battery time consuming could take 6-10 hours just for administration of instruments relies on availability of quality norms this is because reliance is on the outcomes provides reference framework for interpretation of scores Flexible Approach Susceptible to bias hypothesis may be wrong clinician may be misled by certain factors could mistakenly exclude vital points e.g., referall from lawyer - could bias you by adding relevance to some symptoms Relies on training/experience 38:35 |
How do you determine which assessment approach is better? | It depends on the referral question 42:05 |
What are some of the most frequent referral questions? | diagnosis - 70% rehabilitation/treatment planning - 48.3% forensic - 31.8% educational planning - 29.6% capacity to work assessment - 27.9% establish baseline function for future testing - 24.3% assess capacity for independent living - 19.7% pre- and post-medical intervention - 9.6% localisation of lesion 2.7% source Rabin et. al., (2005) 42:30 |
How did the flexible approach originally come about? | in the diagnosis of certain language disorders it was established that using a relatively small number of tests language disorders e.g., aphasia could be accurately diagnosed |
Which assessment approach is better in the following scenario: Fixed or Flexible? Intellectual disability determination | Fixed as don’t want to miss anything also has other implications need to measure against population norms findings also need to be replicable as other professionals will likely be assessing |
Which assessment approach is better for this scenario: Fixed or Flexible? Diagnosis of acquired language deficits | Flexible very specific referral question posterior parts of brain are more modular perceptual, language, motor is probably ok to do flexible wheras general cognitive ability or memory etc would need Fixed |
Which assessment approach is better in the following scenario: Fixed or Flexible? Forensic determination | Fixed Replicability Many professionals involved Court - challenged, needs to be backed up by systematic assessment |
Which assessment approach is better in the following scenario: Fixed or Flexible? Characterisation of a football players deficits post concussion | Fixed in sports concussion brain moves a lot - damage may be away from injury site best to go broad, so as not to miss anything 51:50 |
Which assessment approach is better in the following scenario: Fixed or Flexible? Prognostic assessment of a recently diagnosed multiple sclerosis patient | Flexible already have a diagnosis know what typically occurs in MS 53:20 |
Which approach do professionals use? Fixed, Purely Flexible, or Flexible (combination of both) | Most people use a combination of approaches 54: 30 |
What are the four steps of a combination flexible battery? | An intial "fixed" set of attempts to cover all relevant domains (i.e., cover most of cognitive system) to develop broad quantitative profile Develop hypothesis Select specific instruments to examine hypothesis Interpretation or Reiteration 54:45 |
What are the four phases of a Neuropsychological Assessment? | Phase 1 - Interview Phase 2 - Selection of Instruments Phase 3 - Administration of Instruments Phase 4 - Interpretation of the whole assessment 56:25 |
What happens in Phase 1 of the Neurolopsychological Assessment? | Interview Clarify the Referral Question (this should be done before the interview) Medical History via patient, relatives Developmental Milestones School/Occupational History Psychosocial History Symptoms: evolution & coping 56:35 |
What happens in Phase 2 of the Neuropsychological Assessment? | Selection of Instruments based on the: referral question selected approach information collected at the interview (phase 1) |
What happens in Phase 3 of the Neuropsychological Assessment? | Administration of Instruments Neuropsychological Tests Personality/Mood Scales Behavioural Trials Life-log |
What happens in Phase 4 of the Neuropsychological Assessment? | Interpretation of the whole assessment History analysis Observations Test scores Qualitative observations Estimated impact Feedback is ongoing, not just at the end |
What type of information do neuropsychologists use in assessments? | Medical/psychiatric history Neuropsychological test data Referral source Psychsocial history Mood & affect measures Developmental history Current social supports Objective personality tests Mental status exam Significant other interview Environmental demand charcteristics Behavioural assessments School records Functional Assessments Work records Projective personality tests source: Rabin et al., (2005) 58: 50 |
Why would it be important to include school & work records in a neuropsychological examination? | Important to understand how the patient was before the dysfunction e.g., in order to differentiate lesion related injury from pre-morbid condition |
Which three interviews are important in a Neuropsychological assessment? | Patient Relative (significant other) Both together 1:01:05 |
What should be covererd in the interview with patient? | create rapport - trust, empathy will get more accurate information from them comprehensive history developmental medical vocational social helps to understand how the brain works in different situations Allow patient directed (idiosyncratic) description of symptoms current, evolution, coping Attention to Potential Gains e.g., financial, legal, emotional (attention) 1:01:50 |
What should be covered in the interview with a significant other/relative? | Double check history, symptoms Enquire about more interpersonal aspects e.g., husband, wife, child - how is the patient engaging socially affect, empathy, communication etc Enquire about blind spots 1:04:02 |
What should be covered in the patient/relative joint interview? | Observe interactions how the relative treats patient (e.g., like a child, or harshly) Gently confront inconsistencies Request additional information Outline the assessment plan 1:04:50 |
What should be considered when selecting instruments | Always: Adapt instrument to referral question (relevant, comprehensive) patient status (floor, ceiling) expected prognosis (repeated testing requires test that allow for this) Norms (e.g., Cultural - American vs. Russian norms - fast vs. slow accurate completion) Reliability Construct Validity Be aware of the test limitations - there is no pure Neuropsychological test Depending on the referral question: Sensitivity vs. Specificity ecological validity: Veridicality vs. Verisimiltude Forensic Cases: Attention to base rates, predictive value Select replicable tests Include malingering tests 1:07:05 |
Which aspects of assessment tests should be prioritised in the following case: Neurology Service referral for differential diagnosis between Mild Cognitive Impairment vs. Dementia | Need test that will distinguish between the two Weigh up sensitivity & specificity 1:11:35 |
Which aspects of assessment tests should be prioritised in the following case: Hospital HR referral: Can an employee (surgeon) go back to a previous position after a stroke? | need to consider ecological value of test need to predict how the surgeon will perform the type of tasks normally involved in this position 1:12:25 |
Which aspects of assessment tests should be prioritised in the following case: Self-referral: Strong memory complaints, but no neuroimaging/biomarker evidence | Prioritize subjective memory assessments and tests sensitive to subtle cognitive changes, as well as evaluating psychological factors like anxiety or depression. |
Which aspects of assessment tests should be prioritised in the following case: Self-referral: Recently diagnosed MS client, requesting working hours reduction from the employer | Focus on functional cognitive assessments and work-related abilities to support the client’s request for accommodations at work. |
What instruments are available for Neuropsychological Assessments? | General batteries Domain-specific batteries Disorder-specific batteries Setting-specific batteries 1:13:05 |
What are some general batteries | WAIS can be interpreted from a Neuropsych perspective Halstead-Reitan been used extensively as fixed battery CANTAB Luria-Nebraska |
What are the subtests of the Halstead-Reitan Battery? (fixed battery) | Category Tactual Performance Rhythm Speech sounds perception Finger-tapping Time sense Other tests included are - Trail Making Test, Strength of Grip Test, Miles ABC Test of Ocular Dominance, WAIS, MMPI, Aphasia screening p.560 Text - Table 15-7 |
What is the Luria-Nebraska Neuropsychological Battery? | a fixed battery LNNB takes about 1/3 of the time of Halstead-Reitan contains clinical scales which assess cognitive process & functions Analysis of scores leads to judgement on whether impairment exists if so which part of the brain is affected p.559 |
What is the CANTAB? | Cambridge Neuropsychological Test Automated Battery computer-based cognitive assessment battery administered using a touch screen computer consists of 22 tests examines various areas of cognitive function general memory and learning, working memory and executive function visual memory attention and reaction time (RT) semantic/verbal memory decision making and response control Warning: this slide is taken from WIKI (couldn't find in text) |
What are some domain specific batteries? | McQuarrie (Motor) Boston Diagnostic Aphasia Examination Wechsler Memory Scale Delis-Kaplan Executive Function Systems |
What are some other test batteries? I think these are 'domain specific'??? check | the Neurosensory Centre Comprehensive Examination of Aphasia (NCCEA) focus: communication deficit the Montreal Neurological Institute Battery helps locate specific kinds of lesions the Southern California Sensory Integration Tests assess sensory-integrative & motor functioning in children 4-9yrs the Severe Impairment Battery (SIB) used with severley impaired who may perform near the floor of other tests the Cognitive Behavioural Driver's Inventory determines whether brain damaged individuals are capable of driving a car p.561 - text |
What are some disorder-specific batteries? | MATRICS Consensus Cognitive Battery Schizophrenia CAPSIT Protocol Parkinsons Disease |
What are some setting-specific batteries? | Sports Concussion Battery Military |
What are some of the behaviours/functions you may need to test in a Neuropsychological assessment? | 0-3 yrs milestones IQ or Academic Achievement Test what are abilites required for different courses etc Information input & output (Perceptual/Motor) Language Attention Memory Executive Functions Social Cognition empathy, understnading humour etc. Personality Everyfay functioning Effort/Malingering 1:17:25 |
How is Perceptual/Motor ability assessed & what are the relevant tests? | Visual Perception Visual Discrimination Test Judgement of Line Orientation Test Visual Integration Hooper Visual Organisation Test Visual Construction Rey Complex Figure-Copy Clock Drawing Bender Visual-Motor Gestalt Test Motor Speed Finger Tapping Motor Dexterity Grooved Pegboard Tactual Performance Test 1:19:25 |
How is Language ability assessed & what are the relevant tests? | Perception distinguish between sound, phonemic. lexical levels Comprehension rule following test Production free speech analysis Repetition Reading/Writing Syntax verbs, planning/sequencing some times related to executive function Semantics access, concepts also relatd to executive function 1:19:50 |
How is Memory assessed & what are the relevant tests? | Episodic Memory Verbal learning & memory: Word lists (15-16 words) Learning Slope/Encoding (5 trials) hort-term after interference memory (3 mins) Long-term memory (20-30 mins) Recognition (Recollection/Familiarity) Verbal forgetting: Selective Reminding Test 5-trial word list subsequent presentations (2,3,4,5) dont repeat previously learned words Visual Memory: Rey Complex (but watch perceptual/motor) Continuous Visual Memory Test Semantic memory Verbal Fluency by Category Logical memory Gist from passages, stories Procedural memory (HM case study) Repeated drawing accuracy Meta-memory 120:55 |
Which kind of memory do Neuropsychologists often refer to as 'mental time travel'? | Episodic Memory (which is a form of declarative memory) 1:23:20 |
……………. memory decline is s goof predictor of trouble with daily function? | Episodic 1:23:35 |
What are the different phases of a memory test? | using word lists Learning Phase: Learning Slope/Encoding (5 trials) Short-term after interference memory (3 mins) Long-term memory (20-30 mins) Recognition (Recollection/Familiarity) 1:23:45 |
What are the different kinds of memory problems? | Learning Encoding Recovering Forgetting (Degradation of information) 125:45 |
Which two kinds of memory can be declared? | Episodic & Semantic |
What is a visual memory test? | Rey Complex Test Abstract picture - cannot use things that can be associated with words or semantics, so they are actually remembering what they see asked to copy it after 3 mins > free recall after 30mins > delayed free recall 4. |
What are the average number of elements recalled in the Rey Complex visual Memory test for immediate recall delayed recall | 12-14 elements in immediate recall 10-12 elements in delayed recall 1:28:20 |
How can the type of memory problem be examined? | by comparing Immediate, Delayed & Recognition Phase scores e.g., low scores on immediate & delayed, but high score on recognition may suggest the problem is with memory retrieval, not encoding or storage executive processes e.g., gradual decline from immediate, to delayed, to recognition (information is vanishing with time, forgetting) could suggest degradation of temporal lobe 130:25 |
How is Attention assessed & what are the relevant tests? | complex to assess Energising, Focus, Orientation Reaction time based tasks Visual/Auditory discrimination Matching familiar figures Seashore Rhythm Test Attentional Span Digits then more complex which also involve executive function/control Sustained Attention Continous Performance Test (CPT) Cancellation tests Selective Attention Stroop Divided Attention - alternate PASAT 1:31:30 |
What aspect of brain function is always affected by brain injury? | Attention 1:34:15 |
How is Executive Function assessed & what are the relevant tests? | Inferring Similarities Proverbs 20 questions Answer: Working Memory Letter Number Sequencing N-back Self-Ordered Pointing Response Inhibition Stroop Hayling Sentence Completion Stop-Signal Planning Tower of Hanoi Mazes, Picture Arrangement Shifting Wisconsin Card Sorting Test Trail Making Test Category Test Decision-making Iowa Gambling Task Cambridge Gamble Task 1:34:40 |
What do the following tests assess? Similarities Proverbs 20 questions | Executive function specifically 'Inferring' |
What do the following tests assess? Letter Number Sequencing N-back Self-Ordered Pointing | Executive function specifically 'Working Memory' |
What do the following tests assess? Stroop Hayling Sentence Completion Stop-Signal | Executive function specifically 'Response Inhibition' |
What do the following tests assess? Tower of Hanoi Mazes, Picture Arrangement | Executive function specifically 'Planning' |
What do the following tests assess? Wisconsin Card Sorting Test Trail Making Test Category Test | Executive Function specifically 'Shifting' |
What do the following tests assess? Iowa Gambling Task Cambridge Gamble Task | Executive Function specifically Decision Making |
What is the "no pure test" problem | no single executive function test is a pure measure of any single function i.e., is measuring a tiny portion od each of the executive domains at the same time e.g., TMT is measuring 'shifting' or flexibility but in order to do this you must first 'inhibit' immediate tendency to go from 1 to 2 or A to B e.g., Nback is measuring 'working memory' or updating but will involve 'shifting' e.g., Tower of Hanoi is measuring 'planning' but engages 'working memory' (to project number of movements), 'inhibition' (tendency to just move), 'flexibility' 1:37:40 |
How is Social Cognition relevant to Neuropsychological Assessment | Most info comes from triangle of face (eyes, nose, mouth) Emotion recognition Eyes test Empathy Theory of mind Faux Pas Moral Dilemmas low conflict vs. high conflict (analyse what the style of people) some people have a deontological approach some have a utilitarian, concrete thinking approach (stole motor bike coz keys were there) Affective Prosody Perception Humour Processing |
Which Personality test are used in Neurological Assessment? | General personality tests MMPI, MCMI Projective tests TAT helps access inner experience of brain injured patients Specific personality change scales for brain dysfunction Iowa Scales of Personality Change BRIEF FrSBe: Frontal Systems Behaviour Scale (1:45:00) Apathy Disinhibition Executive Dysfunction |
What types of tests of everyday behaviour (i.e.the Ecological Approach) may be used in a Neuropsychological Assessment? | Rivermead Behavioural Memory Test Test of Everyday Attention Behavioural Assessment of the Dysexecutive System Poker cards N-back Key Search (box - draw best strategy to find the keys) Zoo Map (plan a visit to the zoo, following social rules) Multitasking Clinic-based - Hotel Task (like a real-life job, concierge in hotel) Outside clinic - Multiple Errands Test |
Why is the Ecological approach so valuable to Neuropsychological Assessment? | Neuropsychology so often tries to predict daily life using tests that are very structured and artificial Ecological approach addresses this issue by utilising real life situations |
What are some important aspects of test administration? | optimise patient/client performance minimise performance anxiety hide tools e.g., timer maintain rapport, alertness provide clear guidelines order is important (balance difficult items, with timing etc) stick to manual instructions |
What are some important aspects of Interpretation? | If Quantitative - must have good norms Best way is to Integrate all sources of information Articulate response to the referral question Communicate results of the assessment clearly to the patient (verbal, report) |