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Neuropsychological Assessment Reader & Articles Summary PSMNV-2
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Summary of all the chapters of the reader (1, 4, 5, 6 & 8) and articles for Neuropsychological Assessment PSMNV-2.
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Neuropsychological assessment
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Extensive Lecture summary from the course Diagnostics in Clinical Neuropsychology
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Summary literature for the course 'Diagnostics in Clinical Neuropsychology'of UL: fifth edition of the book Neuropsychological Assessment by Lezak, Howieson, Bigler, & Tranel
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Neuropsychological assessmentChapters 1, 4, 5, 6 & 8 of Neuropsychological Assessment by Lezak, Howieson, Bigler &
Tranel
Chapter 1 The practice of neuropsychological assessment
Clinical neuropsychology is an applied science concerned with the behavioral expression of
brain dysfunction.
- War damaged brains of soldiers WO1/2
- Clinical neurosciences
- Educational psychology (Binet, Spearman
- Measurement specialists (Raven’s progressive matrices, the Wechsler Intelligence
Scales, Wide Range Achievement Tests)
- Experimental studies of cognitive functions in both humans and other animals
The practice of neuropsychology calls for flexibility, curiosity, inventiveness, and empathy
even in the seemingly most routine situations.
EXAMINATION PURPOSES
1. Diagnosis; patient care.
Neuropsychological assessment can be useful for discriminating between psychiatric
and neurological symptoms, identifying a possible neurological disorder in a
nonpsychiatric patient, helping to distinguish between different neurological
conditions, and providing behavioral data for localizing the site of a lesion.
Neuropsychological assessment as a diagnostic tool has diminished while its
contributions to patient care and treatment and to understanding behavioral
phenomena and brain function have grown (because of neuroimaging techniques).
Even when the site and extent of a brain lesion have been shown on imaging, the
image will not identify the nature of residual behavioral strengths and the
accompanying deficits. Despite general similarities in the pattern of brain function
sites, these patterns will differ more or less between people.
Moreover, cognitive assessment can document mental abilities that are inconsistent
with anatomic findings.
The earliest detection of cognitive impairments during the prodrome as well as
conversion to Alzheimer’s disease often comes in neuropsychology assessment, as
well as Huntington’s disease.
2. Patient care and planning.
Precise descriptive information about cognitive an emotional status is essential for
careful management of many neurological disorders.
- Patients capacity of self-care, driving etc.
- Following the course of an illness
- Brain impaired patients must have factual information about their functioning to
understand themselves and set realistic goals.
- Perplexity= self-doubt, distrust of their experiences.
- Relieve the patient’s anxieties and confusion
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, 3. Treatment-1: treatment planning and remediation.
- Determining the most appropriate treatment for each rehabilitation candidate with
brain dysfunction.
- A current and centralized appraisal of patients’ neuropsychological status enables
these treatment specialists to maintain common goals and understanding of the
patient.
4. Treatment-2: treatment evaluation.
- Regarding its worth, cost-benefits.
5. Research.
The practical foundations of clinical neuropsychology are based to a large measure
on neuropsychological research. Studying the organization of brain activity and its
translation into behavior, development, standardization and evaluation.
6. Forensic neuropsychology.
Has this person sustained brain damage as a result of…? Or a description of the
subject’s neuropsychological status.
Usually a neuropsychological examination serves more than one purpose. Integral to all
neuropsychological assessment procedures is an evaluation of the patient’s needs and
circumstances from a psychological perspective that considers quality of life, emotional
status, and potential for social integration.
THE VALIDITY OF NEUROPSYCHOLOGICAL ASSESSMENT
Ecological validity is how well the neuropsychological assessment data reflect everyday
functioning or predict future behavior or behavioral outcomes, not always so good.
Chapter 4 The rationale of deficit measurement
One distinguishing characteristic of neuropsychological assessment is its emphasis on the
identification and measurement of psychological- cognitive and behavioral- deficits, for it is
in deficiencies and dysfunctional alterations of cognition, emotionality, and self-direction
and management that brain disorders are manifested behaviorally. Neuropsychological
assessment is also concerned with the documentation and description of preserved
functions- the patient’s behavioral competencies and strengths.
The assessment of psychological deficit has focused on cognitive impairment for a number of
reasons
- Some degree of cognitive impairment accompanies almost all brain dysfunction and
is a diagnostically significant feature of many neurological disorders
- Interfere most obviously with the patient’s capacity to function
- Psychologists are better able to measure cognitive activity than any other kind of
behavior
COMPARISON STANDARDS FOR DEFICIT MEASUREMENT
Normative comparison standards
The population average
The normative standard, or norm, for many measurable psychological functions and
characteristics is a score representing the average or median performance of some more or
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,less well-defined population. Population norms may be applicable to tests that are relatively
pure (and simple) measures of the function of interest.
Species-wide performance expectations
Many species-wide capacities, although not apparent at birth, are manifested relatively early
and similarly in all intact persons. For instance, capabilities for motor and visuomotor
control, basic perceptual discriminations like color, pattern and form, of pitch, tone,
loudness, and of orientation to personal and extrapersonal space.
For normally distributed functions and abilities for which the normative standard is an
average, only an individual comparison with prior functioning provides a meaningful basis
for assessing deficit.
Individual comparison standards
Individual comparison standards are called for whenever a psychological trait or function
that is normally distributed in the intact adult population is evaluated for change.
THE MEASURMENT OF DEFICIT
- Direct measure of deficit: deficit can be assessed directly when the behavior in
question can be compared against normative standards, it requires the availability of
premorbid test scores, school grades, or other relevant observational data.
- Indirect measure of deficit: the examiner compares the present performance with an
estimate of the patient’s original ability level. Historical and observational data are
obvious sources of information from which estimates of premorbid ability may be
drawn directly. The most techniques for indirect assessment of premorbid ability rely
on cognitive test scores, on extrapolation from current reading ability, on
demographic variables, or on some combination of these.
Mental ability test scores for estimating premorbid ability
A common feature of estimation techniques based on test scores is that the
premorbid ability level is estimated from the sores themselves. A vocabulary score
(Shipley Institute of Living Scale; SILS) was used often, as it is often retained in older
adults.
General Ability Index-Estimate (GAI-E): Matric Reasoning, with Vocabulary or
Informatics of the WAIS-3.
Word reading tests for estimating premorbid ability
National Adult Reading Test (NART): estimating the cognitive deterioration of
patients with diffusely dementing conditions.
North American Adult Reading Test (NAART)
American. National Adult Reading Test (ANART): more ethnically heterogenous
Wide Range Achievement Test-Word Reading (WRAT-READ).
Wechsler Test of Adult Reading (WTAR).
Correlations between these word reading tests and the criterion tests tend to be
directly related to education level.
Many elderly persons are limited in their ability for oral readings, so some examiners
have turned to word recognition tests.
Spot-the-Word (STW)
Lexical Orthographic Familiarity Test (LOFT)
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, Demographic variable formulas for estimating premorbid ability
Because of problems with word-reading, formulas were devised that used
demographic variables. Later, word recognition test scores were combined with
demographic variables.
For instance, The Oklahoma Premorbid Intelligence Estimation (OPIE)
In a critical comparison study, they found out that scores at the extremes of the IQ
range were most vulnerable to estimation errors.
THE BEST PERFORMANCE METOD
A simpler method utilizes test scores, other observations, historical data, and clinical
judgment. This is the best performance method, in which the level of the best performance-
whether it be the highest score or set of scores, nonscorable behavior not necessarily
observed in a formal testing situation, or evidence of premorbid achievement- serves as the
best estimate of premorbid ability.
Assumptions:
- Given reasonably normal conditions of physical and mental development, there is
one performance level that best represents each person’s cognitive abilities and skills
generally.
- By and large, persons who perform well in one are perform well in others; and the
converse also holds true
- Marked discrepancies between the levels at which a person performs different
cognitive functions or skills probably give evidence of disease, developmental
anomalies, cultural deprivation, emotional disturbance, or some other condition that
has interfered with the full expression of that person’s cognitive potential.
- Few persons consistently function at their maximum potential, for cognitive
effectiveness can be compromised in many ways: by illness, educational deficiencies,
impulsivity, test anxiety, disinterests etc.
- Within the limits of chance variations, the ability to perform a task is at least as high
as a person’s highest level of performance of that task.
- A patient’s premorbid ability level can be reconstructed or estimated from many
different kinds of behavioral observations or historical facts.
In general, the examiner should not rely on a single high test score for estimating premorbid
ability unless history or observations provide supporting evidence. The examiner also needs
to be alert to overachievers whose highest scores are generally on vocabulary, general
information, or arithmetic tests, as these are the skills most commonly inflated by parental
or school pressure on an ordinary student. Overachievers frequently have high memory
scores too, but memory is the least reliable indicator of general cognitive ability.
THE DEFICIT MEASUREMENT PARADIGM
Once the comparison standard has been determined, the examiner may assess deficit. This is
done by comparing the level of the patient’s present cognitive performances with the
expected level- the comparison standard. A statistically significant discrepancy between the
expected and observed performance levels for any cognitive function or activity indicates a
probability that this discrepancy reflects a cognitive deficit.
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