Summary Neuropsychological Assessment (all lectures + relevant literature in
blue)
Lecture 1 – Introduction
- Maybe a midterm used as a practice, does not count towards final grade
- Use slides, book as guideline
What is clinical neuropsychology?
= Specialty that applies principles of assessment and intervention based upon the scientific
study of human behaviour as it relates to normal and abnormal functioning of the Central
Nervous System (CNS)
- Study of brain/behaviour relationships & impact of injury/disease on cognitive, emotional
and general adaptive capacities of the individual
- Need to have understanding of
- Functional neuroanatomy
- Certain areas more specialised for specific functions
- Plasticity
- Neurological disorders
- What kind of
- Medical psychology
- Lot of neurological damage
- Brain isn’t functioning optimally
- Psychopathology
- Theoretical background and psychometric properties of the tests used
Neuropsychological assessment
= A means of measuring in a quantitative, standardized fashion the most complex aspects of
human behaviour: attention, perception, memory, speech and language, building and drawing,
reasoning, problem solving, judgement, planning and emotional processing
- Another method of examining the brain by studying its behavioural product
- Involves intensive study of behaviour by means of interviews and standardized tests
and questionnaires that provide precise and sensitive indices of neuropsychological
functioning
- The behavioural effects of brain damage vary with
- Nature, extent, location, and duration (chronic or acute) of the lesion(s) and/or
malfunctioning of the neural networks (how do you measure behavioural product of
problems, what do you see in patient)
- Age, sex, physical condition (need to know what patient was like before damage,
how do they do things, healthy?, the healthier the better), psychosocial background
(education) and status of the patient (access to healthy lifestyle)
- With individual neuroanatomical and physiological differences (lots of differences in
brain, structures quite similar, not everybody exactly the same)
- Used to study the organization of brain activity and its translation into behaviour and to
investigate specific brain disorders and behavioural disabilities
- Neuropsychological assessment techniques provide the data for interpreting brain mapping
studies
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,- Usually a neuropsychological examination serves more than one purpose
Major purposes of neuropsychological assessment
1. Differential diagnosis
- Accurate diagnosis and lesion localization are often achieved by means of the
neurological examination and laboratory data
2. Planning treatment
- Sensitive, broad-gauged and accurate neuropsychological assessment is necessary for
determining the most appropriate treatment for each rehabilitation candidate with brain
dysfunction
- Including delineation of problem areas and evaluation of the patient’s
strengths and potential for rehabilitation
3. Following the course of rehabilitation
4. Legal proceedings
- Patient care:
- Neuropsychologist has a responsibility to describe the patient as fully as
necessary for intelligent understanding and care
- Precise descriptive information about cognitive and emotional status is
essential for careful management of many neurological disorders
- Family needs to know about their patient’s condition in order to respond
appropriately
- Repeated testing: to evaluate performance inconsistencies & to measure the effects of
surgical procedures, medical treatment or retraining
- Most people who sustain brain injury or disease experience changes in their self-awareness
and emotional functioning, but because they are on the inside, they may have difficulty
appreciating how their behaviour has changed and what about them is still the same
- Perplexity: self-doubt and hesitancy of the brain injured person
- Continuing uncertainty or dissatisfaction about their perceptions and productions
- Treatment evaluation
- Forensic neuropsychology
- Telling differences between different types of disorders
- Specific type of dementia, what has this person got, what do you want for the treatment
- Want to know strengths and weaknesses of patients
- What they can do to use as motivation and help in rehabilitation, focus on
what they are good at (feel good about themselves), strengths to help with
weaknesses
- Need to know weaknesses as indication of problems, quality of life as good as
possible
- The goal of neuropsychological assessment isn’t just about gathering test data (cognitive,
emotional, functional), but in understanding the behaviour of the patient in the context of
environment in which he/she functions & discovering their strengths and weaknesses
- Not all tests directed to what they can do in daily life: drive, work, dress themselves, how
independent are they
- Screening tests have been developed for identifying neurocognitive and neurobehavioural
changes in TBI (traumatic brain injury) patients
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,Anatomy of the human brain
- Orient where areas of brain are
- Main areas of brain
- Different views on brain
- Location, extensive
→ See Figure 3.1, page 43 in book for image of a neuron
Structure/function (simplified overview)
Function Brain structures implied
Attention All areas but especially frontal?
Perception Visual cortex (occipital lobe)
Memory Hippocampus, thalamus, mamiliary bodies,
fornix, prefrontal cortex
Language Left hemisphere, Broca’s, Wernicke’s
Executive functions Frontal cortex and feedback loops
Movement Basal ganglia (pons/medulla), cerebellum,
motor cortex
Emotion Amygdala, prefrontal cortex, right
hemisphere
- Sometimes nothing found in scan
- Plasticity important to keep in mind!
- Frontal: attention and executive function (close link between)
- Lots of areas in memory, which is a huge thing, not just one thing
Global issues
- Populations: all ages
- Comorbidity is more common in the elderly as is polypharmacy
- Comorbidity: the older you get, you tend to get other things
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, - When something happens, the more fragile the brain, the more likely to get
something else
- Polypharmacy: you take lots of medication
- Maximizing the patient’s performance (strengths/weaknesses)
- Can or cannot do
- Optimal vs standard conditions
- Optimal conditions: enable patients to do their best on the tests
- Differ from patient to patient
- Freedom from distractions, non-threatening emotional climate and
protection from fatigue
- Standard conditions: to ensure that each administration of the test is as much
like every other administration as possible so that scores obtained on different
test administrations can be compared
- Many testmakers give detailed directions
- Highly standardized test administration is necessary when using
norms of tests that have fine-graded and statistically well standardized
scoring system
- Wechsler Intelligence Scale
- Enables examiner to discover the individual characteristics of each
patient’s responses
- Individual differences often seem to be more ‘marked’ in brain-damaged individuals (may
see extremes of behaviour)
- Determining premorbid level of functioning is crucial
- Very important
- Premorbid level: before onset of disorder
- To make comparisons, what functions were lost or not
- Want a baseline
- Don’t always have access to it
- Change of some prescription
- Not rely on a single high test score for estimating premorbid ability unless history or
observations provide supporting evidence!
Psychometrics
- Includes consideration of:
- reliability
- validity and validation → most fundamental property of psychometric tests
- norms and skewing
- standardizing scores and why important
- correlations that exist between tests (avoid redundant testing)
- Test is good if it:
- has ecological validity/measures what it purports to measure (face validity)
- covers all relevant behavioural domains of interest
- avoids ‘floor’ and ‘ceiling’ effects
- patient can understand what they have to do!
- easy to administer and score
- comparable with other investigators’ work
- has more than one version/form (reduces redundancy)
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