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PSYC31H3 Lecture Notes - Fanca, Paroxysmal Attack, Dementia

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Konstantine Zakzanis

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Chapter 6 Neuropsychological Examination: Interpretation
- Basic data of examinations = behavioural observation
- In order to get meaningful data of patient’s behaviour need to have made or obtained
reports of many different kinds of observations including historical and demographic
Different kinds of Examination Data : Background Data
- Are essential for providing the context in which current observation can be best understood
- Need developmental and medical history, family background, educational and occupation
accomplishment (or failures), and patient’s current living situation and level of social functioning
- Examiner must taken into account a number of patient variables: sensory and motor status,
altertness cycles and fatigability, medication regimen and likelihood of drug and alcohol
- Importance of background data when interpreting examination observation e.g. test score of
millwright must be at least average but more likely to achieve high average vs. Executive chief at
least high average ability but many would perform at superior level
o But keep in mind motivation to reach goal is important too professor at average
ability vs. Shoe clerk who has exceptional ability
Different kinds of Examination Data : Behavioural Observation
- Naturalistic observation can give useful info about patient’s function outside the formalized,
highly structured and possibly intimidating examination setting
o Rarely done so but reports form nursing personnel or family members may help to
understand what the examiner should look for
- Especially important when justly formal examination finding conclude about person capability
more or less than they actually are this error likely to occur when examiner confounds
observed performance w/ ability
o Behavioural characteristics that comprise their adequate and sometimes even excellent
skills are not elicited in usual examination
o E.g. frontal lobe damage show no cognitive deficits but is apparent to people who live
them vs. Others who show deficits but can cope despite it using various strategies
- Patient’s conduct in examination is useful too documented & evaluated as attitudes towards
the examination, conversation or silence, the appropriateness of their demeanour and social
Different kinds of Examination Data : Test Data

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- Testing differ from other psychological data it elicits behaviour samples in a standardized,
replicable, and more or less artificial and restrictive situation
- in the sameness a of test situation for each subject:
o strength is ability to compare the samples b/w individual over to time or w/ expected
performance level
o weakness is that observations are limited to behaviours prompt by test situation
- examiner extrapolates from limited set of observations to the patient’s behaviour in real life
o extrapolations likely to accurate as the observations on which they are based on are
pertinent, precise and comprehensive, as situations are similar and as generalization are
- Most case examiner rely on their common sense judgements and their piratical experience in
their making test-based predictions about a patient’s real-life functioning
o Studies on predictive validity and ecological validity of tests show many have good
predictive relationship w/ variety of disease characteristic
Quantitative and Qualitative Data
- Observation expressed as either numerically (=quantities data) or descriptively (=qualitative
- 2 approaches:
- 1) Actuarial system exemplifies the quantitative method relies on scores, derived indices and
score relationships for diagnostic predictions
- 2) Clinical approach based on richly described observations w/out objective standardization
- Together provide the observational frames of reference and techniques for taking into account,
documenting and communicating the complexity, variability and subtleties of patient behaviour
- Conditions necessary for actuarial predictions to be more accurate than clinical ones:
o There are only a small number of probable outcomes (e.g. left or right cortical lesions,
right cortical regions, diffuse damage, no impairment )
o Predictions variable be known (limit info that can be processed by formula to info on
which the formula was based on)
o Data from which the formula was derived be relevant to questions asked
- Actuarial people over look the fact that in this era most assessment are not taken for
diagnostic purposes bur for the patient’s neuropsychological status & even if so is unique ot
individual case that can’t be know from simple formulas
- Studies trying to support actuarial judgments give examiners w/ only score index not patient
live index
- This debate extend into “fixed” vs. “flexible” approaches practical and clinical experience
support use of flexible selection of tests to address referral questions & problem /issues raised
in consultation
Quantitative and Qualitative Data : Quantitative data

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- Scores are summary statements about observed behaviour obtained for any set of behaviour
samples that can be categorized according to some principle
o Scorer determined if each behaviour fits into a predetermined category & give into
place on numerical scale
- Commonly used scale for individual test item two points: good/pass or poor/fail
o 3 point scales - add “fair or barely pass” often used for grading ability test items
- Scored tests w/ more than one item produces summary score usually simple average of all
individual items w/ occasionally some incorporating correction for guessing scoring so that final
is not just simple summation
- Final test score may misrepresent the behaviour under examination under at least 2 counts:
o Based on only one narrowly defined aspect of set of behaviour sample
o It is 2 or more steps removed from original behaviour
- Global or aggregate or full scale by summing averages of test scores are 3-4 steps removed
- Summary Index scores based on items scores that have had their normal rage restricted to just 2
points of either pass or fail or w/in normal limits or brain damaged (many steps removed)
o if each 2 tests produces a different score pattern or normative distribution or sensitive
to particular kind of brain dysfunction then 2 test treated individually
- test scores satisfy the need for objective, replicable data cast in form that permits reliable
interpretation and meaningful comparisons.
o Standardization allow for comparison of any one test performance score w/ patient’s all
other scores or w/ any group or performance criteria
- Also different behaviour e.g. writing vs. Visual reaction can be compared on single numerical
scale receive high on writing but low reaction time
Quantitative and Qualitative Data: Problems in the evaluation of quantitative data
- Interpretation of test scores keep in mind the artificial and abstract nature of it
- Reification of test scores can lead to overlook or discount direct observations
o approach that minimize the importance of qualitative data can result in serious
distortions in interpretation, conclusions, and recommendations
- To be neuropsychological meaningful scores should represent as few kinds of behaviour or
dimensions of cognitive functions as possible
- If test scores are over-conclusive e.g. summed scores or averaged test battery scores
becomes virtually impossible to know what behavioural or cognitive characteristic it represents
o E.g. Memory quotient by averaging WMS was the same for very different kind of
memory disorders
o Same principle of multi-determinants holds for single test scores too as similar errors
lowering scores in similar ways can occur for different reasons e.g. attention deficits and
motor slowing
- Range of observations by examiner is restricted by the test especially in m/c paper pencil test
and button/ mechanized activity that limits opportunities for self-expression
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