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Psychology 2080A/B Neuropsychology review

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Psychology 2080A/B
Patrick Brown

Neuropsychological assessment • the brain is the most complex object that we know of in the universe • many combinations of behavioral and mental impairment may follow an insult to the brain Goals • diagnosis : what happened that damaged the patients brain? • description : what cognitive emotional, or behavioral impairments resulted • tracking changes : observe in patience performance over time, to monitor healing/ worsening and effects of treatment Advantages of neuropsychological assessment • Standardized : repeatable instructions, stimulus presentation & tasks, norms • Intensive : multiple measures among wide range of domains • Sensitive : valid indicators of skills, capable of detecting abilities and deficits • Scaled : hierarchal items, start/stop rules • Precise : allows reliable, exacting quantification of relative abilities, allows comparison within/over time • Quantitative observations : many tests give standardized scale scores (like wechsler) based on norms Interpretation • E.g., Boston Aphasia Battery – profile of subtest scores indicates nature of disorder • cut off scores used to make decisions • neuropsychologists also make up tests as needed - these typically are not standardized so interpretation may be problematic IQ and neuropsychological testing • estimating pre morbid IQ may be necessary to determine actual loss of function or capacity • often difficult to use a regular IQ test with patients ◦ education, vocabulary, occupation, farm size, self care, demographic formulas reading level, subtest pattern Malingering • faking a disorder or deficit • people sometimes fake a deficit in order to collect insurance payments or narcotics • usually dont know what the deficit looks like, often show too much loss of function • munchausen syndrome - psychopathology involves faking illness, but not for illness or drugs, rarely treated successfully Neuropsychological test batteries • large set of tests • wide variety of tests to tap many different skills and abilities • developed before the era of brain scanning, in part to help locate site of damage Should we use test batteries? • plusses ◦ many batteries have known psychometric properties ( reliability, validity) ◦ tests cover a wide range of cognitive functions and behaviours ◦ use permits comparison of patients even if they are tested by different clinicians • minus ◦ time consuming ◦ test centered rather than patient centered ◦ patient may fail for other reasons ◦ developed for general purposes - may lack flexibility to asses any given patients idiosyncratic deficits ◦ may reduce clinicians potentially useful curiosity, cookie cutter reports • tailor test to your current patient - you may gain info about why your patient fails a test • but the results are more meaningful when testing conditions are standardized • you can often do both Functions of interest to neuropsychologists Laterality ◦ compares functions of the left and right hemispheres of the cortex ◦ especially important if surgery is planned ◦ language functions are in left hemisphere in most people, bilateral in some ◦ definitive assessment - wada test (invasive) ◦ Annett Handedness Questionnaire ■ gives an index of handedness ■ treats handedness as a co
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