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Psychology 2080A/B
Patrick Brown

Testing in Health Psychology and Health Care Test and Measurement - Chapter 17 Neuropsychological Assessment Clinical Neuropsychology  This field is a scientific discipline that focuses on psychological impairments of the central nervous system and their remediation  Clinical neuropsychology is defined as the scientific discipline that studies the relationship between behaviour and brain functioning un the realms of cognitive, motor, sensory, and emotional functioning  Neuropsychologists identify, describe and treat diseases of the brain and spinal cord  Differs from other specializations because it is very specific- focusing on attention, memory, learning, language and communication, spatial integration, and cognitive flexibility  It attempts to relate brain dysfunction and damage to observable and measurable behavioural functioning  There has been huge advancement in neural imaging  People vary with behaviour and function with every lesion  Neurologists no believe that performance on neuropsychological tests gives them clues about which part of the brain to examine  MRI- allows us to see changes in blood flow to different regions of the brain  fMRI- do not expose people to radiation, not very common  Neuropsychology can detect Alzheimer’s disease and other clinical problems in the earliest stages  Pierrre Broca and Carl Wernicke- found that speech was localized to the left side of the brain  Brodmann- first functional map of the cerebral cortex  In 1970 this was a new field  Activities of neuropsychologists are extremely varied an require complex technology  Some neuropsychologists focus on brain dysfunction in children or older adults  They also study how cognitive processes are affected by mental illness as well as alcohol abuse or serious diseases such as AIDS  Some prefer to use batteries of psychological tests where other prefer specific tasks derived from experimental psychology  Neuropsychological assessment has been used to evaluate specific problems in memory  Examiners use a variety of clinical techniques  Short term memory is best assed using verbal tests, these include the immediate recall pan, the digit span, and several word tests  Study: o Compared recently detoxified alcoholics with nonalcoholic controls who were the same age with recovering alcoholics who had been abstinent for at least 18 months o Detoxified alcoholics scored lower on measures of immediate recall, 20 minute delayed recall, and recognition than did comparable subjects who had been off alcohol for 18 months  Neuropsychological evaluation estimates localized problems as well as problems with the brains complex interconnections  Approx. two thirds of left- handed people have language organized on the left side of the brain, approx. 20% have language organized in the right hemisphere, and the remainder appear to have language represented on both sides  Wernicke’s aphasia is characterized by impaired verbal comprehension and ability to repeat information o They utter unintelligible strings of words  Right-handed people who have damage to their right hemisphere develop spatial disorders such as inability to copy or draw objects or difficulties assembling certain objects  Some develop specific problems associated with right hemisphere damage, such as dressing apraxia o They have difficulty identifying the top or the bottom of a garment  Tests can be used to determine whether the problem is in recognition or actual retrieval of information Developmental neuropsychology  Earlier brain injury may be missed until children reach the age where they are challenged with new types of problems  Challenge in evaluating children is brain plasticity o Brain is constantly changing  One category of measures tests general development and adaptive functioning  A second group of measures estimates attention and executive function  Attention and executive function are believed to be separate. Executive function includes volition, such as forming and executing a goal, planning, and taking action to complete a task. It also includes the self-control and self-monitoring to complete the task  Mirsky and colleagues have identified four different factors of mental processing and related them to specific anatomical regions in the brain  One factor: focus execute- child’s ability to scan information and respond in a meaningful way  Second factor: sustain- describes the child’s capacity to pay close attention for a defined interval of time  Third factor: encode- related to information storage, recall, and mental manipulation  Final factor: shift- refers to the ability to be flexible  Dyslexia: specific reading disorder characterized by difficulties in decoding single words, this is a learning disabilities  Federal law now requires that children with specific disabilities receive individualized instructional programs and epical attention  Learning disabilities represents major public health problems  There has been many efforts have been devoted to defining subcategories of learning disabilities, developing procedures to identify them, and instituting methods for helping children overcome these problems  Neuropsychological testing bas been used to determine if people are faking illness o People have been known to exaggerate there symptoms  Another application of neuropsychological testing is to be determine the seriousness of concussions among athletes  One application of clinical neuropsychology is the development of a concussion resolution index (CRI) to track the recovery following a sports-related concussion. CRI is made up of six subtests including reaction time, visual recognition and speed of information processing  Developmental neuropsychologists actively work toward understanding brain- behaviour relationships in children  They have created extensive diagnostic procedures for identifying learning disabilities such as articulation disorders, speech disorders, and dyslexia  They have attempted to link specific medical problems such as birth complications and prematurity to later intellectual function  They have attempted to identify the cognitive consequences of early brain disease and injury  This is a difficult because it requires several levels of assessment  THERE ARE SEVEN STEPS ON PAGE 472- MEMORIZE THEM Adult Neuropsychology  Halstead-Reitan Neuropsychological Battery o The full battery includes many psychological test and sometimes requires 8-12 hours to administer o Patients often receive the full Multiphasic Personality Inventory to evaluate their emotional state in response to a medical situation. The battery also includes a full WAIS o Later studies by Reitan demonstrated that the battery can locate tumors or lesions in the right of left hemisphere of the brain and in the front or back portion of the brain in a significant number of cases o The battery can assist in localizing injury in either the left or right hemisphere of the brain o However this advantage may be meager in relation to the many hours it takes to complete the test  Luria-Nebraska Neuropsychological Battery o Luria did not acknowledge that any single area was solely responsible for any particular behaviour o Luria saw the brain as a functional system with a limited number of brain areas involved in each behaviour o Introduced the concept pluripotentiality: that nay one center in the brain can be involved in several different functional systems  Ex. One center in the brain may be involved in both visual and tactile sense o Luria’s opinion was the only known evidence for the validity of the tests o The battery includes 269 items that can be administered in approx.. 24 hours o The items are divided into 10 subsections PAGE 476 o The inventory is scored by finding a standardized performance level for each of the 11 subtests o In addition three more scores are reported o First a pathognomonic scale consists of 32 items found in previous studies to be highly sensitive to brain dysfunction o The other two scores indicate whether dysfunction is in the right or left hemisphere of the brain o They are taken form the sections of the battery that independently test the function of the left or right side of the body o These studies can be used the battery to estimate the area of the brain damaged by a tumor or lesion o This approach still has serious critics- there is an example on page 475 California Verbal Learning test (CVLT)  The test attempts to link memory deficits with impaired performance on specific tasks for people who have known neurological problems  Example: given 16 items to memorize  Adults with limited learning capacity may do relatively well on early trials but reach a plateau where repeated trials do not reflect improved performance  Adults with limited learning capacity may also have inconsistent recall across trials  Unique features of the CVLT is that one can administer it either in a paper-and pencil form with a microcomputer  Those with Alzheimer’s disease and with Koraskoff’s syndrome appear quite similar, with comparable scores for recall, learning and for getting, semantic clustering and several other cognitive factors  However each of these groups performed at a lower level than did patents with Huntington’s disease  The very nature of the association between variables is different for different patient populations. This challenges the idea that measures have the same validity for different patient groups  Long-delay savings require that subjects learn a list of word. Then after a long dela
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