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PSYC334 Ch 13.pdf

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Queen's University
PSYC 334
Ronald R Holden

PSYC  334   Chapter  13   Neuropsychological  Testing     Neuropsychology:  study  of  brain-­‐behaviour  relationships.     Clinical  neuropsychology:  application  of  knowledge  from  neuropsychology  applied  to  patient   care.     Neuropsychological  testing:  application  of  standardized  procedures  designed  to  assess  and   quantify  brain  function  as  expressed  in  overt  behaviour.  From  this  inferences  can  be  made  about   the  covert  processes  of  the  brain.   -­‐ Tests  specific  domains  and  brain  functions  as  opposed  to  broad  concepts  (e.g.,  memory  vs.   intelligence)   -­‐ More  common  than  imaging  studies,  because  can  actually  observe  which  behaviours  are   intact,  degree  of  skill,  etc.     Valid  neuropsychological  tests  require  maximum  effort  from  the  examinee.     Common  domains  of  study  in  neuropsychological  testing   -­‐ Memory   -­‐ Attention   -­‐ Forgetting   -­‐ Sensory  perception   -­‐ Motor  skills     Components  of  neuropsychological  evaluation:   1. All  of  a  patient’s  relevant  cognitive  skills  should  be  assessed.       -­‐ Involves  examining  intelligence,  higher-­‐order  information  processing,  efficiency  of   mental  processing  (establishes  baseline),  basic  academic  skills,  attention,  and   concentration     -­‐ Problems  with  memory,  attention,  concentration,  and  new  learning  are  the  most  common   neuropsychological  complaints     2. Testing  should  sample  the  relative  efficiency  of  the  left  and  right  hemispheres  of  the  brain.     -­‐ Different  brain  structures  in  the  hemispheres  have  different  implications  for  diagnosis  and   treatment     -­‐ Certain  disorders  (e.g.,  double  Y  syndrome)  or  injuries  (e.g.,  anoxia)  produce  greater   damage  in  one  hemisphere  than  in  the  other     3. Testing  should  sample  anterior  and  posterior  regions  of  cortical  function.   -­‐ Again,  different  functions  have  different  implications  for  treatment   (13  :  1)   PSYC  334   4. Testing  should  determine  the  presence  of  specific  deficits.     -­‐ Determine  and  assess  functional  problems   -­‐ Diagnosis  and  treatment     5. Testing  should  determine  if  problems  are  acute  or  chronic.     -­‐ How  long  as  the  problem  been  present?  –  important  for  diagnosis  and  treatment   -­‐ Distinguish  old  from  new  symptoms  (e.g.,  symptoms  in  people  with  neurodevelopmental   disorders  will  wax  and  wane  as  they  age)     6. Testing  should  locate  intact  complex  functional  systems.       Complex  functional  system:  brain  functions  as  a  series  of  interdependent  systemic  networks.     -­‐ CNS  problems  often  cause  multiple  systems  to  be  impaired,  but  rarely  are  all  systems   impaired     -­‐ Identifying  intact  systems  important  for  treatment  and  positive  prognosis     7. Testing  should  assess  affect,  personality,  and  behaviour.       -­‐ CNS  problems  can  cause  deviations  in  affect,  personality,  and  behaviour   - Direct  (because  of  CNS  changes)  or  indirect  (reaction  +  adjusting  to  CNS  changes)   - Transient  or  permanent     -­‐ Intervention  needed  for  CNS  problems  and  for  psychological  deviations     8. Test  results  should  be  presented  in  ways  that  fit  the  context  of  the  patient’s  life.     -­‐ e.g.,  ways  that  help  in  the  work  or  school  environment,  help  with  either  acute  care  or  long-­‐ term  rehabilitation,  help  supplement  physician  knowledge  of  the  problem,  etc.     -­‐ Most  people  who  sustain  CNS  problems  will  continue  with  education  and  join  the  adult   workforce     -­‐ Important  to  establish  learning  and  vocational  skills     -­‐ Disability  arrangements     Neuropsychological  assessment  approaches  and  instruments.     -­‐ Fixed  battery  approach   -­‐ Flexible  battery  approach     Flexible  battery  approach:  combines  batteries  based  on  deficiencies  and  needs  of  the  patient.   (13  :  2)   PSYC  334   Fixed  battery  approach:  standard  battery  is  administered  to  identify  brain  impairment.     -­‐ Halstead-­‐Reitan  Neuropsychological  Test  Battery  for  Adults   -­‐ Luria-­‐Nebraska  Neuropsychological  Battery     Halstead-­‐Reitan  Neuropsychological  Test  Battery  for  Adults.       Halstead-­‐Reitan  Neuropsychological  Test  Battery  for  Adults:  assesses  behavioural  correlates   of  brain  function  in  6  categories.   -­‐ Input   -­‐ Attention,  concentration,  and  memory   -­‐ Verbal  abilities   -­‐ Spatial,  sequential,  and  manipulatory  abilities   -­‐ Abstraction,  reasoning,  logical  analysis,  and  concept  formation   -­‐ Output     Test   Function/Skills  assessed   Hypothesized  location   Lateral  dominance   -­‐ Determines  dominance  of  a     hemisphere   Aphasia  screening   -­‐ Language  and  construction   -­‐ Language  in  left   -­‐ Construction  in  right   Finger  tapping   -­‐ Motor   -­‐ Frontal  lobe   Grip  strength   -­‐ Motor   -­‐ Frontal  lobe   Finger  localization     -­‐ Sensory-­‐perceptual   -­‐ Unilateral  errors  –   contralateral  parietal  lobe   -­‐ Can  be  bilateral   Rhythm   -­‐ Alertness,  concentration   -­‐ Global   Speech  sounds   -­‐ Alertness,  concentration   -­‐ Global   perception   -­‐ Anterior  left  hemisphere   Category   -­‐ Reasoning   -­‐ Global   Trail  marking     -­‐ Visual-­‐spatial  reasoning   -­‐ Global     Tactual  performance  test     Total  time   -­‐ Motor   -­‐ Frontal  lobe   Memory   -­‐ Immediate  memory   -­‐ Global   Localization   -­‐ Immediate  memory   -­‐ Global   Category  test   -­‐ Reasoning   -­‐ Global     Sensory-­‐perceptual  exam     Tactile  perception   -­‐ Sensory-­‐perceptual   -­‐ Contralateral  parietal  lobe   Auditory  perception   -­‐ Sensory-­‐perceptual   -­‐ Temporal  lobe   Visual  perception   -­‐ Sensory-­‐perceptual   -­‐ Visual  pathways   -­‐ Visual  fields   Tactile  form   -­‐ Sensory-­‐perceptual   -­‐ Parietal  lobe   Fingertip  writing   -­‐ Sensory-­‐perceptual   -­‐ PNS   perception   -­‐ Parietal  lobe     (13  :  3)   PSYC  334   Scores  on  the  General  Neuropsychological  Deficit  scale  are  assigned  based  on  right-­‐left   differences,  dysphasia,  and  cutoff  scores  (separate  normal  functioning  from  deficit)   -­‐ 0  =  perfectly  normal   -­‐ 1  =  normal   -­‐ 2  =  mildly  impaired   -­‐ 3  =  significantly  impaired   (Above  are  based  on  raw  scores)     This  is  the  most  common  fixed  battery  choice.       Limitations   -­‐ 8  –  10  hour  administration   -­‐ Costly   -­‐ Underassessment  of  memory     Luria-­‐Nebraska  Neuropsychological  Battery  for  Adults.     Luria-­‐Nebraska  Neuropsychological  Battery  for  Adults:  diagnoses  cognitive  deficits  with   general  manifestations  and  provides  estimates  of  lateralization/localization  of  deficiencies.       -­‐ Scores  on  12  clinical  scales   -­‐ Yields  T  scores  –  normative  profiles  have  been  developed   -­‐ Interested  in  wrong  answers  and  the  nature  of  the  mistakes     Problems:   -­‐ Scale  homogeneity   -­‐ Demand  characteristics     Boston  Process  Approach.     Boston  Process  Approach  (BPA):  flexible  battery  approach  which  allows  clinician  to  choose  tests   appropriate  based  on  the  referral  question,  functioning,  and  response  limitations.       Looks  at  historical  data   -­‐ Age,  gender   -­‐ Handedness   -­‐ Educational  and  occupational  background   -­‐ Premorbid  talents   -­‐ Patient  +  family  medical,  neurological,  and  psychiatric  history   -­‐ Drug  or  alcohol  abuse   -­‐ Medications   -­‐ Etiology  of  dysfunction   -­‐ Laterality  and  focus  of  legion     Where  fixed  batteries  focus  on  diagnosis  and  localization,  flexible  batteries  analyze   neuropsychological  assets  –  better  for  educational  and  vocational  interventions.     (13  :  4)   PSYC  334   Neuropsychological  instruments  commonly  employed  in  a  flexible  battery   Domain   Tests   Premorbid  ability   -­‐ National  Adult  Reading  Test   -­‐ Wechsler  Test  of  Adult  Reading     General  ability   -­‐ Standford-­‐Binet   -­‐ Wechsler   Achievement   -­‐ Wide  Range  Achievement  Test  4   -­‐ Woodcock-­‐Johnson  III  Tests  of  Achievement   Executive  functions   -­‐ Comprehensive  Trail  Marking  Test   -­‐ Stroop  Test   -­‐ Tower  of  London   Attention   -­‐ Conner’s  Continuous  Performance  Test   -­‐ Paced  Auditory  Serial  Addition  Test   -­‐ Trail  Marking  Test   Memory   -­‐ California  Verbal  Learning  Test  
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