PSYU3344 2024 Week 2 Lecture PDF

Neuropsychological Assessment PSYU3344 NEUROPSYCHOLOGY IN CLINICAL PRACTICE Dr Jasmina Vrankovic Lecture Outline Neuropsychological Assessment Approaches to Neuropsychological Assessment Neuropsychological Tests Neuropsychology Reports Neuropsychological Assessment...

Neuropsychological Assessment PSYU3344 NEUROPSYCHOLOGY IN CLINICAL PRACTICE Dr Jasmina Vrankovic Lecture Outline Neuropsychological Assessment Approaches to Neuropsychological Assessment Neuropsychological Tests Neuropsychology Reports Neuropsychological Assessment 3 What is Psychological Assessment? “The gathering and integration of psychology related data for the purpose of making a psychological evaluation, accomplished through the use of tools such as tests, interviews, case studies, behavioural observation, and specially designed apparatuses and measurement procedures.” (Cohen et al.,1992) What is Neuropsychological Assessment? “Like psychological assessment, neuropsychological assessment involves the study of behaviour by means of interview and standardised tests. The distinctive character of neuropsychological assessment lies in a conceptual frame of reference that takes brain function as its point of departure. The assessment is neuropsychological so long as the questions that prompted it, the central issues, the findings, or the inferences drawn from them ultimately relate to brain function.” (Lezak, 1995) “Systematic collection, organisation, and interpretation of information about a person and his/her situation.” (Sundbery & Tyler, 1962) 5 Neuropsychological Assessment vs Testing “The truth of the matter is that tests are tools. In the hands of a capable and creative person, they can be used with remarkable outcomes. In the hands of a fool or an unscrupulous person, they become pseudo-scientific perversion.” (Sundberg & Taylor, 1962) Neuropsychological testing ― The process of administering a test, scoring it, and interpreting the test scores ▪ Undertaken to answer clear-cut question (e.g., What is Jane’s IQ?) Neuropsychological assessment ― The process of solving problems in which neuropsychological testing is used as only one of the methods of collecting relevant data ▪ Undertaken to answer more complex question (e.g., Why is 6-year-old Jane experiencing difficulty with learning at school?) Neuropsychological tests are tools utilised during a neuropsychological assessment 6 Purpose of Neuropsychological Assessment Allow for clearer delineation of cognitive profile Identify cognitive strengths and weaknesses Hypothesis testing Assist with diagnosis, management, & rehabilitation Longitudinal monitoring of cognitive functioning Baseline vs follow-up assessment (e.g., treatment efficacy) Assessments for specific purposes (e.g., decision making capacity, driving) 7 Neuropsychological Assessment Process Lasts 2 to 8 hours ― Review referral ― Review medical record ― Patient and informant interviews ― Administration of standardised test instruments ▪ Broad battery to assess multiple cognitive domains ▪ Testing is objective ▪ Each test is a sample of behaviour (test scores) obtained under controlled conditions ▪ Tests should have good psychometric properties Reliability: accuracy, consistency, and stability of test scores across situations Validity: the degree to which evidence supports the interpretation of test scores for their intended purposes (does the test measure what it claims to measure) ▪ Undesirable for relatives to be present Test scoring Test interpretation Neuropsychology report 8 What is Assessed? Orientation Premorbid intellectual functioning Effort General intellectual ability (IQ) Attention/Working memory Processing speed Language Visuospatial skills Memory Executive functioning Motor skills (e.g. praxis) Mood & behaviour 9 Neuropsychological Test Interpretation Obtained scores compared to normative data for relevant age/education group Compare current performance to premorbid expectations Further calculations to determine strengths and weaknesses Consider cognitive performance in conjunction with neuroimaging, behaviour on testing, informant reports, motivation level etc. 10 Neuropsychological Test Interpretation 11 Challenging Assessments CALD patients Aphasia (especially receptive aphasia) Significant hearing & visual deficits Comorbid psychiatric illness Differential diagnosis in patients with global deficits Patients who obtain a score of 0 12 Approaches to Neuropsychological Assessment 13 Approaches to Neuropsychological Assessment 14 Fixed Battery Approach Administration of several tests covering a wide range of domains Advantages ― Tests cover broad spectrum of cognitive functioning ― Standardised procedures allow comparison across patients ― Reliable scoring methods Disadvantages ― Time consuming and crude ― Some tests will be redundant ― Tests not always geared to deficits ― Limits exploration and hypothesis testing 15 Flexible Battery Approach Individualised test batteries Advantages ― Briefer assessments ― Allows for more specific testing Disadvantages ― More qualitative than quantitative ― Too much variability ― Can be impacted by personal preference and economic factors 16 Composite Battery Approach Middle ground between fixed and flexible batteries Smaller battery of tests is used to sample various cognitive domains These results are used as a platform to conduct more specific testing in certain areas or elucidate nature of deficits Quantitative and qualitative interpretation Emphasises hypothesis testing 17 Neuropsychological Tests 18 Orientation Name …….. Date of birth ……. Age …….. 19 Premorbid Intellectual Functioning Irregular Word Reading Tests General Knowledge Tests BANAL 1. What day comes after Friday? QUADRUPED 2. What is a ruler used for? PLACEBO 3. Who was the US President assassinated in the GAOLED 1960s? CELLIST ZEALOT HIATUS DEMESNE ABSTEMIOUS DRACHM DETENTE CAMPANILE 20 Effort If the patient does not contribute sufficient effort, test scores are not valid and it is therefore not possible to document the level of cognitive function Recommended practice: utilise several effort measures throughout the cognitive assessment Effort tests rely on revealing inadequate knowledge about how a true patient would perform 21 Intellectual Functioning Battery of subtests that generate an IQ score 22 Attention & Working Memory Digit Span Letter-Number Sequencing 23 Attention & Working Memory Symbol Span 24 Attention & Working Memory Ruff 2 & 7 Test Continuous Performance Test PASAT 25 Processing Speed Coding Symbol-Digit Modalities Test Symbol Search 26 Processing Speed Trail Making Test Colour Trails 27 Language Expressive language ― Naming ― Reading ― Writing ― Spelling 28 Language Receptive language 29 Visuospatial Skills Copying Clock Drawing 30 Visuospatial Skills Block Design Visual Puzzles 31 Memory Verbal Memory Visual Memory - Short stories Listen to the story and try to remember it - Word lists 32 Executive Functioning Verbal reasoning Non-verbal reasoning 33 Executive Functioning Letter Fluency ― Name as many words as you can starting with P in 1 minute Semantic Fluency ― Name as many vegetables as you can in 1 minute Design Fluency 34 Executive Functioning Concept formation & cognitive flexibility Inhibition 35 Executive Functioning Planning & Organisation 36 Neuropsychology Reports 37 Neuropsychology Reports Background ― Reason for referral ― Educational, occupational, and social history ― Developmental, medical, psychological history Current functioning ― Patient interview ― Informant interview Presentation ― Observations ― Behaviour Neuropsychological test results Summary/impression Recommendations 38