Neurocognitive Assessment PDF

Neurocognitive Assessment Shailja Arora Saulat Thaker Aanchal Sharma  INDEX INTRODUCTION TO NEUROCOGNITIVE ASSESSMENT THEORETICAL CONCEPT OF OF NEUROCOGNITIVE ASSESSMENT HISTORY AND EVOLUTION OF NEUROCOGNITVE PERSPECTIVE AN...

Neurocognitive Assessment Shailja Arora Saulat Thaker Aanchal Sharma  INDEX INTRODUCTION TO NEUROCOGNITIVE ASSESSMENT THEORETICAL CONCEPT OF OF NEUROCOGNITIVE ASSESSMENT HISTORY AND EVOLUTION OF NEUROCOGNITVE PERSPECTIVE AND ASSESSMENT STRUCTURE OF THE BRAIN AS SEEN BY NEUROCOGNITION EVALUATION OF NEUROCONITIVE ASSESSMENT-MERITS AND DEMERITS DSM-V NEUROCOGNITIVE DOMAINS DOMAIN-SPECIFIC TESTS APPLICATIONS OF NEUROCOGNITIVE ASSESSMENT TYPES OF NEUROCOGNITIVE ASSESSMENTS RESEARCHES REFERENCES  According to Lezak et al. (2012) in Neuropsychological Assessment, a neurocognitive assessment is defined as: “A performance-based method to assess cognitive functioning in domains such as Neurocognitive memory, attention, language, visuospatial skills, and executive functions. It is used to Assessment evaluate the cognitive impact of brain injuries, neurological illnesses, and psychiatric conditions." Purpose Neuropsychological assessment is based on principles of psychological measurement and psychometrics and behavioral neurology in the objective examination and characterization of normal and abnormal central nervous system (CNS) functioning (Lezak, Howieson, Bigler, & Tranel, 2012; Schoenberg & Scott, 2011; Scott, 2011; Urbina, 2004). History and Evolution of the neurocognitive assessment The history of Neurocognitive Assessment traces the evolution of methods and tools used to discover cognitive functions such as memory, attention, problem-solving, and language as measurable functions. The history of neurocognitive assessment is closely linked to the development of cognitive psychology and the study of cognitive processes. The scientifically informed practice of clinical psychology has taken an innovative new direction and is rapidly gaining momentum. This progress is largely attributable to integrating affective, cognitive, and behavioral neuroscience research with traditional clinical psychology. The decade from 1990 until 2000, known as produced the first wave of empirical studies on the neural bases of psychopathology. The knowledge gained during and after this period is now being applied for the first time to enhance the recognition and treatment of emotional disorders. As a result, the focus on integrating biological and psychological perspectives has never been stronger. This new approach has been termed THE NEUROCOGNITIVE PERSPECTIVE 19th Century Phrenology (Early 1800s): Proposed by Franz Joseph Gall, phrenology suggested that different brain regions are responsible for different personality traits. Though scientifically inaccurate, it laid the groundwork for linking brain anatomy with behavior. Paul Broca (1861): Studied a patient with language difficulties and identified a specific brain region (Broca's area) in the left frontal lobe responsible for speech production, marking one of the earliest discoveries of functional brain localization. Carl Wernicke (1874): Identified Wernicke's area, crucial for language comprehension, complementing Broca’s findings and reinforcing the idea that specific brain regions have specialized functions.  Development of Neuroimaging: In the 1970s, advancements like computerized tomography (CT Rise of Neuroscience scans) and magnetic resonance imaging (MRI) provided detailed brain images, revolutionizing our ability to link brain anatomy to behavior. Roger Sperry’s Split-Brain Research (1960s-1980s): Sperry’s work with split-brain patients (those who had their corpus callosum severed to treat epilepsy) revealed that the left and right hemispheres have distinct cognitive functions, laying the foundation for understanding lateralization in the brain. Luria’s Work on Neuropsychology (1960s-1970s): (1970S-1980S) Alexander Luria integrated cognitive theory with clinical observations, studying how brain damage affected cognitive functions, thereby shaping modern neuropsychology. The Emergence of Cognitive Neuroscience (1980S-1990S) Integration of Disciplines: Cognitive neuroscience emerged as a field combining cognitive psychology’s focus on mental processes with neuroscience’s insights into brain function. This fusion allowed for a comprehensive study of how brain mechanisms give rise to cognition. Michael Gazzaniga and George Miller: Gazzaniga, often called the father of cognitive neuroscience, and Miller emphasized the importance of studying the brain’s role in cognition. They focused on understanding how brain regions interact during mental activities. Cognitive Neuroscience Milestones: Studies of patients with brain injuries, along with advances in neuroimaging, fueled breakthroughs in mapping cognitive processes to specific brain structures.  FUNCTIONAL MAGNETIC RESONANCE IMAGING Neuroimaging (FMRI): Revolutionized cognitive neuroscience by enabling Techniques researchers to observe which brain areas activate during specific tasks. Unlike structural MRI, fMRI tracks blood flow (1990S-PRESENT) changes (a proxy for neural activity), providing insights into functional networks. POSITRON EMISSION TOMOGRAPHY (PET): PET scans measure metabolic activity in the brain by detecting radioactive tracers, allowing visualization of active regions during cognitive tasks. ELECTROENCEPHALOGRAPHY (EEG) AND MAGNETOENCEPHALOGRAPHY (MEG): Electroencephalography (EEG) and Magnetoencephalography (MEG): Provide real-time tracking of electrical and magnetic activity in the brain. While they offer high temporal resolution, their spatial resolution is lower compared to fMRI and PET. Structure of the Brain ACCORDING TO LEZAK ET AL. (2012) IN NEUROPSYCHOLOGICAL ASSESSMENT 1. CEREBRAL CORTEX 2. PREFRONTAL 3. HIPPOCAMPUS 4. AMYGDALA Frontal Lobe: Executive CORTEX functions, decision-making, impulse control, motor planning. Role: Regulation of Role: Memory encoding, Role: Emotional regulation, Parietal Lobe: Sensory integration, spatial navigation. decision-making. spatial processing, attention. executive functions, Temporal Lobe: Auditory social behavior, processing, memory, language comprehension. cognitive flexibility. Occipital Lobe: Visual processing. 5. BASAL GANGALIA 6. THALAMUS 7. CEREBELLUM 8. CORPUS CALLOSUM Role: Motor control, Role: Sensory relay, Role: Coordination, Role: Hemispheric procedural learning. attention, alertness. timing, attention. communication. 9. LIMBIC SYSTEM 10. BROCA’S & 11. WHITE MATTER WERNICKE’S AREAS TRACTS Role: Emotion and Broca’s Area: Speech memory (hippocampus production. Role: Connectivity, and amygdala). Wernicke’s Area: processing speed. Language comprehension.  Development of Neurocognitive Batteries Roots in Cognitive Psychology Late 20th Century Wechsler Intelligence Scales (1939 onwards): Late 19th to Early 20th Century Developed by David Wechsler Cognitive psychology emerged as a distinct field, Computerized Cognitive Tests (1980s-1990s): primarily as a response to the limitations of Cambridge Neuropsychological Test behaviorism. Automated Battery (CANTAB) Growth of Research in Cognitive Aging and Dementia: Mini-Mental State Examination Wilhelm Wundt and Hermann Ebbinghaus (MMSE) and the Montreal Cognitive Assessment (MoCA) (known for studying memory through self- Modern Neurocognitive Assessment experimentation) laid the groundwork for understanding cognitive processes 21st Century Introduction of Factor-Analytic Models of Integration with Neuroscience and AI: neuroimaging, Intelligence: Researchers like Raymond machine learning, and computational models. Functional Cattell and John Horn introduced the 1860s imaging techniques (e.g., fMRI, EEG) concepts of fluid and crystallized Franciscus Donders introduced intelligence Development of Online and Mobile Cognitive Assessments the concept of “mental chronometry.” Spearman’s Two-Factor Theory of Intelligence (1904) Cognitive Revolution Mid-20th Century The mid-20th century saw the cognitive revolution, driven by researchers like George Miller, Noam Chomsky, and Ulric Early Development of Intelligence Testing Lewis Terman and the Neisser. This shift from behaviorism to cognitive psychology Early 20th Century Stanford-Binet Scale (1916) focused on understanding the mind as an information-processing system. Alfred Binet and and Théodore Simon developed the first intelligence test, the Binet-Simon Scale (1905) laying the foundation for later neurocognitive assessments.  EVALUATION OF NEUROCOGNITIVE ASSESSMENTS DEMERITS 1. Cultural and Language Bias 2. Limited Ecological Validity MERITS 3. Overemphasis on Test Scores 4. Time-Consuming and Resource 1. Objective Measurement of Intensive Cognitive Functioning 5. Subject to Practice Effects 2. Diagnosis and Differentiation of 6. Interpretation Challenges Disorders 3. Guiding Treatment and Rehabilitation 4. Monitoring Progress and Outcomes 5. Legal and Educational Applications Cognitive 1.Aaron T. Beck (Cognitive Deficit Psychologist): Might describe cognitive deficits as impairments in cognitive processes that affect an individual's ability to think clearly, remember information, or make decisions, particularly in relation to disorders like depression or anxiety. 2. Muriel Deutsch Lezak (Neuropsychologist) Lezak defines cognitive deficits as reductions in specific cognitive abilities, such as attention, memory, executive functions, language, and perception, often associated with brain damage or neurodegenerative conditions. DSM -5 COGNITIVE IMPAIRMENT Cognitive impairment in the DSM-5 refers to a range of conditions characterized by difficulties in cognitive functioning. The DSM-5 categorizes these conditions under various disorders, including: NEURO -COGNITIVE DISORDERS (DELIRIUM, MAJOR,MILD ) These disorders involve significant cognitive decline from a previous level of performance Neurocognitive Domains The brain controls both cognitive and functional aspects of our brain, meaning it controls how we think and move. Due to the high complexity of the brain, there are many different ways to categorize its functions. However, the functions are most commonly split into six categories. While this framework is not absolute, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines six key domains of cognitive function. Identifying the domains and subdomains affected in a particular patient can help establish the aetiology and severity of the neurocognitive disorder.According to the DSM-5, six key domains of cognitive function are complex attention, executive function, learning and memory, language, perceptual-motor control, and social cognition.  DOMAINS FUNCTIONS STRUCTURE OF THE BRAIN DOMAIN SPECIFIC TESTS ability to focus on multiple things at once Simple and choice Complex Attention and our ability to choose what to pay frontal and parietal cortex attention to and what to ignore reaction time tasks refer to high-level cognitive abilities required Executive Function to control and coordinate other cognitive prefrontal cortex Stroop Color and Word Test abilities and behaviors. ability to record information, such as facts Learning and Memory or events, and retrieve it when needed Hippocampus Facial recognition test Language links strongly with our ability to the Wernicke's area, in the left Language communicate, whether through writing, temporal lobe and Broca's area in Western Aphasia Battery reading, or speaking. the left frontal lobe ability to coordinate our bodies’ Perceptual-Motor movements in response to what is the cerebellum Finger tapping Test Control happening around us. how we process, remember, and use Social Cognition information in social contexts to explain and Reading the Mind in the Eyes the amygdala predict our behavior as well as the behavior Test of others  01 Complex Attention The Simple Reaction Time (SRT) and Choice Reaction Time (CRT) tests are psychological assessments used to measure how quickly a person can respond to a stimulus. These tests are widely used in cognitive and neurological research to Now Lets evaluate attention, processing speed, and decision-making. Simple Reaction Time tests measure the basic speed of Discuss the response to a stimulus, while Choice Reaction Time tests evaluate more complex processing involving decision- domain-specific making and response selection. tests in Brief 02 Exexutive Function The Stroop Color and Word Test psychological assessment that measures cognitive processing speed, attention, and executive function, particularly focusing on the brain's ability to manage conflicting information. It's named after John Ridley Stroop, who first described the effect in the 1930s. It is a simple yet powerful tool for examining how our brains handle conflicting information and how well we can control our automatic responses. 03 Learning and Memory The Facial Recognition Test Facial recognition impacts on social functioning, peer 05 Perceptual-Motor Control Finger tapping Test The finger-tapping (FT) test has been used for almost a relationships and behaviour and is the ability to determine century to evaluate muscle control and motor ability in the facial emotions or differentiate familiar and unfamiliar faces. upper extremities. This task is frequently used to evaluate This is important for successful interaction with others and to patients with Parkinson’s disease, Alzheimer’s disease, as well actively participate in the social environment (Morris, as in individuals who have suffered an acute stroke. Weickert, & Loughland, 2009).This review focuses on facial Moreover, the finger-tapping test is widely used to evaluate affect (emotion) recognition in children and adolescents: motor function in the upper limbs and the relationship commonly measured by identifying the emotions of between hand preference and hand skill in healthy photographs of strangers from available series (Ekman & individuals and to assess hand skill and coordination for Friesen, 1976). occupations in which the hands are essential. The finger- tapping test is also used for psychomotor evaluations. 04 06 Language Social Cognition Western Aphasia Battery Reading the Mind in the Eyes Test The Western Aphasia Battery (WAB) was developed by (often simply referred to as the "Eyes Test") is a psychological Kertesz in 1979. It was designed as an assessment tool to assessment designed to measure an individual's ability to examine the linguistic skills (information content, fluency, understand and interpret the emotions and mental states of auditory comprehension, repetition, naming and word others by looking at their eyes. It is a tool used primarily in finding, reading, and writing) and main nonlinguistic skills research on social cognition and empathy. It has been widely (drawing, block design, calculation, and praxis) of adults with used to measure theory of mind—the ability to recognize aphasia. and understand another person’s mental state—or social intelligence. Applications of Neurocognitive assessments are essential tools in both clinical and research Neurocognitive settings. They are used to evaluate cognitive functioning across various domains, Assessments helping to identify impairments, monitor changes over time, and guide interventions. Neurocognitive assessments are vital for identifying cognitive impairments that might not be obvious in day-to-day life. Early identification of cognitive issues allows for timely intervention, which can significantly impact the quality of life and outcomes for individuals with neurological and psychiatric conditions. Some of the applications are as follows: Clinical Diagnosis Treatment Planning and Research Applications Monitoring neurological disorders understanding cognitive psychiatric disorders personalized treatment disorders developmental disorders monitoring progress clinical trials Military and Veterans Occupational Health Legal and Forensic Applications Traumatic Brain Injury (TBI) forensic assessment workplace assessments Post-TraumaticStress competency fit-for-duty assessments Disorder (PTSD) evaluations What are the Types of Neurocognitive Assessment TYPE OF COMMON EXAMPLES OF NEUROCOGNITIVE DESCRIPTION APPLICATIONS TESTS ASSESSMENT Traditional assessments using printed Clinical settings (e.g., diagnosing cognitive materials. They often evaluate specific Mini-Mental State Examination Paper-Pen Tests impairments) Educational assessments cognitive functions like memory, Psychological evaluations Trail Making Test attention, and problem-solving. Digital tests administered via CogState - CNS Vital Signs CANTAB Research studies Remote cognitive computer, allowing for automated Computer-Based Tests scoring, adaptive testing, and assessments Cognitive training and (Cambridge Neuropsychological Test rehabilitation Automated Battery) precise timing. Experimental tasks often used in Cognitive psychology research Experimental research to measure specific Stroop Test Cognitive Laboratory (Cog-Lab) Tests cognitive processes like attention, psychology labs Studying the effects of interventions Go/No-Go Task Simon Task decision-making, or reaction time. Performance Assessment of Self-Care Real-world or simulated tasks that Skills (PASS) Executive Function Functional measure cognitive abilities through Performance-Based Tests practical application, often in context- assessments Occupational therapy Performance Test (EFPT) Evaluating daily living skills Complex multi-step task evaluations specific scenarios. Wechsler Adult Intelligence Scale  American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental References Disorders (DSM-5) (5th ed.). American Psychiatric Publishing. Armstrong, C. L., & Morrow, L. (2010). Handbook of Medical Neuropsychology. Springer Science & Business Media. Baron-Cohen, S., Jolliffe, T., Mortimore, C., & Robertson, M. (1997). Another Advanced Test of Theory of Mind: Evidence from Very High Functioning Adults with Autism or Asperger Syndrome. Journal of Child Psychology and Psychiatry, 38(7), 813–822. https://doi.org/10.1111/j.1469-7610.1997.tb01599.x Baron-Cohen, S., Wheelwright, S., Hill, J., Raste, Y., & Plumb, I. (2001). The “Reading the Mind in the Eyes” Test revised version: a study with normal adults, and adults with Asperger syndrome or high-functioning autism. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 42(2), 241–251. https://pubmed.ncbi.nlm.nih.gov/11280420/ Gazzaniga, M. S., Ivry, R. B., & Mangun, G. R. (2019). Cognitive neuroscience : the biology of the mind (5th ed.). W.W. Norton & Company. Jobbágy, Á., Harcos, P., Karoly, R., & Fazekas, G. (2005). Analysis of finger-tapping movement. Journal of Neuroscience Methods, 141(1), 29–39. https://doi.org/10.1016/j.jneumeth.2004.05.009 Lezak, M. D., Howieson, D. B., Bigler, E. D., & Tranel, D. (2012). Neuropsychological assessment. Oxford University Press. Mohlman, J., Thilo Deckersbach, & Weissman, A. (2015). From Symptom to Synapse. Routledge. Nissan, J., Liewald, D., & Deary, I. J. (2013). Reaction time and intelligence: Comparing associations based on two response modes. Intelligence, 41(5), 622–630. https://doi.org/10.1016/j.intell.2013.08.002 Thank you!