Neuropsychological Assessment

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Neuropsychological Assessment

• William P. Wattles, Ph.D.
• Francis Marion University

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Practicum Log

• Supervision Hours (coaching, feedback sessions,
  etc.) (S),
• Student-contact Hours (i.e. assessment,
  intervention) (ST),
• Consultation Hours (i.e. direct contact with
  consultees, interviews, meetings) (C )
• Research Hours (projects, program evaluation,
  etc.) (R)
• Administrative Hours (i.e. scheduling, record
  review, scoring, report writing) (A),
• Other Hours (e.g. staff meetings, in-service,
  conferences) (O)

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Neuropsychology

• Nothing more than the study of human
  brain/behavior relationships.

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Neurologist

• A physician specializing in diseases and
  disorders of the brain, spinal cord, nerves, and
  muscles, including stroke, Parkinson's disease,
  epilepsy, Alzheimer's disease, and muscular
  dystrophy

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Neuropsychologist

• A psychologist with specialized training in the
  evaluation of cognitive functions.
  Neuropsychologists use a battery of standardized
  tests to assess specific cognitive functions and
  identify areas of cognitive impairment

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• Classically, brain/behavior relationships have
  been inferred from the study of individuals with
  head injuries, tumors, neurological disease, and
  other unpleasant brain pathologies.

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Phineas Gage

• Amazingly, he was talking and could walk. He lost
  a lot of blood, but after a bout with infection,
  he not only survived to the ghastly lesion, but
  recovered well, too.

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Phineas Gage

• He became extravagant and anti-social, a
  fullmouth and a liar with bad manners, and could
  no longer hold a job or plan his future.  "Gage
  was no longer Gage",

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Phineas Gage

• His skull was recovered and in 1994 researchers
  discovered that most of the damage was done to
  the ventromedial region of the frontal lobes on
  both sides

• The part of the frontal lobes responsible for
  speech and motor functions was apparently spared,
  so they concluded that the changes in social
  behavior observed in Phineas Gage were probably
  due to this lesion

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Phineas Gage

• "Gage's story was the historical beginnings of
  the study of the biological basis of behavior

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Methods of Neuropsychological Assessment

• Medical History
• Clinical Interview
• Behavioral Observations
• Psychometric Tests

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Neuropsych assessment

• Major cognitive domains typically assessed
  include
• Attention
• Memory
• Intelligence
• Visual-Spatial-Perceptual functions

• Psychosensory and Motor abilities
• "Executive" or "Frontal Lobe" functions
• Personality or Emotional Functioning.

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Executive Functioning

• Elaborated functions of
• logic,
• strategy,
• planning,
• problem solving
• reasoning.

• These capacities help us solve problems of all
  sizes in our lives.

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Executive Functioning

• Executive Functioning difficulties relate to
  planning, organizing and strategizing behaviors.

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Executive Functioning

• Analyze the context and the expected objective in
  order to formulate hypotheses on the probable
  outcomes of a decision

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• Behavioral changes are assumed to be due to this
  brain tissue damage.
• For instance, stroke damage to the back of
  brain results in visual difficulties even though
  eyes are intact.

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CNS involvement

• Behavioral manifestation of CNS deficits is
  highly heterogeneous.
• Thus, a battery is often called for.

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Organic Mental Disorders

• Prior to DSM-IV we had a category called organic
  mental disorders for those with a physical or
  organic cause.
• Suggest mind body separation
• Most disorders involve a mix of biological and
  psychological factors

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Dysfunctions of the Brain

• Cause
• Head injuries
• Diseases of the brain
• Endocrinological disorders
• Exposure to toxins

• Symptom
• Depression
• Anxiety
• Delusions
• Mental impairment
• aggressiveness

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Substance Abuse

• One Tequila
• Two Tequila
• Three Tequila
• Floor

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Goal of Neuropsychological assessment

• Originally to Differentiate between organic and
  functional

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Distinguishing Brain Damage

• Lesion Detection
• Localization
• Lateralization

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Neuropsychologist

• A Neuropsychologist is a psychologist who
  specializes in studying brain behavior
  relationships.

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Two approaches

• Comprehensive Battery Approach
• Qualitative hypothesis-testing approach

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Detect Impairment

• The first method is to use an assessment
  technique in which a fixed battery of tests is
  given and in which we only want to know what
  functions are impaired and what functions are not
  impaired.

• The most commonly used representative of this
  type of test is the Halstead - Reitan
  Neuropsychological Battery.

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Advantages of Battery Approach

• Advantages
• Easier to use for research
• Better norms
• Easier to learn

• Disadvantages
• Time consuming
• Can overlook reasons
• Difficult to tailor to client

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Assess level of impairment

• The second method is to assess a hierarchical
  arrangement of items within each subtest so that
  if a function is impaired, the level at which it
  is impaired can be determined.

• The most common representative of this type of
  test is the Luria - Nebraska.

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Advantages of Qualitative approach

• Advantages
• Tailor to individual
• Emphasizes process
• Time efficient
• More depth

• Disadvantages
• Focuses on weaknesses
• More difficult to research
• Requires extensive experience

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Specificity Sensitivity

• Specificity means when we measure "A" with our
  test, we know that the test does not measure "B",
  "C," or "D."

• If we wish to measure a thing "A" then the test
  has to be able to measure "A" even when very
  little of "A" is present this is sensitivity.

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Specificity and Sensitivity

• Specificity- the ability to rule out those
  without the condition

• Sensitivity the ability to provide a definitive
  diagnosis

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Screening Battery

• Visuoconstructive Abilities
• Mental Activity (Attention and speed of
  information processing)
• Memory and Learning
• Verbal Functions and Academic skills

• Motor Performance
• Executive Functions
• Emotional Status

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Interviewing for Brain Impairment

• The strongest tool for a clinician is still a
  clear, thorough and well-informed history.

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Bender Gestalt

• Developed 1938
• Narrow focus resulting in low sensitivity and
  high number of false negatives (misses)

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Bender Gestalt

• The Bender test is a brief, non-verbal assessment
  consisting of nine stimulus cards, each showing a
  figure.The client is asked to reproduce the
  figures.

• The task requires visual association, motor
  coordination,and the ability to integrate
  perceptual and motor skills to achieve accurate
  reproductions

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Bender Gestalt

• The results of the Bender Gestalt alone are
  rarely sufficient to make a differential
  diagnosis between neuropsychological impairment
  and emotional disturbance.

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Training

• Neuropsychologists have extensive training in the
  anatomy, physiology, and pathology of the nervous
  system.

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Changes is Neuropsych Assessment

• Emphasis more on application than measurement.
• Employability
• Treatability
• Need for support

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Impairment vs. Disability

• Impairment reflects normative comparisons and
  test data.
• Disabilty considers context including
  circumstances, environment, interests.

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Functional assessment

• Identifies the vocational and everyday impact of
  cognitive disability, and the real life obstacles
  related to work, school, and daily living.

• Through functional assessment individuals gain a
  better understanding of strengths and needs, and
  the effect these have on career choice

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Executive Functions

• Ability to effectively regulate and direct
  self-behavior.
• Most often involves frontal lobe damage.

• Volition
• Planning
• Purposive action
• Effective performance

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Verbal Functions

• Most frequently associated with left hemisphere
  brain damage
• Aphasia
• Speech production.

• Six Major Functions
• Spontaneous speech
• Speech repetition
• Speech comprehension
• Naming
• Reading
• Writing

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The name for the yellow organism shown below is

• Yellow Jessamine
• Gelsemium sempervirens
• Witch's butter
• Tremella mesenterica,
• King Bolete
• Boletus edulis
• Dog Vomit Slime Mold
• Fuligo Septica

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The End
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Aphasia

• loss or impairment of the power to use or
  comprehend words usually resulting from brain
  damage
• back