Basic issues in neuropsychological assessment

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Basic issues in neuropsychological assessment

• Verbal functions

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Cognition
Speech and language
Memory
Attention and goal dircted behavoiurs
Orientation in time and space
Emotions
Personality
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Disorders of verbal functions

• Aphasias
• Dysarthria
• Aprxias of speech

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Possible symptoms in aphasia

• inability to comprehend language
• inability to pronounce, not due to muscle
  paralysis or weakness
• inability to speak spontaneously
• inability to form words
• inability to name objects
• poor enunciation
• excessive creation and use of personal neologisms
  
• inability to repeat a phrase
• persistent repetition of phrases
• paraphasia (substituting letters, syllables or
  words)
• agrammatism (inability to speak in a
  grammatically correct fashion)
• dysprosody (alterations in inflexion, stress, and
  rhythm)
• incompleted sentences
• inability to read
• inability to write

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Clasification of aphasias

• Fluent aphasias, also called receptive aphasias,
  are impairments related mostly to the input or
  reception of language, with difficulties either
  in auditory verbal comprehension or in the
  repetition of words, phrases, or sentences spoken
  by others.
• Speech is easy and fluent, but there are
  difficulties related to the output of language as
  well, such as paraphasia.
• Examples of fluent aphasias are Wernicke's
  aphasia, Transcortical sensory aphasia,
  Conduction aphasia, Anomic aphasia

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• I called my mother on the television and did
  not understand the door. It was too breakfast,
  but they came from far to near. My mother is not
  too old for me to be young.
• patient with
  Wernickes aphasia

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Clasification of aphasias

• Nonfluent aphasias, also called expressive
  aphasias are difficulties in articulating, but in
  most cases there is relatively good auditory
  verbal comprehension.
• Examples of nonfluent aphasias are Broca's
  aphasia, Transcortical motor aphasia, Global
  aphasia

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Clasification of aphasias

• "Pure" aphasias are selective impairments in
  reading, writing, or the recognition of words.
• These disorders may be quite selective. For
  example, a person is able to read but not write,
  or is able to write but not read.
• Examples of pure aphasias are Alexia, Agraphia,
  Pure word deafness

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Brocas and Wernickes areas
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Dysarthria

• A motor speech disorder resulting from
  neurological injury, characterised by poor
  articulation
• Any of the speech subsystems (respiration,
  phonation, resonance, prosody, articulation and
  movements of jaw and tongue) can be affected.

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Apraxia of speech

• A motor speech disorder (MSD) affecting an
  individual's ability to translate conscious
  speech plans into motor plans. Like other
  apraxias, it only affects volitional movement
  patterns.

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• together with aphasia writing and reading skills
  might be impaired
• aphasia might be mistaken with (e.g)
• general confusional state
• hearing disorder

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During examination

• You are checking the following aspects of verbal
  behaviour
• Spontaneous speech
• Repetition of words phrases sentences
• (toungue twisters tests for integrity of
  connections between the center for expressive
  speech - Brocas area and receptive speech
  centre Wernickes area)
• Speech comprehension (simple commands yes, no
  questions requests to point specific subjects)
• Naming (What is this?)
• Reading
• Writing

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During examination

• Ease and quality of production (fluency)
• Articulatory errors
• Speech rythyms intonation (prosody)
• Grammar and syntax
• Presence of mispoken words (paraphasias)

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Aphasia tests and batteries

• Boston Diagnostic Aphasia Examination (BDAE-2
  Goodlass, Kaplan, 1983 a,b BDAE-3 Goodlass,
  Kaplan, Barresi, 2000)
• Multilingual Aphasia Examination (MAE) (Benton,
  Hamster, 1989 Benton, Hamster, Sivan, 1994)

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Boston Diagnostic Aphasia Examination

• Aphasia Severity Rating Scale
• Rating Scale Profile of Speech Characteristics
• Subtest Summary Profile

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Boston Diagnostic Aphasia Examination

• Auditory comprehension
• Word discrimnation
• Body-part identification
• Complex ideational material

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Boston Diagnostic Aphasia Examination

• Oral expression
• Nonverbal agility
• Verbal agility
• Automatized sequences
• Recitation, singing, rhythm
• Repetition of words
• Repeating phrases and sentences
• Word reading
• Responsive naming
• Visual confrontation naming
• Animal naming
• Oral sentence reading

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Boston Diagnostic Aphasia Examination

• Understanding written language
• Symbol and word discrimination
• Phonetic association
• Word-picture matching
• Reading sentences and paragraphs

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Boston Diagnostic Aphasia Examination

• Writing
• Mechanics of writing
• Recall of written symbols
• Written word finding
• Written formulation

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Aphasia Screening Tests

• Token Test (De Renzi, Vignolo, 1966 Baller,
  Vignolo 1962)
• Aphasia Screening Test (Halstead, Wepman, 1959)

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Verbal Expression

• Naming
• Vocabulary
• Discourse
• Verbal fluency

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Verbal Academic Skills

• Reading
• Writing
• Spelling
• Knowledge aqusition and retention

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Naming

• Inability to pull out the correct word at will
• Boston Naming Test (BNT) (Goodlass, Kaplan, 2001)
• Consists of 60 large ink drawings revised ed.
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• Adults begin with position nr 30 (unless 8
  correct answers)
• 8 mistakes you stop the test
• Semantic or phonetic cues possible
• Decline after 70s, 60s qualitative differences
• Aphatic patients more persevaration errors

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Vocabulary

• Wechsler (1955, 1981, 1997a)
• What does . mean- 33 trails scoring 1-2
  points
• Results rising in 20 falling after 70
• Educational factor
• Not one of the most depressed by left hemisphee
  demage
• Nonverbal response vocabulary tests

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Discourse

• Story telling
• Describing activities work dificulty in
  comparison among patients routine activities
  discription

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Verbal fluency

• Changes in speed and ease of verbal production
• Not only in patients with aphasia but also
  frontal lobes trauma (responsible in general for
  fluency), and difuse brain damage
• Fluency problems may show up in speech, writing
  and reading

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Fluency of speech

• subjects ability to organize output in terms of
  clusters of meaningfully related words
• Controlled Oral Word Association (COWA) (Benton,
  Hamster, 1989 Spreen, Straus, 1998)

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The Right Hemisphere Language Battery (K. L.
Bryan, 1995)

• Lexical-semanting processing
• Complex language processing
• Metaphorical language
• Humour
• Integration of linguistic information
• Discourse
• Prosody and stress

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Biblography

• Lezak, M., Howieson, D. B., Loring, D. W. (2004).
  Neuropsychological assessment. Oxford University
  Press
• Verbal Functions and Language Skills, p.500-530