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Neuropsychological Assessment. William P. Wattles, Ph.D. Francis Marion University. Practicum Log. Supervision Hours (coaching, feedback sessions, etc.) (S), Student-contact Hours (i.e. assessment, intervention) (ST),

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neuropsychological assessment

Neuropsychological Assessment

William P. Wattles, Ph.D.

Francis Marion University

practicum log
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)
neuropsychology
Neuropsychology
  • Nothing more than the study of human brain/behavior relationships.
neuropsychology goals
Neuropsychology goals
  •  Diagnosis determine the nature of the underlying problem.
  • Understand the effects of any brain injury
  • measure change in functioning over time, such as to determine the consequences of treatment
neurologist
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
neuropsychologist
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
slide9
Classically, brain/behavior relationships have been inferred from the study of individuals with head injuries, tumors, neurological disease, and other unpleasant brain pathologies.
phineas gage
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.
phineas gage1
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",
phineas gage2
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

Phineas Gage
phineas gage3
Phineas Gage
  • "Gage's story was the historical beginnings of the study of the biological basis of behavior
methods of neuropsych assessment
Methods of Neuropsych Assessment
  • Medical History
  • Clinical Interview
  • Behavioral Observations
  • Psychometric Tests
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.

Neuropsych assessment
executive functioning
Elaborated functions of

logic,

strategy,

planning,

problem solving

reasoning.

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

Executive Functioning
executive functioning1
Executive Functioning
  • Executive Functioning difficulties relate to planning, organizing and strategizing behaviors.
executive functioning2
Executive Functioning
  • Analyze the context and the expected objective in order to formulate hypotheses on the probable outcomes of a decision
slide19
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.
cns involvement
CNS involvement
  • Behavioral manifestation of CNS deficits is highly heterogeneous.
  • Thus, a battery is often called for.
organic mental disorders
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
dysfunctions of the brain
Cause

Head injuries

Diseases of the brain

Endocrinological disorders

Exposure to toxins

Symptom

Depression

Anxiety

Delusions

Mental impairment

aggressiveness

Dysfunctions of the Brain
substance abuse
One Tequila

Two Tequila

Three Tequila

Floor

Substance Abuse
goal of neuropsychological assessment
Goal of Neuropsychological assessment
  • Originally to Differentiate between organic and functional
distinguishing brain damage
Distinguishing Brain Damage
  • Lesion Detection
  • Localization
  • Lateralization
neuropsychologist1
Neuropsychologist
  • A Neuropsychologist is a psychologist who specializes in studying brain behavior relationships.
two approaches
Two approaches
  • Comprehensive Battery Approach
  • Qualitative hypothesis-testing approach
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.

Detect Impairment
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

Advantages of Battery Approach
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.

Assess level of impairment
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

Advantages of Qualitative approach
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.

Specificity & Sensitivity
specificity and sensitivity
Specificity- the ability to rule out those without the condition

Sensitivity the ability to provide a definitive diagnosis

Specificity and Sensitivity
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

Screening Battery
interviewing for brain impairment
Interviewing for Brain Impairment
  • The strongest tool for a clinician is still a clear, thorough and well-informed history.
bender gestalt
Bender Gestalt
  • Developed 1938
  • Narrow focus resulting in low sensitivity and high number of false negatives (misses)
bender gestalt1
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

Bender Gestalt
bender gestalt2
The results of the Bender Gestalt alone are rarely sufficient to make a differential diagnosis between neuropsychological impairment and emotional disturbance. Bender Gestalt
rbans
RBANS
  • Repeatable Battery for Assessment of Neuropsychological Status (1998)
  • Focuses on Verbal skills, attention, visual memory, and visuoconstruction.
  • 11 subtests
  • 5 indices
rbans1
RBANS
  • Broad band (Assesses multiple domains)
  • Brief (under 30 mins)
  • Portable
  • alternate forms
  • moderate difficulty
rbans2
RBANS
  • Standard scores with mean of 100 and standard deviation of 15.
  • Thus, 70 represents the 2nd percentile.
slide42

Utility of the RBANS in detecting cognitive impairment associated with Alzheimer’s disease: Sensitivity, specificity, and positive and negative predictive powers

  • Duff, et al 2009
  • Each patient with AD was matched to a comparison patient on variables shown to affect cognitive functioning (i.e., age, education, and gender) (In matching patients, age was considered first, followed by education, followed by gender
slide43

 Results suggest that RBANS scores yield excellent estimates of diagnostic accuracy and that the RBANS is a useful screening tool in detection of cognitive deficits associated with AD.

training
Training
  • Neuropsychologists have extensive training in the anatomy, physiology, and pathology of the nervous system.
changes is neuropsych assessment
Changes is Neuropsych Assessment
  • Emphasis more on application than measurement.
    • Employability
    • Treatability
    • Need for support
impairment vs disability
Impairment vs. Disability
  • Impairment reflects normative comparisons and test data.
  • Disabilty considers context including circumstances, environment, interests.
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

Functional assessment
executive functions
Ability to effectively regulate and direct self-behavior.

Most often involves frontal lobe damage.

Volition

Planning

Purposive action

Effective performance

Executive Functions
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

Verbal Functions
the name for the yellow organism shown below is
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
aphasia
Aphasia

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

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