Transcript Neuropsychological Assessment

Neuropsychological
Assessment
1) Mental Activity-Attention and
speed of information processing
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Filtering, focusing, shifting tracking
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Filter and attend to relevant info/stimulus,
while ignoring the irrelevant
Ability to shift attention and Focus
Either being overly focused or too ready to shift
will cause difficulty (perseverations vs.
distractibility)
 Attention can be measured by reaction time
Trails A & B and Digit Span
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2) Visuoconstructive Abilities
Accurate construction of objects;
Perceptual, Spatial, Motor
Tests for VC: Bender Gestalt, Block
Design, Object Assembly, HTP, Free
Drawing
Bender Gestalt
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Bender Gestalt Test (pg 540 for scoring
sheet) Nine designs to be drawn by
client. Test is brief, economical, flexible,
nonverbal, and researched
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Right hemisphere lesions- fragmented and
lose overall design
Left hemisphere- duplicate design, but leave
out details
This test is to “screen” for severe types of
brain damage DOES NOT DIAGNOS
How Children may compensate can
be seen on the Bender Gestalt
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Reproductions maybe accurate but observe
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Length of time (excessive)
“anchoring” items with a finger
Reproducing by memory
Checking and rechecking dots, but being unsure of
number
Rotating their paper of the card itself
Drawing impulsively/quickly and then correcting with
extreme difficulty
Expressed dissatisfaction with poor designs after
repeated attempts to correct them
Children and inadequate reception
vs expression
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Reception- difficulty in visual perception
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Child report poor designs as accurate
Expression- difficulty in reproducing what
is accurately seen
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Recognition that design has been poorly
reproduced
Block Design and Object Assembly
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Block Design- is more abstract so may
show clients with a more concrete form of
problem solving
Object Assembly-is more concrete, thus
the same person may do well on it
3)Memory and Learning
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Sensory, short-term, long term, rehearsal,
consolidation, recall, recognition and
forgetting
Declarative Memory- learning about
information, objects, and events
Procedural or implicit memory- automatic,
habitual responses
Overview of general intactness of
memory
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Extent to which cl can acquire and retain
material
How quickly material is forgotten
Extent to which competing information interferes
with learning
Degree of specificity or generality of deficit
Stability or fluctuation of deficit over time
Distinguish between memory and attention
Tests of Memory
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Start in the interview
Weschler Memory Scale
WAIS-III or WISC-III
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Digit symbol coding, information, (digit span,
letter-number sequencing-measure attention
too)
Rey Auditory Verbal Learning Test- Cl
repeats back a list of 15 unrelated words
4) Verbal Functions and Academic
Skills
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Aphasias- impaired speech, writing or
understanding spoken or written language
Problems with speech production
Resulting in poor articulation, loss of
verbal fluency, word-finding problems,
poor repetition of words/sentences, poor
auditory comprehension, reading
difficulties and impaired writting
Tests for Verbal Functions
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Information, Comprehension, Similarities,
Vocabulary, and Arithmetic
Clinical Interview noting for difficulties
Controlled Oral Word Association- Cl says
as many words as possible beginning with
a certain letter in a fixed amount of time
5) Executive Functions
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Ability to regulate and direct self behavior
Initiate, Plan, Act purposefully, and
Effective performance
Frontal lobe damage is most typically the
difficulty and can be impaired while other
cognitive functioning remains intact
Interview, behavioral observations, look
for detail in description of activities, family
members ( due to lack of awareness)
What to look for in assessing
executive functions
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Does patient initiate activity?
Are there unusual social behaviors?
Are these behaviors pre or post morbid if there
is an injury?
Look at planning abilities when cl organize
Bender Gestalt, Bock Design, Stories on TAT.
Do they have difficulty attending to stimuli while
simultaneously performing another task
(freedom from distractibility on WISC/WAIS)
6) Motor Performance
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Expected difference between the
dominant hand and the nondominant
hand should be 10%. Differences of 20%
or more infer lesions contralateral to the
side of weakness or slowing. (Use with
Caution)
Finger Tapping Test
7) Emotional Status
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Are Cognitive difficulties the cause or result of
emotional problems?
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Concentration (Anxiety, Depression)
Impulsivity (Anxiety, ADHD)
Processing speed- (depression)
Retention and Retreval (Anxiety)
Paranoia, aggressiveness, and irritability can effect
test results
Limited self-awareness, impulsivity, concreteness, and
poor social awareness could be due to frontal lobe
damage
LD can lead to depression and anxiety
Assessing LD and ADHD
See Worksheet