Summary Knowledge Clips needed for the Quizzes of Neuropsychological Assessment Tilburg University

Knowledge Clips Neuropsychological Assessment A.E.M. van Wordragen


Why a Neuropsychological Assessment?
o There are mainly 6 different categories on why you would perform a neuropsychological
assessment:
 Diagnosis
 Identifying a neurological disorder
 Discriminate between psychiatric and neurological symptoms
 Helping to localize the site of lesion
 Describing neuropsychological status
 How a particular disease or lesion is affecting the patient’s cognition,
behavior, personality and emotion.
 Treatment planning
 Assessment of impairments and strengths
 Treatment evaluation
 Improvements by treatments
 Rehabilitation
 Research
 Fundamental: neuropsychological bases of behavior.
 Clinical: brain disorders, behavioral disabilities, research based best
rehabilitation treatments.
 Forensic applications
 Used in legal proceedings



The Process: the Referral
o The referral = the reason for a neuropsychological assessment.
o It is important to clarify the reason for the referral to get a good assessment plan.
o To clarify the reasons for the referral, the initial interview can be used.



The Process: the Initial Interview
o The aims of the initial interview:
 Clarify the referral so concrete assessment goals can be made.
 Gather important background information about the patient (anamnesis).
 Hypothesis
 Impact of symptomatology on the daily life of the patient
 Know the expectations of the patient about the assessment
o Topics to be covered in the initial interview:
 Identifying information > age, sex, martial status, race etc.
 Reasons for referral

,Knowledge Clips Neuropsychological Assessment A.E.M. van Wordragen


 Assessment goals (if different from the referral) > differential diagnoses,
establish a baseline to measure future improvement/decline.
 Presenting problems > cognitive, physical, and psychological
 Onset and course of the current problem(s)
 Functional status > how are the symptoms affecting daily life activities (ADLs)
 Past medical and psychiatric history
 Medications
 Substance use history
 Family medical and psychiatric history
 Academic history
 Occupational history > what did the patient do for a living, is the patient
currently working, is the person able to return to work?
 Social history > quality of relationships
 Legal issues/history
 Collateral report > hetero-anamnesis
 Behavioral observations



The Process: Hypotheses & Test Selection
o 3 main approaches for the selection of tests for an assessment:
 Fixed battery approach > the examinator gives the same test to every patient.
The examinator knows which test is being performed even before meeting the
patient.
 Totally flexible battery approach > the examinator chooses the tests entirely on
the patient.
 Intermediate flexible battery approach > different subsets of tests are used
(Alzheimer/Parkinson).
o Referral + initial interview > anamnesis > hypothesis > initial test battery
o The selection of tests depends on different factors:
 Good psychometric properties & appropriate norms
 Face validity > it appears to measure what is should be measuring.
 Ecological validity > predict behavior in everyday situations.
 Reliability > constant and accurate results
 Sensitivity > proportion of people with the target disorder who have a
positive result. The degree to which a test can diagnose the patients with
the disease.
 Specificity > proportion of people without the target disorder who have a
result within normal range. The degree to which the test can discriminate
the patients without the disorder.
o Positive predictive value of a test > the probability that a person with a positive test
performance (abnormal) has the target condition.

, Knowledge Clips Neuropsychological Assessment A.E.M. van Wordragen


o Negative predictive value > the probability that a person with a negative test
performance (normal) does not have the target condition.
o When doing a test multiple times to see possible treatment progression, parallel forms of
a test a necessary to sort out learning.
o Also administration time is important to cancel out fatigue.
o Costs and availability (language and cultural norms).



The Process: the End
o Do the results of the tests confirm the hypotheses.
o There are 2 kinds of reports:
 Interpretive interview > explain the results of the assessment (face to face) and
to give recommendations. Also advice giving is an important part of this
interview. The interpretive interview may be seen as the beginning of the
treatment.
 Written report > a communication of the results for the patient of patient’s
family. Therefore, 3 ‘rules’ may be used to write the report in easy to write text:
 Grandmother rule > use words and expressions your grandmother would
understand. Avoid profession jargon and technical expressions.
 Shakespeare rule > use commonly understood words and expressions.
 Don’t overwrite > use short sentences and simple language.
o Content of most reports:
 Identifying report (also about the examiner)
 Referral information
 Current complaints and history of complaints
 Medical, social and psychiatric history
 Current medications
 Mental status and general constitutions (observations)
 Assessment procedures
 Neuropsychologic functioning (results)
 Psychological and personality functioning
 Conclusions and diagnostic impressions
 Recommendations



The Description of Test Scores
o To interpret scores you need to describe the scores in distance in Standard Deviation to
the Mean of the population.
o To determine if a patient has cognitive impairment, the examiner needs to interpret the
test scores together with the anamnesis, (possible) premorbid level, and a pattern
analysis.