Chapter 1: Practice of Neuropsychological Assessment
- Clinical neuropsych = applied science concerned with the behavioral expression of
brain dysfunction
1. 19th century = controlled observations became generally accepted
o Conceptual tool used to lay out the basic schema of brain-behavior
relationships
2. Contributions from:
o Clinical neurosciences
o Psychology:
Assessment dimension = educational psychology (concept of
intelligence); mental measurement specialties (exam screening
techniques)
Cognitive dimension = experimental psychology
- Assessments = address variety of neurological and psychological questions
Examination Purposes:
- Diagnosis:
1. Discriminating between psychiatric and neurological symptoms, identifying
neurological disorders, distinguishing between different neurological conditions
and provide behavioral data to localize site of lesion
2. Imaging = can show site and extent of lesion
o Neuropsych assessment = needed to identify residual behavioral strengths
and deficits
3. Aids in prodromal or early detection and prediction of dementing disorders or
outcomes
4. Screening = used to identify those most likely at risk for some specified condition
or in need of further diagnostic study
- Patient care and planning:
1. Descriptive evaluations = info about cognitive and emotional status is essential for
careful management of disorders
2. Rational planning = depends on understanding one’s abilities and deficits, types of
psychological change, and impact of these changes
3. Use of repeated testing to monitor developments
, 4. Perplexity = self-doubt of brain injured individuals
- Treatment 1 = treatment planning and remediation
1. Delineation of problem areas and evaluation of strengths and potential for
rehabilitation
2. Repeated assessments used to adapt programs and goals to the patient’s changing
needs
- Treatment 2 = treatment evaluation
1. Demonstrate neurobehavioral response to interventions and/or drug efficacy
- Research:
1. Study organization of brain activity and its translation into behavior
2. Investigate specific disorders and behavioral disabilities
- Forensic psychology:
1. Used for diagnostic opinion or to describe one’s neuropsych functioning
2. In criminal cases, used to detect malingerers and exaggerators
Multiple Examination:
- Psychological perspective = neuropsych assessment considers quality of life,
emotional status, and potential for social integration
Validity of Neuropsych Assessment:
- Ecological validity = degree to which neuropsych assessment data reflects everyday
functioning, or predicts future behavior or behavior outcomes
Neuropsych Assessment in the 21st Century:
- Predictions about the future:
1. With their increased efficacy and capacity, computer assessments will continue to
proliferate
2. Neuropsych assessment techniques need to be adaptive and integrative with other
neurodiagnostic and assessment tools
3. Neuropsych maintains its unique role while continuing to contribute to the larger
clinical neuroscience, psychological and medical knowledge base
- The big revolution occurred due to:
1. Neuroinformatics
2. Three factors:
, o Cognitive ontologies
o Collaborative neuropsych knowledge bases
o Universally available and standardized knowledge bases
Lecture 1: Introduction
Learning Goals:
- Basic skills important for neuropsych assessments:
1. Determine for which disorders the neuropsych tests introduced can be used
2. Interpret results of neuropsych assessments
3. Use neuropsych tests that were introduced in differential diagnostics
4. Integrate and interpret results of multiple neuropsych tests
5. Critically judge the use of tests with regard to the manual, test instructions, patient
behavior and environmental factors
Purpose:
- Diagnosis:
1. Distinguish between different neurological disorders
2. Discriminate between psychoactive and neurological disorders
3. Identify possible neurological disorders
4. Neuropsych assessment cannot locate site of lesion!
- Patient care and planning = irrespective of diagnosis; needed for optimal and careful
management of many disorders:
1. Identify cognitive strengths and weaknesses
2. Identify behavioral alterations
3. Identify personality features
- Treatment plan and remediation = finding the most appropriate rehabilitation
treatment
- Treatment evaluation = whether treatment was effective or not
- Research
- Forensic neuropsych:
1. Claims of injury or loss of function
2. Criminal cases:
, o Reasons to suspect brain dysfunction that contributes to misbehavior
o Whether individual’s mental capacity is sufficient to stand trial
Diagnostic Cycle:
- N = 1 study
- Referral question => medical history => (hetero)anamnesis => neuropsych tests =>
report
1. All influenced by formulated hypotheses = based on scientific literature
Evidence-Based Medicine (EBM):
- Clinical judgement, relevant scientific evidence, patient’s values and preferences
Quality of Evidence:
- Background info, expert opinion, non-EBM guidelines
- Observational studies:
1. Individual case reports
2. Case studies
3. Cohort studies
- Experimental studies:
1. Non-randomized controlled trials
2. Randomized controlled trials
- Critical appraisals
1. Systematic reviews
2. Meta-analyses
3. Critically appraised literature = evidence-based practice guidelines
Reason for Hypotheses:
- Without formulating hypotheses:
1. Risk of easily making interpretation errors:
o Tendency to rely strongly on some result and disregard others
o Disregarding the base rates of disorders: one who works with many
Alzheimer’s patients = tendency to diagnose the disorder more often
o Confirmation bias = looking for results to support hypothesis
o Thinking that subjective complaints are objective disorders
- Clinical neuropsych = applied science concerned with the behavioral expression of
brain dysfunction
1. 19th century = controlled observations became generally accepted
o Conceptual tool used to lay out the basic schema of brain-behavior
relationships
2. Contributions from:
o Clinical neurosciences
o Psychology:
Assessment dimension = educational psychology (concept of
intelligence); mental measurement specialties (exam screening
techniques)
Cognitive dimension = experimental psychology
- Assessments = address variety of neurological and psychological questions
Examination Purposes:
- Diagnosis:
1. Discriminating between psychiatric and neurological symptoms, identifying
neurological disorders, distinguishing between different neurological conditions
and provide behavioral data to localize site of lesion
2. Imaging = can show site and extent of lesion
o Neuropsych assessment = needed to identify residual behavioral strengths
and deficits
3. Aids in prodromal or early detection and prediction of dementing disorders or
outcomes
4. Screening = used to identify those most likely at risk for some specified condition
or in need of further diagnostic study
- Patient care and planning:
1. Descriptive evaluations = info about cognitive and emotional status is essential for
careful management of disorders
2. Rational planning = depends on understanding one’s abilities and deficits, types of
psychological change, and impact of these changes
3. Use of repeated testing to monitor developments
, 4. Perplexity = self-doubt of brain injured individuals
- Treatment 1 = treatment planning and remediation
1. Delineation of problem areas and evaluation of strengths and potential for
rehabilitation
2. Repeated assessments used to adapt programs and goals to the patient’s changing
needs
- Treatment 2 = treatment evaluation
1. Demonstrate neurobehavioral response to interventions and/or drug efficacy
- Research:
1. Study organization of brain activity and its translation into behavior
2. Investigate specific disorders and behavioral disabilities
- Forensic psychology:
1. Used for diagnostic opinion or to describe one’s neuropsych functioning
2. In criminal cases, used to detect malingerers and exaggerators
Multiple Examination:
- Psychological perspective = neuropsych assessment considers quality of life,
emotional status, and potential for social integration
Validity of Neuropsych Assessment:
- Ecological validity = degree to which neuropsych assessment data reflects everyday
functioning, or predicts future behavior or behavior outcomes
Neuropsych Assessment in the 21st Century:
- Predictions about the future:
1. With their increased efficacy and capacity, computer assessments will continue to
proliferate
2. Neuropsych assessment techniques need to be adaptive and integrative with other
neurodiagnostic and assessment tools
3. Neuropsych maintains its unique role while continuing to contribute to the larger
clinical neuroscience, psychological and medical knowledge base
- The big revolution occurred due to:
1. Neuroinformatics
2. Three factors:
, o Cognitive ontologies
o Collaborative neuropsych knowledge bases
o Universally available and standardized knowledge bases
Lecture 1: Introduction
Learning Goals:
- Basic skills important for neuropsych assessments:
1. Determine for which disorders the neuropsych tests introduced can be used
2. Interpret results of neuropsych assessments
3. Use neuropsych tests that were introduced in differential diagnostics
4. Integrate and interpret results of multiple neuropsych tests
5. Critically judge the use of tests with regard to the manual, test instructions, patient
behavior and environmental factors
Purpose:
- Diagnosis:
1. Distinguish between different neurological disorders
2. Discriminate between psychoactive and neurological disorders
3. Identify possible neurological disorders
4. Neuropsych assessment cannot locate site of lesion!
- Patient care and planning = irrespective of diagnosis; needed for optimal and careful
management of many disorders:
1. Identify cognitive strengths and weaknesses
2. Identify behavioral alterations
3. Identify personality features
- Treatment plan and remediation = finding the most appropriate rehabilitation
treatment
- Treatment evaluation = whether treatment was effective or not
- Research
- Forensic neuropsych:
1. Claims of injury or loss of function
2. Criminal cases:
, o Reasons to suspect brain dysfunction that contributes to misbehavior
o Whether individual’s mental capacity is sufficient to stand trial
Diagnostic Cycle:
- N = 1 study
- Referral question => medical history => (hetero)anamnesis => neuropsych tests =>
report
1. All influenced by formulated hypotheses = based on scientific literature
Evidence-Based Medicine (EBM):
- Clinical judgement, relevant scientific evidence, patient’s values and preferences
Quality of Evidence:
- Background info, expert opinion, non-EBM guidelines
- Observational studies:
1. Individual case reports
2. Case studies
3. Cohort studies
- Experimental studies:
1. Non-randomized controlled trials
2. Randomized controlled trials
- Critical appraisals
1. Systematic reviews
2. Meta-analyses
3. Critically appraised literature = evidence-based practice guidelines
Reason for Hypotheses:
- Without formulating hypotheses:
1. Risk of easily making interpretation errors:
o Tendency to rely strongly on some result and disregard others
o Disregarding the base rates of disorders: one who works with many
Alzheimer’s patients = tendency to diagnose the disorder more often
o Confirmation bias = looking for results to support hypothesis
o Thinking that subjective complaints are objective disorders
