Psychology 125: Clinical Neuropsychology and Assessment Lecture 5: Neuropsychological Assessment Fredric E. Rose, Ph.D.
Distribution of Neuropsychology Practice
Gordon & Zillmer, 1997
Types of Patients Seen by Neuropsychologists
Gordon & Zillmer, 1997
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Aims of Clinical Assessment • • • • •
Describe behavior Diagnose problems Predict risks and outcomes Monitor treatment responses Guide interventions
Overview of the Neuropsychologist’s Role in Assessment
Gordon & Zillmer, 1997
General Considerations in Neuropsychological Testing • Basic definition: An objective, comprehensive assessment cognitive and behavioral functioning • The neuropsychologist integrates his/her findings with the data from other assessments
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General Considerations in Neuropsychological Testing • Through testing, link cognitive functioning to CNS integrity • Facilitates diagnosis, rehabilitation and treatment
– Advantages of the NP evaluation – Similarity of NP evaluation to other psychological assessments
Key Concepts in Assessment • Reliability – Consistency in measurement – Test retest, split-half, internal consistency
• Validity – Measuring what you think you’re measuring in this context? – Face, construct, content, criterion
• Standardization – Consistent use of a technique
Relationship Between Reliability and Validity A measure cannot be valid unless it is reliable, though a measure can be reliable but not valid
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Relationship Between Reliability and Validity
Relationship Between Reliability and Validity
Relationship Between Reliability and Validity
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Relationship Between Reliability and Validity
Psychometric Issues • Diagnosis and Signal Detection Disease Present Test: Positive Test: Negative
Disease Absent
Valid acceptance
False Positive
(hit)
(Type I error, false alarm)
False Negative (Type II error, miss)
Valid rejection (Correct rejection)
Psychometric Issues True Status Test Result
AD
NL
Positive
90
20
110
Negative
10
80
90
100
100
200
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The Effect of Base Rates True Status Test Result
AD
NL
BR = 50%
Positive
90
20
90/(90+20) PPV =.82
Negative
10
80
80/(10+80) NPV = .89
90/(90+10) Sens = .90
80/(80+20) Spec. = .80
200
The Effect of Base Rates True Status Test Result
AD
NL
BR = 10%
Positive
18
36
18(18+36) PPV = .33
Negative
2
144
144(2+144) NPV = .99
18/(18+2) Sens = .90
144/(144+36) Spec. = .80
200
General Considerations in Neuropsychological Testing
• Approaches to Assessment – Flexible Battery
• Individually tailored for each patient • “Hypothesis Testing”
– Fixed • A pre-determined set of tests used for every patient.
– Both approaches have benefits and drawbacks
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Neuropsychological Assessment • • • • • • •
Review background Available medical records Interview (+ mental status exam) Testing Written report Feedback Followup
Domains of Assessment • My Soup Lacks Many Hot Peas – Motor – Sensory/Perceptual – Language – Memory – Higher Cognitive Functioning – Personality/Emotional
Neuropsychological Tests • Motor Skills – Fine and gross manual motor speed/dexterity – Graphomotor skills (drawing tasks) and motor apraxia (ability to carry out motor sequences)
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Neuropsychological Tests • Sensation and Perception – Helps to rule out dysfunctional sensory/perceptual systems in test performance – One standardized test: The Sensory/Perceptual Exam from the HRNB – Visuospatial functioning is a higher level component • With/without motor involvement • Construction, drawing, perception
Neuropsychological Tests • Examples of Visuospatial Testing: – Spatial orientation, directional skills, map-reading – Clock drawing – Spatial manipulation – Visual sequencing – Facial recognition (of both the face itself and facial affect)
Neuropsychological Tests • Language – Receptive / comprehension • Simple spoken commands • Three-step commands (e.g., as in MMSE)
– Expressive speech • • • •
Defining words Repetition (e.g., as in MMSE) Verbal fluency Naming
– Reading, writing, and spelling
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Neuropsychological Tests • Memory – Mostly test episodic and semantic – Interview about history (retrograde) – Declarative • Stories • Lists • Figures
– Acquisition, recall, recognition
Neuropsychological Tests • Higher Cognitive Functions – Attention/Concentration • Immediate • Sustained
– Executive Functioning • Abstract reasoning • Novel problem solving • Cognitive flexibility
Stroop Color Word Test
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Wisconsin Card Sorting Test
Neuropsychological Tests • Personality/Mood – Minnesota Multiphasic Personality Inventory 2nd Edition (MMPI-2) • 744 true-false items; 11 clinical scales • “I am easily angered when things don’t go my way.”
– Disorder-specific
After the Assessment • Written report – Objective – MUST provide specific, meaningful recommendations capable of being implemented
• Feedback • Follow-up
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