Summary of all 6 lectures of Neuropsychological Assessment 2024

Neuropsychological assessment lecture 1 - Introduction

Purpose of neuropsychological assessment
1. Diagnosis
 Discriminating between psychiatric and neurological disorders
 Identifying a possible neurological disorder
 Distinguish between different neurological disorders
 Neuropsychological assessment cannot localize the site of the lesion. For this you need
neurodiagnostic techniques (neuroimaging).
 Neuroimaging will not identify the behavioural strengths and accompanying deficits. For
this you need neuropsychological assessment.
(Xphrenology)

2. Patient care and planning (most often used purpose)
 Identifying cognitive strengths and weaknesses
 Identifying behavioural alterations
 Identifying personality characteristics
 Needed for optimal and careful management of many disorders/ job selections
 Irrespective of (apart from) a diagnosis

3. Treatment planning and remediation
 What is the most appropriate cognitive rehabilitation treatment?

4. Treatment evaluation
 Did the treatment have an effect?

5. Research
 Examine specific brain disorders and behavioural disabilities
 Development, standardization, and evaluation of NPA techniques

6. Forensic neuropsychology
 In the context of claims of injury and loss of function
 In criminal cases  is there reason to suspect brain dysfunction that contributes to
misbehaviour / is the suspect suitable to stand trial?

Diagnostic cycle




 N=1, number of steps

,  You use hypotheses throughout the cycle. During each step hypotheses can be
formulated, rejected or accepted. By doing this you get a transparent and well-
considered diagnostic process.
 If you don’t formulate hypotheses and go through the diagnostic cycle, you will easily
make interpretation errors:
 Confirmation bias; seek and value supportive evidence for the hypotheses at the expense
of contrary evidence
 Overgeneralizing: if this, then that (similar pattern of scores lead to correlation)
 Disregarding base rates of disorders; when a sign occurs more frequently than the
condition it indicates

Evidence based medicine




EBM = Clinical judgement + relevant scientific evidence + patient’s values and preferences

Two classical approaches




Psychometric approach: Reitan – Halstead test battery
 Standardized assessment and scoring
 Quantitative test approach
 Normative data and cut-off scores
-Ex; tactual performance test  patient is blind-folded and has to place the blocks in their
appropriate space with the dominant hand
-Ex; speech-sounds perception test  patient has to underline the syllable he/she hears
-Ex; trail making test (simple instructions, easy to administer test)
Scoring: for each subtest: does the patient score above/below the cut-off?
Summary index of brain damage: impairment index = #impaired test performances/#tests
Consistency of impairment?

, Criticism:
 A-theoretical (not based on theories about the brain)
 Nonflexible (not adjusted to the individual)
 Only focuses on abilities not on dysfunctions (no insight into the nature or cause of
the problem/gives no direction for rehabilitation)

Behavioural neurological approach: Luria’s behavioural
After 2nd WW, large number of patients with brain injury  developed test battery based on
his view/theory of the brain:
 Functional units  attention (brain stem), perception (posterior) and organization &
planning (anterior)
 Hierarchy within each unit  primary (image), secondary (interpretation) and tertiary
(cross-model integration, combination of senses)




Linking behaviour to neurological regions.
 Based on observation
 Flexible test battery  testing hypotheses
 Qualitative assessment  gives direction to rehabilitation
The tasks are simple because the goal is to provoke symptoms.
Ex: recreating hand gestures, objects in objects drawings, find figure in figure

Criticism:
 Theory is strongly focused in the left and less on the right hemisphere (emotion is not
assessed)
 No empirical testing of theory