Beknopte samenvatting B&C2: Clinical Neuropsychology

BRAIN AND COGNITION 2: SUMMARY

Chapter 3: neuropsychology in clinical practice

Neuropsychologists working in hospitals
 Mainly focuses on adults and elderly.
 Collaboration with specialists.
 Maps out the cognitive, emotional and behavioral functioning to determine the
(suspected) disorder.
 Short duration.
 Psycho-education is an important first step in treatment.
 Goal: patient returning to daily activities.

Neuropsychologists working in mental health care
 Examines the relationship between the brain, cognition, emotion and behavior.
 Looking into the nature of psychiatric disorders.
 Diagnostic processes with for example structured interviews to investigate the cause
of the problems.
 Longer duration.
 Working closely with psychiatrists and psychiatric nurses.

Neuropsychologists working in rehabilitation care
 Multidisciplinary approach.
 Both inpatient and outpatient settings.
 Goal: participate in society as independently as possible.
 Diagnosis process has already taken place.
 If treatment stagnates; determine the reason.
 Help with coping.
 Psycho-education.
 Cognitive behavioral therapy.
 Relatives are explicitly involved in the treatment.

Neuropsychologists working in long-term care
 Neurodegenerative diseases.
 Coping with cognitive disorders and behavioral changes.
 Direct treatment is not possible  CBT is already too challenging for them.
 Help how to deal with the patients by observing behavior.

Neuropsychologists working in forensic care
 Working with legal framework; patients are in detention or preventive custody.
 Explanatory diagnostics; can the patients behavior be explained by cognitive
disturbances?
 Serving support for a treatment indication.
 Risk assessment en determine if there could be re-offending.
 Examine if patient pretends to have complaints/exaggerates them to avoid
punishment.

,Neuropsychological examination: consists of a complete hypothesis-testing diagnostic cycle
which is similar to the empirical cycle used in scientific research.

The steps of neuropsychological examination
 Referral question.
o Aim of the assessment must be clear.
 Patient file investigation.
o Medical and psychiatric history.
o Possible previous (neuro)psychological examination.
 Formulating hypothesis.
o Specific set of neuropsychological test and questionnaires.
 Extensive clinical interview.
o Complaints are discussed.
 Interviewing informant
o Preferably without the patient so that the informant can speak freely.
 Psychometric test examination.
o The tests results itself but also observations how the patient completes it; the
pace, the mistakes, the working approach, behavior outside of the tests etc.
 Conclusion.
o Recommendations for the patient.

 One must collect sufficient information to answer the question, but the patient must
not be burdened unnecessarily.

Distinction between reported complaints and objectified disorders: patients might find it
difficult to identify the underlying cause of their symptoms. For example: the patients
complaints about having memory deficits, but the memory domain might not be affected.
Instead it could be having difficulty in keeping an overview and planning which results in
‘forgetting things’ rather than memory problems.

Reliability of tests
 Test-retest: another test leads to the same result.
 Inter-rater reliability: different researches should come to the same result.

Validity of tests
 Face validity: does test measure what it is supposed to measure at first sight?
 Content validity: is the test representative for this subject?
 Concept validity: is the result actually an indication for the statement that wants to
be made?
 Criterion validity: can the test predict a patient’s performance on external criterion?
o Predictive validity: how well does a test predict actual behavior?
o Concurrent validity: the comparison between a neurological test and another
instrument that measures the same construct.
 Ecological validity: form of predictive validity that predicts how a patient will
function in their own daily environment.

, Cofounding factors: factors that influence the test results.
 Visual/hearing problems.
 Fatigue.
 Pain.
 Tension.
 Uncertainty of the test.
 Limited commitment or motivation.

Anosognosia: lack of awareness of the illness by the patient.

The Netherlands Institute of Psychologists (NIP): various guidelines.
 Monodisciplinary guideline for neuropsychological research in mild cognitive
impairment and dementia.
 Offers questions you can ask during an interview with the patient or informant.
 Examples for how the results of examination can be discussed with the patient and
relatives.

 You can always deviate from the guidelines for example cultural or educational
reasons of the patient, but this must always be motivated.

Ethics rules according to AST
 The right to view the report before it is issued.
 The right for correction to the report.
 The right to block the report from being issued.

Rowland Universal Dementia Assessment (RUDAS): a screening instrument for dementia
that can also be used in a valid way for patients with different cultural background.
 Standardized testing is based on the western society, so if a patient with a non-
western background needs to have a psychological assessment, adaptations like
these need to be made.

Cognitive multifactorial complaints (biopsychosocial-model): physical complaints that can
negatively influence cognitive functioning and could lead to subjective cognitive complaints.