Summary Neuropsychological Assessment
Functions and Areas
1. Attention - All, especially Frontal
2. Perception - Visual cortex, Occipital lobe
3. Memory - Hippocampus, Thalamus, Mamillary bodies, Fornix, PFC
4. Language - LH, Broca’s, Wernicke’s
5. Executive Functioning- Frontal Cortex, feedback loops
6. Movement - Basal ganglia, Cerebellum, Motor cortex
7. Emotion - Amygdala, PFC, RH
Rest
Important terminology
Comorbidity: interfering diseases
Polypharmacy: interfering medicines
Premorbid: before the disease
General assessment procedure
Examination – referral – decide on approach – clinical interviews – case history – testing –
level of prem. functioning – score and compare – diagnose – treatment – report – feedback
and follow-ups.
Take into account for Neuropsychological Assessment:
- Cognition, emotion and functional problems
- Premorbid functioning levels (not just IQ)
- Patients and proxies used
- Education, age, work, financial situation, relationships, environment etc.
- Who they are vS who they were
- Impairments and strengths are important
- Individual differences cause need for patient-centered care
- Manner of success and failure in tests
Testing premorbid functioning
• NART: National Adult Reading Test: 50 low frequency words, errors define the score,
not for aphasia patients.
• Best Performance Method: Best test scores used for premorbid achievement. Never
only rely on one test alone.
Testing perception Pseudo-agnosia =
no visual analysis
• Farnsworth Panel D15 Test: for colorblindness, check to see the
numbers with deviating colors in the stippled drawing.
Apperceptive agnosia =
• Visual Object and Space Perception (battery): 8 tests namely
cannot perceive an
incomplete letter (20 stimuli), silhouettes (15 animals), object
object as a whole
decision (20 name-meaning), progressive silhouettes (rotation),
dot counting (10), position discrimination (dot in the middle),
Associative agnosia =
number location (dot match example) and cube analysis (count
perceives an object but
blocks).
doesn’t know the
meaning
, • JLO: Judgement of Line Orientation: match with example.
• Recognition of Pictured Objects: Conventional/ unconventional view.
• Face Recognition: with or without emotion.
• Figure and Design Recognition: Visual form discrimination, distinguish in shape, size,
things can be the same form in different objects, DOG = Dog = dog.
• Ghent Overlapping Figures Test: Distinguish overlapping figures. Rosach
• Visual Organization: Three elements: Technique: inky
1. Fill in missing elements (picture completion) figures à what
2. Reorganize jumbled elements (incomplete pictures, Hooper) is it?
3. Impose structure to test stimuli (Rosach Technique, ambiguous
stimuli)
• Hooper Visual Organization Test (VOT): Tests arousal, concept formation, memory,
oral/written labeling. A picture of an object is cut up and the patient has to say what
it is if it was put together.
• Figure-Ground Tests: part of visual interference, Verbal auditory agnosia: word
finding hidden and overlapping figures. deafness, word repetition,
stupid questions.
Olfaction: Odor Detection Test:
UPSIT Auditory amusia: recognition of
familiar music. à Seashore
Test of Musical Talent,
Seashore Rhythm Test
Attention Networks
- Vigilance network: subcortical, brainstem, thalamus, locus coeruleus, right frontal
cortex (waakzaamheid).
- Posterior attention network: for visuospatial orientation and identifying events,
cortex behind central fissure, PPL, inferior temporal cortex.
- Anterior attention network: for executive aspects of attention, frontal gyrus cinguli,
lateral cortex from left frontal lobe, part of basal ganglia.
Levels of attention tests
- Operational = high time pressure = high structure, stimulus driven
- Tactical = intermediate time “ = partially structured, memory “
- Strategic = low time pressure = unstructured, strategy driven
Testing attention
• Neurobehavioral Rating Scale: 27 items, observer rated instrument.
• Cognitive Performance Test: For vigilance, 500 trials, 1’s and 2’s are shown, only click
mouse when 1 is presented.
• Digit Span Forward: for efficiency of attention, for short-term storage capacity, how
fast attentional system operates and how much it can process at once.
• Digit Span Backwards: for working memory and tracking, short term storage capacity,
concrete thinking, difficult for LH problems and visual field deficits.
• Digit Repetition: resistant to effects of many disorders.
• Mental Tracking: Digits backwards, mental controls (count 20 à 0, alphabet, 1 à 40
by 3’s, which is good for progressive deterioration in AD), PASAT (add last called out
Functions and Areas
1. Attention - All, especially Frontal
2. Perception - Visual cortex, Occipital lobe
3. Memory - Hippocampus, Thalamus, Mamillary bodies, Fornix, PFC
4. Language - LH, Broca’s, Wernicke’s
5. Executive Functioning- Frontal Cortex, feedback loops
6. Movement - Basal ganglia, Cerebellum, Motor cortex
7. Emotion - Amygdala, PFC, RH
Rest
Important terminology
Comorbidity: interfering diseases
Polypharmacy: interfering medicines
Premorbid: before the disease
General assessment procedure
Examination – referral – decide on approach – clinical interviews – case history – testing –
level of prem. functioning – score and compare – diagnose – treatment – report – feedback
and follow-ups.
Take into account for Neuropsychological Assessment:
- Cognition, emotion and functional problems
- Premorbid functioning levels (not just IQ)
- Patients and proxies used
- Education, age, work, financial situation, relationships, environment etc.
- Who they are vS who they were
- Impairments and strengths are important
- Individual differences cause need for patient-centered care
- Manner of success and failure in tests
Testing premorbid functioning
• NART: National Adult Reading Test: 50 low frequency words, errors define the score,
not for aphasia patients.
• Best Performance Method: Best test scores used for premorbid achievement. Never
only rely on one test alone.
Testing perception Pseudo-agnosia =
no visual analysis
• Farnsworth Panel D15 Test: for colorblindness, check to see the
numbers with deviating colors in the stippled drawing.
Apperceptive agnosia =
• Visual Object and Space Perception (battery): 8 tests namely
cannot perceive an
incomplete letter (20 stimuli), silhouettes (15 animals), object
object as a whole
decision (20 name-meaning), progressive silhouettes (rotation),
dot counting (10), position discrimination (dot in the middle),
Associative agnosia =
number location (dot match example) and cube analysis (count
perceives an object but
blocks).
doesn’t know the
meaning
, • JLO: Judgement of Line Orientation: match with example.
• Recognition of Pictured Objects: Conventional/ unconventional view.
• Face Recognition: with or without emotion.
• Figure and Design Recognition: Visual form discrimination, distinguish in shape, size,
things can be the same form in different objects, DOG = Dog = dog.
• Ghent Overlapping Figures Test: Distinguish overlapping figures. Rosach
• Visual Organization: Three elements: Technique: inky
1. Fill in missing elements (picture completion) figures à what
2. Reorganize jumbled elements (incomplete pictures, Hooper) is it?
3. Impose structure to test stimuli (Rosach Technique, ambiguous
stimuli)
• Hooper Visual Organization Test (VOT): Tests arousal, concept formation, memory,
oral/written labeling. A picture of an object is cut up and the patient has to say what
it is if it was put together.
• Figure-Ground Tests: part of visual interference, Verbal auditory agnosia: word
finding hidden and overlapping figures. deafness, word repetition,
stupid questions.
Olfaction: Odor Detection Test:
UPSIT Auditory amusia: recognition of
familiar music. à Seashore
Test of Musical Talent,
Seashore Rhythm Test
Attention Networks
- Vigilance network: subcortical, brainstem, thalamus, locus coeruleus, right frontal
cortex (waakzaamheid).
- Posterior attention network: for visuospatial orientation and identifying events,
cortex behind central fissure, PPL, inferior temporal cortex.
- Anterior attention network: for executive aspects of attention, frontal gyrus cinguli,
lateral cortex from left frontal lobe, part of basal ganglia.
Levels of attention tests
- Operational = high time pressure = high structure, stimulus driven
- Tactical = intermediate time “ = partially structured, memory “
- Strategic = low time pressure = unstructured, strategy driven
Testing attention
• Neurobehavioral Rating Scale: 27 items, observer rated instrument.
• Cognitive Performance Test: For vigilance, 500 trials, 1’s and 2’s are shown, only click
mouse when 1 is presented.
• Digit Span Forward: for efficiency of attention, for short-term storage capacity, how
fast attentional system operates and how much it can process at once.
• Digit Span Backwards: for working memory and tracking, short term storage capacity,
concrete thinking, difficult for LH problems and visual field deficits.
• Digit Repetition: resistant to effects of many disorders.
• Mental Tracking: Digits backwards, mental controls (count 20 à 0, alphabet, 1 à 40
by 3’s, which is good for progressive deterioration in AD), PASAT (add last called out
