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1、OutlineHealth&Neuropsychology概述健康与神经心理学(56),1,Outline Health & Neuropsychology,Neuropsychological AssessmentBackground on brain function & behaviorGoals of neuropsychological assessmentPsychometric approach advantagesPsychometric approach interpretationNeuropsychological Test Batteries Halstead-Reit
2、an,OutlineHealth&Neuropsychology概述健康与神经心理学(56),2,Outline Health & Neuropsychology,IQ and Neuropsychological TestingMalingeringFunctions of interest to neuropsychologistsLateralityVisual PerceptionLanguageMemoryAttention & Executive Control,OutlineHealth&Neuropsychology概述健康与神经心理学(56),3,Neuropsycholog
3、ical testing,Basic ideas:Human mind is most complex system we know of in the universe.Human brain is also very complicated.As a result, there are many ways that things can go wrong.Many combinations of behavioral and mental impairment following an insult to the brain.,OutlineHealth&Neuropsychology概述
4、健康与神经心理学(56),4,Goals of neuropsychological assessment,Diagnosis,What happened? What went wrong as a result?,OutlineHealth&Neuropsychology概述健康与神经心理学(56),5,Goals of neuropsychological assessment,DiagnosisDescription,Cognitive and behavioral deficits that result,OutlineHealth&Neuropsychology概述健康与神经心理学(
5、56),6,Goals of neuropsychological assessment,DiagnosisDescriptionTracking changes,in patients performance over time, to monitor healing/worsening and effects of treatment,OutlineHealth&Neuropsychology概述健康与神经心理学(56),7,Psychometric assessment - advantages,Standardized:,Repeatable instructions, present
6、ation, and tasksNorms,OutlineHealth&Neuropsychology概述健康与神经心理学(56),8,Psychometric assessment - advantages,StandardizedIntensive:,Multiple measures within and among wide range of domains,OutlineHealth&Neuropsychology概述健康与神经心理学(56),9,Psychometric assessment - advantages,StandardizedIntensiveSensitive,V
7、alid indicators of skills, capable of detecting abilities and deficits,OutlineHealth&Neuropsychology概述健康与神经心理学(56),10,Psychometric assessment advantages,StandardizedIntensiveSensitiveScaled,Hierarchical items start/stop rules,OutlineHealth&Neuropsychology概述健康与神经心理学(56),11,Psychometric assessment adv
8、antages,StandardizedIntensiveSensitiveScaledPrecise,Allows reliable, exacting quantification of relative abilitiesAllows comparison within/over time,OutlineHealth&Neuropsychology概述健康与神经心理学(56),12,Psychometric assessment Interpretation,Quantitative observations:Many tests give standardized scale scor
9、es (like Wechsler tests) based on norms,Actuarial results (e.g., Boston Aphasia Battery) pro subtest scores indicates nature of disorderCut-off scores used to make decisions,OutlineHealth&Neuropsychology概述健康与神经心理学(56),13,Psychometric assessment Interpretation,Neuropsychologists also make up tests as
10、 needed these typically are not standardized, so interpretation may be problematic.,Example: line-crossing task used to detect “neglect” following right-hemisphere brain damage,OutlineHealth&Neuropsychology概述健康与神经心理学(56),15,Line-crossing task to detect neglect,What do we know about this test? What c
11、ognitive operations are involved in test performance?,Why do neglect patients fail at this test?Is this test valid? Reliable?,OutlineHealth&Neuropsychology概述健康与神经心理学(56),16,IQ and neuropsychological testing,IQ is frequently of interest to clinicians testing a BD patient.,Often difficult to use a reg
12、ular IQ test with patients e.g., they may not understand instructions, or may not be able to move their right hand,OutlineHealth&Neuropsychology概述健康与神经心理学(56),17,IQ and neuropsychological testing,We sometimes try to estimate pre-morbid IQ on the basis of education, job, or other evidence,Individual
13、IQ subtests are often used to assess broader cognitive skills without producing a full IQ score,OutlineHealth&Neuropsychology概述健康与神经心理学(56),18,Estimating pre-morbid IQ,Clinical approaches,Educational levelVocabulary skillsOccupational background, farm sizeFunctional capacities: self-care, finances,
14、drivers license, food preparation, parenthood, daily activities,OutlineHealth&Neuropsychology概述健康与神经心理学(56),19,Estimating pre-morbid IQ,Clinical approachesActuarial & psychometric approaches,Demographic FormulasReading levelSubtest pattern,OutlineHealth&Neuropsychology概述健康与神经心理学(56),20,Neuropsycholo
15、gical test batteries,Test batteries are large sets of tests that tap a variety of skills and abilitiesDeveloped before the era of scanning, in part to help locate site of brain damageWide variety, large number of tests thought necessary because human behavior is so complex,OutlineHealth&Neuropsychol
16、ogy概述健康与神经心理学(56),21,To use test batteries or not?,On the plus side:Many batteries have known psychometric properties (e.g., reliability, validity).Use of standardized procedure permits comparison of one patient with others, even if the others are tested by different clinicians.Tests cover a wide ra
17、nge of cognitive functions and behaviors,OutlineHealth&Neuropsychology概述健康与神经心理学(56),22,To use test batteries or not?,On the minus side:Test-centered rather than patient-centeredTime-consumingPatient may fail a test for many different reasonsBatteries are developed for general purposes may lack flex
18、ibility to assess any given patients idiosyncratic deficits.May reduce clinicians potentially useful curiosity, lead to “cookie-cutter reports.”,OutlineHealth&Neuropsychology概述健康与神经心理学(56),23,Halstead Reitan Neuropsychological Tests,Ward Halstead Ph.D. psychologist, taught in U Chicago Medical Schoo
19、lThrough 1940s, devised and tried out many tests for use with brain-damaged patientsWith his student Ralph Reitan, settled on a battery of tests that allowed comprehensive evaluation of BD patients,OutlineHealth&Neuropsychology概述健康与神经心理学(56),24,Reitans four-fold approach,Inferential decision-making
20、using the HRNTB based on:,Level of performancePattern of performanceSpecific behavioral deficitsComparison of two sides of the body (right-left comparisons),OutlineHealth&Neuropsychology概述健康与神经心理学(56),25,Reitans four-fold approach,Level of performance,Comparison of individual with normative groups o
21、f impaired and non-impaired persons,OutlineHealth&Neuropsychology概述健康与神经心理学(56),26,Reitans four-fold approach,Level of performancePattern of Performance,Examination of intra-test performance and subtest scores,OutlineHealth&Neuropsychology概述健康与神经心理学(56),27,Reitans four-fold approach,Level of perform
22、ancePattern of PerformanceSpecific Behavioral Deficits (Pathognomonic Signs),Sensitivity to deviant or deficient performance which, of itself, points to impairment,OutlineHealth&Neuropsychology概述健康与神经心理学(56),28,Reitans four-fold approach,Level of performancePattern of PerformanceSpecific Behavioral
23、DeficitsComparison of Two Sides of the Body,Looking for discrepancies in test performance which may reveal weakness or lateralized impairment,OutlineHealth&Neuropsychology概述健康与神经心理学(56),29,Halstead-Reitan Neuropsychological Tests,Category testTests abstraction and reasoningTactual performance testMa
24、nual dexterity, spatial memory, tactile discrimination,Seashore rhythm test & Speech-sounds perception test Attention, concentration, auditory discriminationFinger tapping test Motor speed and manual dexterity,OutlineHealth&Neuropsychology概述健康与神经心理学(56),30,Halstead-Reitan Neuropsychological Tests,Tr
25、ail making (see below)Reitan-Indiana Aphasia Screening Examination,Reitan-Klove Sensory Perceptual ExaminationVersion of standard neurological screening test for sensory processesStrength of Grip TestUses hand dynamometerLateral Dominance Examination,OutlineHealth&Neuropsychology概述健康与神经心理学(56),31,Ma
26、lingering,Faking a disorder or deficit.,Important for legal and financial reasons people sometimes fake a deficit in order to collect insurance payments, or to fraudulently obtain narcotics,OutlineHealth&Neuropsychology概述健康与神经心理学(56),32,Malingering,In general, tests to catch malingering are based on
27、 the fact that malingerers dont know what real deficits look like they often show too much loss of function.,Munchausen Syndrome psychopathology involves faking illness, but not for money or drugsRarely treated successfully,OutlineHealth&Neuropsychology概述健康与神经心理学(56),33,Functions of interest to neur
28、opsychologists,Laterality Visual Perception Language Memory Attention & Executive Control,OutlineHealth&Neuropsychology概述健康与神经心理学(56),34,1. Laterality,Compares functions of the L and R hemispheres of the cortexEspecially important if neurosurgery is planned: where are language functions?,Language fu
29、nctions are in left hemisphere in most people, bilateral in someAnnett Handedness Questionnaire,OutlineHealth&Neuropsychology概述健康与神经心理学(56),35,Annett Handedness Questionnaire,Please indicate which hand you habitually use for each of the following: (R, L or E)1. Writing2. Throwing a ball3. Holding a
30、racquet 4. Striking a match5. Cut with scissors6. Threading a needle7. At top of broom8. At top of shovel9. To deal cards10. To hammer a nail11. To hold a toothbrush12. To unscrew a lidThere are several ways to score this test,OutlineHealth&Neuropsychology概述健康与神经心理学(56),36,2. Visual Perception,Visua
31、l field deficits informal assessment: clinician moves fingers into patients field of vision from the side. Patient announces when he/she can see fingers.,Assessed more precisely using special optometry equipment.,OutlineHealth&Neuropsychology概述健康与神经心理学(56),37,2. Visual Perception,Agnosia inability t
32、o recognize familiar objects visually.Objects can be recognized on basis of sound (e.g., lawnmower),Meaning of objects has not been lost its a deficit of visual recognition.To test ask patient to name various objects,Figure/ground discrimination separate figure from background,The embedded figures t
33、est task is to find all the objects in this figure.,The objects in the embedded figures test stimulus,OutlineHealth&Neuropsychology概述健康与神经心理学(56),41,Visual agnosias,visual object agnosia inability to identify common visual objectsprosopagnosia inability to recognize familiar faces,color agnosia inab
34、ility to discriminate between colors and to name colorssimultanagnosia visual perception of simultaneously presented objects is impaired,OutlineHealth&Neuropsychology概述健康与神经心理学(56),42,Visual Memory,Rey-Osterrieth figurecomplicated, abstract figure (next slide)patient looks at it briefly then asked t
35、o reproduce the figure from memory,scoring is quite complexassesses visual memory, visual construction skill,The Rey-Osterrieth Complex Figure (Osterrieth, 1946),OutlineHealth&Neuropsychology概述健康与神经心理学(56),44,3. Language,A very important function for humans, typically mediated by left hemisphereExpr
36、essive and receptive language can be independently lost or sparedBatteries include Boston Diagnostic Aphasia Examination and Western Aphasia Battery (developed at UWO School of Medicine),OutlineHealth&Neuropsychology概述健康与神经心理学(56),45,Boston Diagnostic Aphasia Examination,Oral Expression word repetit
37、ion, body part naming, visual confrontation namingWriting,Auditory comprehension: Body part identificationUnderstanding written language: Word picture matching.,OutlineHealth&Neuropsychology概述健康与神经心理学(56),46,3. Language,Task-specific tests used with patients having comparatively isolated dysfunction
38、sGraded Naming Test or Boston Naming Test - both assess ability to name objects.,Token Test - detects non-obvious loss of receptive languagePyramid & Palm Trees Test - tests the understanding of words,Graded Naming Test examples test has 30 of these, presented in order of increasing difficulty,Bosto
39、n Naming Test examples,Pyramid,Palm Tree,Fir Tree,3 Picture Version,3 Word Version,Pyramid and Palm Trees Test which one of the two lower items goes with the upper item?,OutlineHealth&Neuropsychology概述健康与神经心理学(56),49,4. Memory,Amnesia is loss of episodic (personal) memory, which may include knowledg
40、e of public people/eventsTwo distinct kinds of amnesia:,Retrograde loss of memory for events from patients pastOld things in memory cannot be retrievedAnterograde loss of ability to store new memories.New things cannot be put into memory,OutlineHealth&Neuropsychology概述健康与神经心理学(56),50,Retrograde amne
41、sia,Boston Remote Memory test2 types of questionsEasyHard,2 types of materialName famous faces (hints given if needed)Events asked to recall information about them,OutlineHealth&Neuropsychology概述健康与神经心理学(56),51,Anterograde amnesia,Warringtons Recognition Memory Test50 faces and 50 words presented se
42、parately2AFC test administered immediately after learning phase,Mild impairment in young patients not detectedSeverely impaired patients may perform at chance. Then, its hard to tell whats wrong with their memory,OutlineHealth&Neuropsychology概述健康与神经心理学(56),52,Anterograde amnesia,Wechsler Memory Scal
43、e IIISeparate short-term and long-term retention scoresTries to differentiate between verbal and non-verbal elements of memory,Includes recall and recognition tests2+ hours to administer,OutlineHealth&Neuropsychology概述健康与神经心理学(56),53,5. Attention & Executive Control,Spatial attention: Line bisection
44、, cancellation tasksSustained attention / vigilance: Continuous performance test (CPT),Focused attention: Dichotic listening / visual searchDivided attention: Trail making, task combinations,OutlineHealth&Neuropsychology概述健康与神经心理学(56),54,Trails A and Trails B from Halstead-Reitan test battery,Outlin
45、eHealth&Neuropsychology概述健康与神经心理学(56),55,5. Attention & Executive Control,Executive functionsAssess higher cortical functions such as planning, response inhibition, controlled functions (e.g., new task, or new environment).,Wisconsin Card Sort Task used frequently,Sort according to unspoken rule; examiner changes rule can patient adapt to new rule?,Sort by number,Sort by color,