Outline Health & Neuropsychology,Neuropsychological Assessment Background on brain function & behavior Goals of neuropsychological assessment Psychometric approach advantages Psychometric approach interpretation Neuropsychological Test Batteries Halstead-Reitan,Outline Health & Neuropsychology,IQ and Neuropsychological Testing Malingering Functions of interest to neuropsychologists Laterality Visual Perception Language Memory Attention & Executive Control,Neuropsychological 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.,Goals of neuropsychological assessment,Diagnosis,What happened? What went wrong as a result?,Goals of neuropsychological assessment,Diagnosis Description,Cognitive and behavioral deficits that result,Goals of neuropsychological assessment,Diagnosis Description Tracking changes,in patients performance over time, to monitor healing/worsening and effects of treatment,Psychometric assessment - advantages,Standardized:,Repeatable instructions, presentation, and tasks Norms,Psychometric assessment - advantages,Standardized Intensive:,Multiple measures within and among wide range of domains,Psychometric assessment - advantages,Standardized Intensive Sensitive,Valid indicators of skills, capable of detecting abilities and deficits,Psychometric assessment advantages,Standardized Intensive Sensitive Scaled,Hierarchical items start/stop rules,Psychometric assessment advantages,Standardized Intensive Sensitive Scaled Precise,Allows reliable, exacting quantification of relative abilities Allows comparison within/over time,Psychometric assessment Interpretation,Quantitative observations: Many tests give standardized scale scores (like Wechsler tests) based on norms,Actuarial results (e.g., Boston Aphasia Battery) profile of subtest scores indicates nature of disorder Cut-off scores used to make decisions,Psychometric assessment Interpretation,Neuropsychologists also make up tests as needed these typically are not standardized, so interpretation may be problematic.,Example: line-crossing task used to detect “neglect” following right-hemisphere brain damage,Line-crossing task to detect neglect,What do we know about this test? What cognitive operations are involved in test performance?,Why do neglect patients fail at this test? Is this test valid? Reliable?,IQ and neuropsychological testing,IQ is frequently of interest to clinicians testing a BD patient.,Often difficult to use a regular IQ test with patients e.g., they may not understand instructions, or may not be able to move their right hand,IQ and neuropsychological testing,We sometimes try to estimate pre-morbid IQ on the basis of education, job, or other evidence,Individual IQ subtests are often used to assess broader cognitive skills without producing a full IQ score,Estimating pre-morbid IQ,Clinical approaches,Educational level Vocabulary skills Occupational background, farm size Functional capacities: self-care, finances, drivers license, food preparation, parenthood, daily activities,Estimating pre-morbid IQ,Clinical approaches Actuarial & psychometric approaches,Demographic Formulas Reading level Subtest pattern,Neuropsychological test batteries,Test batteries are large sets of tests that tap a variety of skills and abilities Developed before the era of scanning, in part to help locate site of brain damage Wide variety, large number of tests thought necessary because human behavior is so complex,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 range of cognitive functions and behaviors,To use test batteries or not?,On the minus side: Test-centered rather than patient-centered Time-consuming Patient may fail a test for many different reasons Batteries are developed for general purposes may lack flexibility to assess any given patients idiosyncratic deficits. May reduce clinicians potentially useful curiosity, lead to “cookie-cutter reports.”,Halstead Reitan Neuropsychological Tests,Ward Halstead Ph.D. psychologist, taught in U Chicago Medical School Through 1940s, devised and tried out many tests for use with brain-damaged patients With his student Ralph Reitan, settled on a battery of tests that allowed comprehensive evaluation of BD patients,Reitans four-fold approach,Inferential decision-making using the HRNTB based on:,Level of performance Pattern of performance Specific behavioral deficits Comparison of two sides of the body (right-left comparisons),Reitans four-fold approach,Level of performance,Comparison of individual with normative group