Clinical Application of Neuropsychological Test Batteries Clinical Application of Neuropsychological Test Batteries

Edited by THERESA INCAGNOLI Veterans Administration Medical Center Northport, New York and School of Medicine State University of New York Stony Brook, New York GERALD GOLDSTEIN Veterans Administration Medical Center, Highland Drive and University of Pittsburgh Pittsburgh, Pennsylvania and CHARLES J. GOLDEN University of Nebraska Medical Center Omaha, Nebraska

Plenum Press • New York and London Library of Congress Cataloging in Publication Data Main entry under title: Clinical application of neuropsychological test batteries. Includes bibliographies and index. 1. Neuropsychological tests. 2. Halstead-Reitan Neuropsychological Test Bat• tery. 3. Luria-Nebraska Neuropsychological Test Battery. I. Incagnoli, Theresa. II. Goldstein, Gerald, 1931- . III. Golden, Charles J., 1949- [DNLM: 1. Neuropsychological Tests. 2. Neuropsychology. WL 103 C6413j RC386.6.N48C52 1985 152 85-25674 ISBN-13: 978-1-4684-4993-8 e-ISBN-13: 978-1-4684-4991-4 DOl: 10.1007/978-1-4684-4991-4

© 1986 Plenum Press, New York Softcover reprint of the hardcover 1st edition 1986 A Division of Plenum Publishing Corporation 233 Spring Street, New York, N.Y. 10013 All rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher Contributors

Nelson Butters, San Diego Veterans Administration Medical Center and Department of Psychiatry, University of California School of Medi• cine, San Diego, California

Gordon J. Chelune, Veterans Administration Medical Center and De• partment of Psychiatry, University of California, San Diego, California

Kathleen L. Edwards, Department of Psychiatry, University of Pitts• burgh School of Medicine, Pittsburgh, Pennsylvania

William Ferguson, Behavioral Medicine Service, St. Joseph's Hospital, Lancaster, Pennsylvania

Carol Gainer, Murfreesboro, Tennessee

Charles J. Golden, University of Nebraska Medical Center, Omaha, Nebraska

Gerald Goldstein, Veterans Administration Medical Center, Highland Drive, Pittsburgh, and Department of Psychiatry and Psychology, Uni• versity of Pittsburgh, Pittshurgh, Pennsylvania

Harold Goodglass, Boston Veterans Administration Medical Center, and Department of Neurology, Boston University School of Medicine, Boston, Massachusetts

Theresa Incagnoli, Veterans Administration Medical Center, North• port, New York, and School of Medicine, State University of New York, Stony Brook, New York

Robert L. Kane, Veterans Administration Medical Center, East Orange, v vi CONTRIBUTORS

New Jersey and Department of Neurosciences, University of Medicine and Dentistry of New Jersey, Newark, New Jersey

Andrew Kertesz, Department of Clinical Neurological Sciences, st. Joseph's Hospital Research Institute, London, Ontario, Canada

Mark Maruish, National Computer Systems, Minnetonka, Minnesota

Kurt Moehle, Department of Psychology, Purdue University School of Science, Indianapolis, Indiana

Oscar A. Parsons, Department of Psychiatry and Behavioral Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma

Andrew Phay, Veterans Administration Medical Center, Murfreesboro, Tennessee

Abigail Sivan, Child Development Clinic, Department of Pediatrics, University of Iowa, Iowa City, Iowa

Ralph E. Tarter, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

Nils R. Varney, Veterans Administration Medical Center, and Depart• ment of Psychiatry, University of Iowa College of Medicine, Iowa City, Iowa Preface

Clinical neuropsychology has become a field of major prominence dur• ing the past several years, as well as a field of great complexity. As a result of the extensive amount of activity that neuropsychology has experienced recently, two major developments have emerged. First, several approaches have evolved regarding comprehensive neuro• psychological assessment. There are presently several standard test bat• teries in common use, as well as an approach to assessment that does not make use of standard batteries, but rather fits the evaluation accom• plished to the particular diagnostic problems presented by the indi• vidual patient. Second, a great deal of specialization has emerged, with assessment procedures developed for evaluation of specific types of neuropsychological deficit. The purpose of this volume is to review these developments, particularly with reference to their implications for application in clinical settings. The history of this book's development is of particular interest. Some years ago, the Veterans Administration became concerned with developing an optimal method of neuropsychological assessment for its many health-care related facilities. Initially, the problem was con• ceptualized in terms of whether the VA should encourage wider use of the long-established Halstead-Reitan Neuropsychological Test Battery (HRB) or promote more extensive use of the recently developed Luria• Nebraska Neuropsychological Test Battery (LNNB). A conference was funded to bring together authorities in clinical neuropsychology to dis• cuss this matter and present a series of papers to invited psychologists from various VA facilities. However, the planners of the conference soon discovered that a simple comparison between these two pro• cedures would not be the most productive route, and that a broader perspective needed to be taken. It was pointed out that many neuropsy• chologists do not use standard batteries, but have adopted a more flexi• ble approach representing the philosophies of such pioneers in the vii viii PREFACE field as Kurt Goldstein, Heinz Werner, and Alexander R. Luria. It was pointed out further that not all neuropsychological assessment is a matter of administering comprehensive screening batteries of the HRB or LNNB type. Some of it involves detailed assessment of specific areas, notably language, memory, and visual-spatial skills, that may only be briefly evaluated by the standard batteries. Additionally, it became clear that the administration of tests was not the only means of neuro• psychological assessment, and that much can be learned from clinical interviews of the patient, from the medical and social history, and from interviews with informants. The conference that was held, therefore, consisted of a much broader array of topics than was originally contem• plated, and went far beyond comparisons between the HRB and LNNB. There were also papers on memory evaluation, language testing, flexi• ble and individualized approaches to evaluation, and the use of the interview and history in neuropsychological assessment. When this book was planned, the editors took note of these devel• opments in the planning of the conference and of the issues and contro• versies that were raised at the conference itself. They decided that the book should reflect a wide range of assessment strategies and philoso• phies including contributions by advocates of the two major standard neuropsychological batteries, as well as by advocates of the indi• vidualized, flexible battery approach. Furthermore, contributions were invited from individuals with expertise in the use of the interview and history, in the use of standard psychological tests as applied to clinical neuropsychological areas, and in various aspects of specialized testing. The book as a whole therefore reflects a comprehensive overview of the recent status of neuropsychological assessment and of the controver• sies and issues in the field that are of great current interest. The editors are pleased to note, as students of clinical neuropsychology are no doubt aware, that the list of contributors contains individuals who are in distinct disagreement among themselves regarding major philosoph• ical and practical matters. We would like to note the spirit of friendly controversy that characterized the development of the book, and to compliment the contributors not only on their scholarly work, but on their willingness to participate in a joint effort with others of persua• sions different from their own. Drs. Incagnoli and Goldstein would like to acknowledge the sup• port of the Veterans Administration with regard to preparation of the book and for support of the VA-sponsored research that it contains. We are indebted to Joseph 1. Mancusi, Associate Director of Psychology, Veterans Administration, for his encouragement of that conference. Vivian Avery, Nelson Butters, and Andrew Phay were instrumental in planning the conference. Special thanks are also due to Christopher PREFACE ix

Carlson, Chief, Psychology Service, VA Medical Center, Northport, New York for his continued support of this project. We would like to acknowledge the assistance of Lorraine Hummel and Adelaide Goertler for assistance in preparation of the manuscript.

THERESA INCAGNOLI GERALD GOLDSTEIN CHARLES J. GOLDEN Contents

CHAPTER 1

Current Directions and Future Trends in Clinical Neuropsychology 1

Theresa Incagnoli The Evolving Role of the Clinical Neuropsychologist ...... 1 Framework Within Which to Conduct Neuropsychological Evaluation ...... 3 Approaches to Evaluation ...... 7 Current Issues and Future Directions in Clinical Neuropsychology ...... 12 References ...... 32

CHAPTER 2

Clinical Interviewing of the Patient and History in Neuropsychological Assessment 45

Andrew Phay, Carol Gainer and Gerald Goldstein Purposes of the Interview and History in Neuropsychological Assessment ...... 46 The Role of the Interview and History in Treatment Planning .. 53 Assessment Methods ...... 56 General Summary and Conclusions ...... 69 References ...... 70

xi xii CONTENTS

CHAPTER 3

The Role of Standard Cognitive and Personality Tests in Neuropsychological Assessment 75

Gordon J. Chelune, William Ferguson and Kurt Moehle Introduction...... 75 Neuropsychology and the Role of Assessment ...... 76 Neurodiagnosis and the Standard Battery ...... 80 Assessment Versus Screening...... 107 Future D~ections ...... 108 Summary and Conclusions ...... 110 References ...... 111

CHAPTER 4

The Flexible Battery in Neuropsychological Assessment 121

Harold Goodglass Introduction...... 121 Nonfocal Cognitive Deficits and their Evaluation ...... 124 Focal Cognitive Deficits and their Evaluation ...... 128 References ...... 134

CHAPTER 5

Neuropsychological Batteries 135

Ralph E. Tarter and Kathleen 1. Edwards Introduction ...... 135 Characteristics of Test Batteries ...... 136 Types of Test Batteries ...... 137 Theoretical Bias in Battery Development...... 138 A Decision Approach to Systematic Assessment...... 142 The Meaning of Neuropsychological Test Results...... 146 Dimensions of Neuropsychological Assessment ...... 148 Assessment of Children and Adults: Special Considerations. . .. 149 Normative and Criterion Assessment ...... 151 Summary ...... 151 References ...... 152 CONTENTS xiii

CHAPTER 6

Overview of the Halstead-Reitan Battery 155

Oscar A. Parsons Introduction...... 155 Development of the Halstead-Reitan Battery...... 156 Clinical Application of the Halstead-Reitan Battery ...... 163 Examples of Neuropsychological Reports ...... 174 Future Developments of the Halstead-Reitan Battery ...... 184 References ...... 189

CHAPTER 7

The Luria-Nebraska Neuropsychological Battery 193

Charles J. Golden and Mark Maruish The Luria-Nebraska Scales...... 194 Research on the Luria-Nebraska...... 197 Interpretation of the Luria-Nebraska ...... 204 References ...... 227

CHAPTER 8

An Overview of Similarities and Differences between the Halstead-Reitan and Luria-Nebraska Neuropsychological Batteries 235

Gerald Goldstein Introduction...... 235 Historical Considerations ...... 236 Similarities and Differences ...... 243 Questions and Answers ...... 261 Concluding Remarks ...... 268 References ...... 271

CHAPTER 9

Comparison of Halstead-Reitan and Luria-Nebraska Neuropsychological Batteries: Research Findings 277 xiv CONTENTS

Robert L. Kane Studies Using Raters ...... 279 Statistical Relationships ...... 281 The HRB, LNNB, and Psychometric Intelligence ...... 294 The LNNB and the Assessment of Memory ...... 295 Concluding Comments ...... 298 References ...... 300

CHAPTER 10

A Comparison of the Halstead-Reitan, Luria-Nebraska, and Flexible Batteries Through Case Presentations 303

Gerald Goldstein and Theresa Incagnoli Introduction ...... 303 A Case of Huntington's Disease ...... 304 A Case of Schizophrenia ...... 311 A Case of Mnestic Dysfunction in Thalamic Infarction...... 318 Summary ...... 325 References ...... 326

CHAPTER 11

Assessment of Aphasia 329

Andrew Kertesz The Development of Aphasia Testing...... 329 Principles of Aphasia Testing...... 331 Comprehensive Aphasia Examinations ...... 338 Tests of Communicative Function...... 351 Short Screening Tests in Aphasia ...... 352 Aphasia Examinations for Polyglots, and in other Languages ... 354 Modality Specific Tests of Aphasia...... 354 Conclusion ...... 356 References 356

CHAPTER 12

The Clinical Aspects of Memory Disorders: Contributions from Experimental Studies of Amnesia and Dementia 361 CONTENTS xv

Nelson Butters Comparisons of the Memory Disorders of Patients with Alcoholic Korsakoff's Syndrome and Patients with Huntington's Disease ...... 362 Conclusions ...... 379 References ...... 380

CHAPTER 13

Visual-Spatial Disabilities 383

Nils R. Varney and Abigail B. Sivan Introduction ...... 383 Constructional Apraxia ...... 384 Recognition and Discrimination of Faces ...... 388 Dressing Apraxia ...... 389 Optic Ataxia ...... 392 Topographical Disorientation ...... 393 Neglect ...... 395 Perception of Direction ...... 398 Conclusion ...... 399 References ...... 400

Index ...... 403