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Unit 3 Neuropsychology Test Batteries Neuropsychological UNIT 3 NEUROPSYCHOLOGY TEST Assessment and Screening BATTERIES Structure 3.0 Introduction 3.1 Objectives 3.2 Neuropsychological Assessment 3.2.1 The Nervous System and Behaviour 3.2.2 Neuropsychological Examination 3.3 Neuropsychological Understanding of Behavioural Deficits 3.4 Goals of Neuropsychological Assessment 3.5 Nature of Neuropsychological Tests 3.6 Identifications of a Deficit by Neuropsychological Tests 3.7 The Luria-Nebraska Neuropsychological Battery 3.7.1 History 3.7.2 Structure and Content 3.7.3 Theoretical Foundations 3.7.4 Standardisation Research 3.8 The Halstead-Reitan Neuropsychological Battery 3.8.1 History 3.8.2 Structure and Content 3.8.3 Theoretical Foundations of Component Tests 3.8.4 Standardisation Research 3.8.5 The NIMHANS Neuropsychological Battery 3.9 Let Us Sum Up 3.10 Unit End Questions 3.11 Suggested Readings 3.0 INTRODUCTION In this unit we are dealing with neuropsychological batteries and tests. We start with the definition of neuropsychological assessment and present the various aspects related to the same. Then we discuss how Neuropsychological Assessment would also lead to obtaining information regarding the neurological deficits resulting in behavioural deficiencies. Then we take up Goals of Neuropsychological Assessment and discuss the various factors and clues that may be obtained in regard to the neurological problems within the individual. This is followed by a discussion on the nature of neuropsychological tests and how to identify a deficit with the help of neuropsychological test battery. Two major batteries, the Luria Nebraska and the Halstead Reitan Neuropsychological batteries are presented with their history, structure and content within the tests, the theoretical foundations underlying these tests and the validity and reliability of these tests. Then we deal with the NIMHANS Neuropsychological battery and give a description of the various tests within the same. 49 Brain Behaviour Inter-relationship 3.1 OBJECTIVES After completing this unit, you will be able to: • Define and describe Neuropsychological; • Explain how neuropsychological tests can be used for understanding of behavioural deficits; • Elucidate the goals of neuropsychological assessment; • Describe the nature of neuropsychological tests; • Explain how to identify a deficit through neuropsychological tests; • Describe the various aspects of the Luria-Nebraska Neuropsychological Battery; • Delineate how the test was evolved and devised; • Describe the Halstead-Reitan battery and its contents, tests and subtests; and • Explain the NIMHANS Neuropsychological Battery. 3.2 NEUROPSYCHOLOGICAL ASSESSMENT Neuropsychological assessment has its roots in neurology, the branch of medicine that focuses on the nervous system and its disorders. It focuses on the relationship between brain functioning and behaviour. It used to be a specialty area within clinical psychology. In neuropyshcological assessment the psychologists screen for signs and symptoms of a neurological deficit during: • History Taking • Interviewing • Test-taking • Intelligence Tests • Other Tests. 3.2.1 The Nervous System and Behaviour Damage to certain parts of the brain will be reflected as behaviour deficits. For example, damage to the temporal lobe may affect: sound discrimination, sound recognition, voice recognition, visual memory storage.Tests and procedures employed in a neuropsychological examination vary as a function of: Purpose of examination, Neurological intactness of the examinee, Thoroughness of the examination. 3.2.2 Neuropsychological Examination For a neuropsychological examination a battery of tests administered should include, at a minimum: • Intelligence Tests • Personality Tests • Perceptual-Motor / Memory Tests 50 If impairment is discovered, the examinee will be referred for further and more Neuropsychology Test detailed tests. Batteries The typical neuropsychological exam begins with a careful history taking. Areas of interest include: • Medical history of patient. • Medical history of patient’s family. • Presence of absence of developmental milestones. • Psychosocial history. • Character, severity, and progress of any history of complaints. The MSE deals with questions concerning the addressee’s Consciousness, Emotional State, Thought Content and Clarity, Memory, Sensory Perception, Performance of Action, Language, Speech, Handwriting, Handedness.Tests and assessment procedures assess various aspects of functioning including aspects of: • Perceptual functioning • Motor functioning • Verbal functioning • Memory Functioning • Cognitive Functioning These tests are also used in screening for deficits and in adjunct to medical examinations. The tests can be helpful in the assessment of: • Change in mental status • Abnormalities in function before abnormalities in structure can be detected. • Strengths and weaknesses of patient. • Ability of individual to stand trial. • Changes in disease process over time. The Wechsler Scales are often used as a diagnostic tool for intellectual ability testing. Formal testing for memory may involve the use of instruments such as the Wechsler Memory Scale-Revised: • The task is to recall stories and other verbal stimuli. • The test is appropriate for people within the ages of 16-74. Verbal memory, non verbal memory etc. are tested through the presentation of stimuli such as verbal learning test, selective reminding test Benton test of visual retention etc. As for tests of cognitive functioning, difficulty in thinking abstractly is a relatively common consequence of brain injury. One popular measure of verbal abstraction ability is the Wechsler Similarities Subtest in which the task is to identify how two objects are alike. Proverb interpretation is another way to assess ability to think abstractly. Nonverbal tests of abstraction include sorting tests such as the Wisconsin Card Sorting Test. 51 Brain Behaviour A neuropsychological assessment is a clinical examination of both the working Inter-relationship brain and dysfunctional brain. Neuropsychological tests are an aid in this examination. The objective of neuropsychological assessment is to chart the deficits and adequacies in the behaviour of patients. The behavioural deficits are explained by underlying cognitive, emotional, and volitional deficits as well as changes in the patient’s behaviour. The outcome of a neuropsychological assessment is a profile of the patient’s deficits and adequacies. Fig.3.1: Structural and functional brain 3.3 NEUROPSYCHOLOGICAL UNDERSTANDING OF BEHAVIOURAL DEFICITS Behaviour is an outcome of the interaction of the brain with the environment. A composite of multiple psychological processes shape behaviour. The chief domains of the psychological processes are cognition, emotion and volition. Each of these three cardinal domains has specialised processes and each of the specialised process has components, which constitute the sub process. Nuances in behaviour arise because of the nuances of the domains/ process/ components. The objective of neuropsychological assessment is to identify the disturbed psychological domain/process/ component, which could be giving rise to the behavioural disruption. 3.4 GOALS OF NEUROPSYCHOLOGICAL ASSESSMENT The psychological domains/processes/ components are mediated by specific brain structures and connected brain structures forming functional networks. Identification of disruptions in specified psychological components/processes/ domains indicate damage to the brain structures/networks, which mediate these processes. 52 Neuropsychological assessment therefore has twin goals. Neuropsychology Test Batteries i) The first goal is to identify the disrupted psychological components/ processes/domains in an individual patient and arrive at a profile of adequacies and deficits of psychological functions. ii) The second goal is to identify the brain structures/ functional networks, which are dysfunctional or damaged using the neuropsychological profile that has previously been derived. Finally, this information is used to lateralise and localise the bran lesion. 3.5 NATURE OF NEUROPSYCHOLOGICAL TESTS Neuropsychological tests are aids in the neuropsychological examination. The tests measure specified psychological processes including the constituent components of the process. The level of difficulty is not high, as the goal of the testing is to identify a deficit in functioning and not to test the limits of the top end of performance. These are that the test should have adequate reliability and validity, the scoring should be objective, and the test should have adequate normative data. 3.6 IDENTIFICATIONS OF A DEFICIT BY NEUROPSYCHOLOGICAL TESTS Ideometric approach and psychometric approach are the two methods that are used in the identification of deficits through neuropsychological tests. Ideometric approach is suitable for clinical examinations of individual patients. Psychometric approach is suitable for the assessment of abilities/ aptitudes using quantitative scores. While the first is used in a clinical examination that takes into account the background of the patient, the second is used in an examination of abilities and aptitudes of the patient irrespective of his or her background. Ideometric approach in the context of neuropsychological assessment emphasises the patient’s premorbid functioning with reference to education, occupation, social and occupational functioning as well as performance on other neuropsychological tests. Factors such as the patient’s currents
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