The document provides an overview of neuropsychological assessment and profiles for various cognitive and neurological conditions. It discusses the objective of neuropsychological assessment to comprehensively evaluate cognitive and behavioral functioning through a battery of tests. This allows identification of strengths and weaknesses to inform differential diagnosis, management recommendations, and understanding of condition progression over time. Neuropsychological profiles for conditions like dementia, HIV, substance use disorders, learning disorders, autism, and ADHD are presented, highlighting common cognitive deficits seen in each condition. The document emphasizes the integration of test results with clinical history to form diagnostic formulations.

1. NEUROPSYCHOLOGICAL
ASSESSMENT AND
PROFILES
- PRAGYA
CLINICAL PSYCHOLOGIST 1

2. INTRODUCTION
• OBJECTIVE, COMPREHENSIVE ASSESSMENT OF WIDE RANGE OF COGNITIVE
& BEHAVIORAL AREAS OF FUNCTIONING
• DESIGNED TO IDENTIFY EXTENT AND SEVERITY OF PATIENT’S COGNITIVE &
BEHAVIORAL IMPAIRMENT
• REQUIRES ADMINISTRATION OF BATTERY OF TEST DSIGNED TO ASSESS
VARIOUS COGNITIVE SKILLS WHICH ALLOWS US TO DETERMINE PATTERN OF
COGNITIVE STRENGTH AND WEAKNESS
2

3. • SERIAL NEUROPSYCHOLOGICAL ASSESSMENT DEMONSTRATE GRADUAL
IMPROVEMENT OR DETERIORATION OVER TIME, ALLOW BETTER
DIFFERENTIATION OF COGNITIVE DEFICITS
• RECOMMENDATION CAN BE MADE FOR TREATMENT OR REHABILITATION
• ADDRESSES ISSUE OF CEREBRAL LATERALIZATION, LOCALIZATION AND
PROGRESS OF ILLNESS OVER TIME
• PROVIDE USEFUL INFORMATION ABOUT IMPACTS OF PATIENT’S LIMITATION
ON HIS/HER EDUCATIONAL, SOCIAL AND VOCATIONAL ADJUSTMENT DUE TO
ILLNESS/INJURY 3

4. PROCESS OF ADMINISTRATION
1. CLINICAL/ DIAGNOSTIC REVIEW OF AVAILABLE MEDICAL RECORDS
2. COMPREHENSIVE INTERVIEW WITH PATIENT AND FAMILY MEMBER
REGARDING ONSET, COURSE, DEGREE AND NATURE OF COGNITIVE AS
WELL AS PERSONALITY CHANGES AND PRE-MORBID FUNCTIONS
3. BEHAVIOR OBSERVATION
4. SERIES OF TESTS ARE ADMINISTERED
5. INTERPRETATION
6. REPORT WRITING 4

5. CLINICAL INTERPRETATION
• INVOLVES INTEGRATION OF HISTORICAL INFORMATION, BEHAVIORAL
OBSERVATION AND TEST RESULT AND INTEGRATE FINDINGS IN DIAGNOSTIC
FORMULATION OF PATIENT’S PRESENTING PROBLEM FROM A
NEUROPSYCHOLOGICAL PERSPECTIVE
• TEST RESULT ARE EVALUATION OF LEVEL OF PERFORMANCE ON EACH TASK
AND PATTERN OF PERFORMANCE
5

6. • CLINICAL IMPRESSION SHOULD NOT BE CONSIDERED AS DEFINITIVE
FINDINGS UNLESS THERE IS STRONG EVIDENCE
• IDENTIFYING STRENGTH IS AS IMPORTANT AS IDENTIFYING DEFICITS
• RECOMMENDATIONS FOR MANAGEMENT ARISE FROM EVALUATION OF RISK
ASSOCIATED WITH NEUROPSYCHOLOGICAL PROFILE & ENVIRONMENTAL
DEMANDS
6

7. PURPOSE OF NEUROPSYCHOLOGICAL
ASSESSMENT
1. DIFFERENTIAL DIAGNOSIS
2. LONGITUDINAL PROGRESSION
3. PLAN MANAGEMENT
4. ASSESS OVERALL FUNCTIONING AND COMPETENCE
5. RESEARCH
7

8. FACTORS AFFECTING TEST PERFORMANCE
1. SEVERITY AND EXTENT OF IMPAIRMENT
2. SLEEP DEPRIVATION
3. EXPECTATION FROM TESTS
4. HEARING AND VISUAL IMPAIRMENT
5. ATTENTIONAL DEFICITS
8

9. AREAS COVERED BY NEUROPSYCHOLOGICAL
TESTS
Orientation
• Arousal
• Orientation towards
time
• Orientation towards
place
• Orientation towards
people
Sensation/
perception
• Recognition
• Visual acuity
• Auditory
• Taste/ smell
• Tactile
• awareness
Attention
• Span
• Selective
• Focused
• Divided
• Sustained
• Distractibility
Motor
• Cerebral dominance
• Initiation/ perseveration
• Balance
• Motor speed
• Motor strength
9

10. Visuo-
Spatial
• Construction
• Route finding
• Spatial orientation
• Facial recognition
Language
• Receptive speech
• Expressive speech
• Articulation
• Syntax & grammar
• Aphasia- Broca’s,
Wernicke’s, conduction
Memory
• Verbal
• Visual
• Immediate
• Short-term
• Long-term
• Recognition
• procedural
Abstract
reasoning
• Comprehension
• Judgment
• Calculation
• Problem-solving
• Organizational
abilities
• Higher-order
reasoning
• Sequencing
10

11. Mood
• Depression
• Motivation
• Locus of control
• Impulse
• Irritability
• Aggression
• Disinhibition
Activity of
Daily Living
• Dressing
• Toileting
• Bathing
• Continence
• feeding
11

12. DEMENTIA
• CHARACTERIZED BY PROMINENT AMNESIA WITH ADDITIONAL COGNITIVE
DEFICITS, LEADS TO DECLINE IN EVERYDAY FUNCTION AND OVERALL QOL
• DUE TO DISEASE IN BRAIN IN WHICH THERE IS DISTURBANCE OF MULTIPLE
HIGHER CORTICAL FUNCTIONS (THINKING, MEMORY, ORIENTATION,
COMPREHENSION, LANGUAGE AND JUDGEMENT, ETC.)
12

13. DEMENTIA- NEUROPSYCHOLOGICAL PROFILE
1. FLUCTUATING ATTENTION AND SLOW PROCESSING SPEED
2. NON-FLUENT, AGRAMMATIC SPEECH, PROFOUND ANOMIA AND DEFICIT IN
SENTENCE REPETITION
3. EPISODIC MEMORY IMPAIRMENT (EARLIEST & PROMINENT FEATURE) IN
ALZHEIMER’S DISEASE
4. IMPAIRED MEMORY IN FRONTO-CORTICAL DEMENTIA WITH PATTERN OF
POOR RETRIEVAL & SIGNIFICANT IMPROVEMENT IN CUED RECALL &
RECOGNITION
13

14. 5. LEWI BODY DEMENTIA EXHIBIT DISPROPORTIONATE IMPAIRMENT IN
VISUAL PERCEPTION & CONSTRUCTIONAL DEFICITS
6. FRONTO-TEMPORAL DEMENTIA IS ASSOCIATED WITH CONCRETE
THOUGHT, PERSEVERATION AND POOR ORGANIZATION
14

15. HIV-ASSOCIATED NEUROCOGNITIVE DISORDER
(HAND)
• BRAIN IS SECOND MOST INFECTED ORGAN AFTER LUNGS PREFERENTIALLY
DISRUPTS FRONTO-STRIATO-THALAMO-CORTICAL LOOPS
• ALSO AFFECTS STRUCTURE & FUNCTION OF OTHER WHITE MATTER TRACTS
INCLUDING HIPPOCAMPUS AND PARIETAL CORTEX
• HI-VIRUS INFILTRATE CNS BY CROSSING BLOOD-BRAIN-BARRIER (BBB) AND
CAUSE SYNAPTO-DENDRITIC INJURY WHICH CAUSES DAMAGE TO VARIETY
OF NEURAL SYSTEM
15

16. HAND
Cognitive impairment related to HIV No HAND diagnosis
Interference with daily functioning
Severely affect ADLs
HIV associated
Dementia
(moderate-severe
cognitive
impairment)
Mild neuro
cognitive disorder
(MND)
(mild-moderate
cognitive
impairment)
Asymptomatic
neurocognitive
impairment (ANI)
(mild cognitive
impairment)
NO
YES
YES
YES
NO
NO
16

17. HAND - NEUROPSYCHOLOGICAL PROFILE
• SEVERE MOVEMENT ABNORMALITIES (CHOREA) WHICH INCLUDE
BRADYKINESIA (SLOW MOVEMENT) & BRADYPHRENIA (SLOW INFORMATION
PROCESSING)
• EPISODIC MEMORY IMPAIRMENT & RAPID FORGETTING WHICH IS RELATED
WITH AFFECTIVE DISTRESS AND FATIGUE
• IMPAIRMENT IN DIVIDED ATTENTION & RESPONSE INHIBITION
• DIFFICULTIES WITH VERBAL & VISUAL WORKING MEMORY
17

18. • DEFICIT IN VISUAL PROCESSING
• IMPAIRMENT IN EXECUTIVE FUNCTION LEADS TO RISKY DECISION MAKING
AND SENSATION SEEKING
• EXPRESSIVE LANGUAGE DIFFICULTIES
18

19. SUBSTANCE USE DISORDER
• PERSISTENCE USE OF DRUGS DESPITE SUBSTANTIAL HARM & ADVERSE
CONSEQUENCES CHARACTERIZED BY ARRAY OF MENTAL, PHYSICAL AND
BEHAVIORAL PROBLEM
• THIS LEADS TO MAJOR HEALTH ISSUES OR PROBLEMS AT WORK, SCHOOL
OR HOME AND ALSO IMPACT VARIOUS BRAIN STRUCTURE & FUNCTIONS
WHICH IMPACT ACTIVITIES OF DAILY LIVING (ADLS)
• MARIJUANA AND COCAINE ARE 2 MOST COMMON ABUSED SUBSTANCES
19

20. SUD- NEUROPSYCHOLOGICAL PROFILE
MARIJUANA
• ALTERED PATTERN OF BRAIN ACTIVITIES
• IMPAIRED MEMORY, ATTENTION, DECISION MAKING, PSYCHOMOTOR SPEED,
DEFICITS IN INHIBITORY CONTROL WHICH PERSISTS LONG PERIOD OF TIME
• POOR C0GITIVE ABILITIES/FUNCTIONS RELATED TO RISK TAKING, IMPAIRED
DECISION MAKING AND IMPAIRED EPISODIC MEMORY WHICH HAVE
NEGATIVE HEALTH CONSEQUENCE
• TETRAHYDROCANNABINOL (THC) ALTER TIME PERCEPTION AND ASSOCIATED
WITH HIGH RISK OF DEVELOPING PSYCHOTIC DISORDER 20

21. COCCAINE
• PROBLEM IN EXECUTIVE FUNCTION & DECISION MAKING
• INCREASED IMPULSIVITY
• IMPAIRED VISUO-PERCEPTION
• ABNORMAL PSYCHOMOTOR SPEED
• IMPAIRED VERBAL LEARNING AND MEMORY FUNCTIONS
21

22. ALCOHOL USE DISORDER
• INABILITY TO CONTROL DRINKING DUE TO PHYSICAL & EMOTIONAL
DEPENDENCE ON ALCOHOL
• LONG TERM CHRONIC ALCOHOLISM IS ASSOCIATED WITH IMPAIRED BRAIN
FUNCTIONING AND BEHAVIOR AS WELL AS EMOTIONAL ABNORMALITIES
• CHRONIC ALCOHOL USE AFFECT MAJOR COGNITIVE FUNCTION, WHICH
DETERMINE EVERYDAY MANAGEMENT OF PATIENT & IMPACT EFFICACY OF
MANAGEMENT
• CAUSES SOCIAL AND HEALTH PROBLEM WITH NEGATIVE IMPACTS ON QOL 22

23. AUD- NEUROPSYCHOLOGICAL PROFILE
• 4-PROFILE IN PATIENT WITH ALCOHOL USE DISORDER
1. NO COGNITIVE IMPAIRMENT
2. ISOLATED EXECUTIVE FUNCTION DEFICITS
3. IMPAIRED EXECUTIVE FUNCTION AND MEMORY
4. GLOBAL IMPAIRMENT DEFICITS (WORKING MEMORY, MENTAL
FLEXIBILITY, DIVIDED ATTENTION, DECISION MAKING, PROBLEM
SOLVING AND RESPONSE INHIBITION
23

24. • ALTERED EPISODIC MEMORY RESULTS IN LIMITED LEARNING CAPACITIES,
IMPAIRED ENCODING AND RECOLLECTION PROCESS
• VISUO-SPATIAL FUNCTIONS (VISUAL LEARNING, VISUO-SPATIAL
ORGANIZATION AND VISUO-SPATIAL CONSTRUCTION) PREDOMINANTLY
AFFECTED IN CASE OF ALCOHOL USE DISORDER
24

25. SPECIFIC ASSESSMENT IN CHILDREN
• GENERAL COGNITIVE ABILITY : CAN BE ASSESSED USING STANDARD
INTELLIGENCE TEST
• VISUO-SPATIAL AND CONSTRUCTIONAL ABILITIES: NON-VERBAL DEFICITS
PREDICT POOR PERFORMANCE IN CERTAIN ACADEMIC DOMAINS
PARTICULARLY ARITHMETIC AND ALSO ASSOCIATED WITH HEIGHTENED
RISK OF PSYCHOSOCIAL MALADJUSTMENT (POOR PEER RELATIONSHIP)
25

26. • ACADEMIC SKILLS: ACADEMIC UNDERACHIEVEMENT IS ONE OF THE MOST
COMMON REASONS FOR THE REFERRAL. SELECTIVE PROBLEMS IN
ACHIEVEMENT CAN PROVIDE EVIDENCE OF SPECIFIC LEARNING DISORDER
• EMOTIONAL STATUS, BEHAVIORAL ADJUSTMENT AND ADAPTIVE
BEHAVIOR : ADAPTIVE FAILURE FREQUENTLY OCCURS IN DOMAINS OTHER
THAN ACADEMIC PERFORMANCE. THIS MAY BE MANIFEST IN PSYCHOSOCIAL
DISTRESS, UNDESIRABLE BEHAVIOR AND DEFICITS IN EVERYDAY
FUNCTIONING (INCLUDE POOR ADLS OR SOCIAL SKILLS)
26

27. • LANGUAGE ABILITY: CRITICAL DETERMINANT OF ACADEMIC SUCCESS AND
SOCIAL COMPETENCE, CHILDREN WITH LEARNING DISORDERS AND BRAIN
INJURIES
• A CAREFUL ANALYSIS OF DEFICITS IN ADJUSTMENT AND ADAPTIVE
BEHAVIOR CAN HELP TO DEFINE- INCONGRUENCE BETWEEN CHILD’S
NEUROPSYCHOLOGICAL PROFILE AND ENVIRONMENTAL DEMANDS PLACED
ON CHILD
27

28. HOW CAN WE MAXIMIZE CHILD’S
PERFORMANCE
1. CONDUCT ASSESSMENT IN MORNING
2. ESTABLISH GOOD RAPPORT
3. BASED ON AGE OF CHILD, EXPLAIN REASON OF BEING ASSESSED
4. PRAISE EFFORT NOT SUCCESSFUL RESPONSE
5. REMOVE POSSIBLE DISTRACTION
28

29. 6. DEPENDING ON AGE AND EMOTIONAL STATE, PARENTS SHOULD NOT BE
PRESENT
7. PROVIDE REST BREAKS
8. BREAK ASSESSMENT OVER A NUMBER OF SESSIONS
9. BE CARING, SENSITIVE AND POSITIVE
10. PRESENT INFORMATION OR INSTRUCTION SLOWLY & CLEARLY IN AGE
APPROPRIATE LANGUAGE
29

30. LEARNING DISORDER (LD)
• IMPAIRMENT OF ONE OR MORE ACADEMIC SKILLS THAT CANNOT BE
ACCOUNTED BY SENSORY OR MOTOR DEFICITS, MENTAL RETARDATION,
EMOTIONAL DISTURBANCE OR ENVIRONMENTAL, CULTURAL AND ECONOMIC
DISADVANTAGE
• COMMON LD INCLUDES: DYSLEXIA (IMPAIRMENT IN READING), DYSCALCULIA
(ARITHMETIC) AND DYSGRAPHIA (WRITTEN EXPRESSION)
30

31. Dyslexia
Surface dyslexia : impaired
whole word reading and
intact ability to sound
Deep dyslexia : intact whole
word reading and impaired
ability to sound
31

32. DYSLEXIA - NEUROPSYCHOLOGICAL PROFILE
• CHILDREN WITH SIGNIFICANT READING DEFICITS CAUSED BY VISUAL AND
VISUO-PERCEPTUAL ANOMALIES AND STEP FROM AUDITORY LANGUAGE
DYSFUNCTION
• IMPAIRMENT OF ORTHOGRAPHIC SKILLS AND PHONOLOGICAL SKILLS
• DEFICIT IN TRANSLATING LETTER STRING INTO WORD SOUND (WORD
DECODING), WHICH CAUSES READING SLOW AND DEFICITS IN IDENTIFY AND
COMPREHEND WORDS
32

33. • ASSOCIATED WITH LIMITATIONS IN-
1. WORKING MEMORY,
2. POOR VERBAL & VISUAL MEMORY
3. PERCEPTUAL MOTOR IMPAIRMENT
4. ATTENTIONAL DEFICITS
5. IMPULSIVITY
6. EMOTIONAL LABILITY
• NOT ALL LEARNING DISABLED CHILDREN EXHIBIT ALL THE DEFICITS
33

34. AUTISM
• SEVERE IMPAIRMENT IN SOCIAL RELATEDNESS AND LANGUAGE
DEVELOPMENT AND PERSEVERATION OF UNUSUAL REPETITIVE AND
STEREOTYPIC PATTERN OF BEHAVIOR
• TWO MOST IMPORTANT SKILLS
34
HYPERLEXIA SAVANT SKILLS
Early acquisition of reading skills
without comprehension
Extraordinary developed skills
despite of limited cognitive ability

35. ASPERGER’S SYNDROME:
• EXHIBIT AUTISTIC LIKE FEATURE BUT DO NOT FULFILL CRITERIA OF
AUTISM
• CHILDREN DISPLAY-
1. POOR SOCIAL SKILLS
2. ODD BEHAVIOR
3. RESTRICTIVE PATTERN OF INTEREST AND ACTIVITIES WITHOUT
SIGNIFICANT DELAY IN COGNITION AND LANGUAGE ABILITIES
35

36. • BIOLOGICAL MARKERS:
1. GREATER HEAD CIRCUMFERENCE
2. LARGE BRAIN SIZE AT TIME OF BIRTH
3. HIGH LIKELIHOOD OF CO-OCCURRING MEDICAL CONDITION (DUE TO
POTENTIAL PRESENCE OF GENETIC & CHROMOSOMAL ABNORMALITIES
36

37. AUTISM- NEUROPSYCHOLOGICAL PROFILE
• RELATIVE STRENGTH IN VISUAL-PERCEPTUAL AND VISUAL-SPATIAL AS
CONTRASTED WITH VERBAL PROBLEM SOLVING
• POOR INFERRING-INTEGRATING-ABSTRACTING ACROSS LANGUAGE AND
POOR ACADEMIC PERFORMANCE
• THINKING IS OFTEN CONCRETE
• DEFICITS IN THEORY OF MIND
37

38. • UNIQUE TYPE OF EXECUTIVE DEFICIT – “STUCK-IN-SET”
• POOR PERFORMANCE IN-
1. EXECUTIVE FUNCTION
2. PLANNING
3. SET SHIFTING ABILITY
4. WORKING MEMORY
5. MENTAL FLEXIBILITY
6. RESPONSE INHIBITION
• PERSEVERATION IN PERFORMANCE
38

39. ATTENTION DEFICIT HYPERACTIVITY
DISORDER (ADHD)
• CORE SYMPTOM OF INATTENTION, IMPULSIVITY AND HYPERACTIVITY WHICH
GENERALLY CONTINUES IN ADOLESCENCE AND ADULTHOOD
• NUMBER OF NEURAL SUBSTRATE HAVE BEEN IMPLICATED IN ETIOLOGY AND
NEUROPSYCHOLOGICAL MANIFESTATION OF ADHD
39

40. • BIOLOGICAL MARKER-
1. ABNORMALITY IN STRUCTURE OF CORPUS CALLOSUM
2. PATHOLOGY IN FRONTAL LOBE
3. DISRUPTION OF FRONTAL-BASAL GANGLIA CIRCUIT
4. MORPHOLOGICAL DIFFERENCES (SMALL VOLUME OF CEREBRAL
HEMISPHERE)
40

41. ADHD- NEUROPSYCHOLOGICAL PROFILE
• IMPAIRMENT IN-
1. EXECUTIVE PLANNING
2. WORKING MEMORY
3. ATTENTION
4. MENTAL FLEXIBILITY
5. INHIBITORY CONTROL
41

42. 42