Clinical neuropsychological testing

CLINICAL
NEUROPSYCHOLOGICAL
TESTING
• PRESENTED BY: DR.SHILPA PRAJAPATI ( 1ST YR M.P.T)

TESTING OF INTELLIGENCE AND
PERSONALITY
• Intelligence & personality plays a relatively minor
role in psychiatric diagnosis its more use in some
special situation like:

– To establish the degree of mental retardation

– Neuropsychological tests help quantify and localize brain
damage.

TESTING OF INTELLIGENCE AND
PERSONALITY
• TYPES OF TESTS : introduction
Objective test:
– Pencil and paper tests based on specific items and question

– They yield numerical score and profile easily subject to
mathematical or statistical analysis
Projective test:
– These tests present stimuli whose meanings are not
immediately obvious; some ambiguity forces persons to
project their own needs into the test situations

– These test presumably no right or wrong answers.

INTELLIGENCE TESTING
– Defined as the ability to assimilate factual knowledge, to
recall either recent or remote events, to reason logically, to
manipulate concept, to translate abstract, to analyze and
synthesize forms and to deal meaningfully and accurately
with problems and priorities important in a particular
setting.

• In1905, Allred Binet, introduced

IQ= MA*100/ CA

• An IQ of 100 results when chronological and mental
age are equal.

• IQ is a measure of present functioning ability.

• Although, under ordinary circumstances the IQ is a
stable throughout life.

• The most useful intelligence test must measure a
variety of skill and abilities, including;
– Verbal and performance,
– Early learned and recently learned,
– time and untimed,
– culture free and culture bound

• WECHSLER ADULT INTELLIGENCE SCALE(WAIS):
– This is best standardized and most widely used test given
by David Wechsler at New York university medical center
and Psychiatric hospital,1939.

– The latest revision, the WAIS-III, is designed for
o persons 16 to 89 years of age,
o children 5 to 15 years,
o children 4 to 6.5 years

Construction of the test
• VERBAL SKILL:
1. Information:
– It covers general information and knowledge and is subject to
cultural variables

– Person from lower socioeconomic with little schooling do not
perform as well as those from high socioeconomic with more
schooling

2. Comprehension:
it measures subjects knowledge of social convention and
common sense and examine quality of persons thinking and
how persons ought to behave under certain circumstances

3. Arithmetic:
– ability to do arithmetic and other simple calculations, which
is adversely influenced by anxiety and poor attention
concentration

4. Similarities:
– sensitive indicator of intelligence.
– it covers the ability to abstract by asking subjects to explain
the similarities btw two things.

5. Digit span:
– immediate retention is measured
– Subjects are ask to learn a series of 2 to 9 digits. Immediately
recall

6. Vocabulary:
– Intelligence has a high correlation with vocabulary which
is related to level of education, definition of words may
give clues to personality structure.

• PERFORMANSE:
1. Picture completion:
– It initiates the consist of completing a picture in which a
part is missing .
– Visuoperceptive defects become evident when mistakes
are made on this test

2. Blok design
– To match colored blocks and visual design. brain dysfunction
interferes with in performance.

3.picture arrangement
– Subjects are required to arrange a series of picture in a
sequence that tells a story. Cognitive style is tested.

4. object assembly:
– Subject must assemble objects, like figure of animal, In the
proper order and organization.
– Visuoperception, somatoperception, and manual dexterity
are tested

5.Digit symbol:
– Subject receive a code that pairs symbols with digits.
Matching a series of digits to their corresponding
symbols in as little time as possible

• CLASSIFICATION OF INTELLIGENCE BY IQ RANGE:
Profound mental retardation(MR) Below 20 or 25

Severe MR 20-25 to 35-40

Moderate MR 35-40 to 50 55

Mild MR 50-55 to about 70

Borderline 70-79

Dull normal 80 to 90

Normal 90 to 110

Bright normal 110 to 120

Superior 120 to 130

Very superior 130 and above

ADULT PERSONALITY ASSESMENT
• Objective assessment:
– Characterized by reliance on structured, standardized
measurement devices, which have a self report nature
– Structured reflects the straightforward test stimuli.

• Minnesota multiphasic personality inventory(MMPI):
– Developed in 1937, by Starke Hathaway and J. Chamley
McKinley. Its eventually updated and now called the MMPI-2.
– It consists of more than 500 statements to which subject
must respond ‘true’ ,’false’ or ‘cannot say’
– Test may be used in car or booklet form and several
computer programs.

• Projective personality assessment:
– Defined by the use of unstructured , often ambiguous test
stimuli.
– It is assume that persons bring certain needs
characteristics, defenses, and other qualities that be
– come apparent through the testing process

1) Rorschach Test:
– Study designed by Herman Rorschach, 1910
– standard set of 10 inkblot serves in number from I to X.
– Five of blot are black and white and five include colors.
– Cards are shows in a particular order and psychologist
keeps a record of patients verbatim response along with
time spend for each card.

• Name description
1. Rorschach test 10 card of inkblots, Some colored other acromatic

2. Thematic apperception test 20 cards depleting num. of scenes of varying
ambiguity

3. Sentence completion test A num. of different devices available, all sharing the
same format with more similarities than differences

4. Holtzman Inkblot Tech Two parallel forms of inkblot cards with 45 cards per
form

5. Figure drawing Typically human forms but can involve houses or other
forms

6.Make-a –Picture story(MAPS) Similar to TAT; however , stimuli can be manipulated
by the pt.

• Thematic Apperception Test(TAT):
– Study designed by Henry Murray Christiana Morgan, in
1943.
– It consists of series of 30 cards `
– TAT requires patient to construct or create a story.
– No generally accepted scoring system results in poor
consistency in interpretation; time consuming
administration
– Their stories reflect their own approaches to
organization, sequence, vocabulary, style,
preconception, assumption and outcome.

• Sentence completion test(SCT):
– To tap patients conscious associations to areas of
functioning
– Compose of series of sentences stems usually 75-100 .
– Such as , I like……., sometime I wish…….., etc
– That patients are ask to complete in their own word.

• Word association tech.:
– Carl Gustav Jung presented stimulus word to pt. and had
them respond with the first word that come to mind

• Draw a person test:
– First used as a measure of intelligence in children.
– Easily administrated with the instruction “I ‘d like you to
draw the picture of person, draw the best person you
can.
– After completion of 1st drawing a patient is asked to
draw a picture of a person of the sex opposite that of 1st
drawing
– Generally, the drawing of person represents the
expression of the self in environment
– Primarily it’s a screening technique particularly for the
detection of the brain damage

ASSESSMENT OF ADULTS
• It is examines the relationship btw behavior and brain
functioning in the realms of cognitive, motor, sensory
and emotional functioning

• AIM: To achieve quantifiable and reproducible result

• Assessment is indicated to identify cognitive defects
– to differentiate incipient depression from dementia,
– to determine the course of an illness,
– to assess neurotoxic effects,
– to evaluate the effect of treatment

• The Wisconsin card sorting test(WCST):
– It assess abstract reasoning and flexibility in problem solving
– Stimulus card of different color, form and number are
presented
– As the pt. sort the cards he is told the response s are correct
or incorrect, number of trials are 10.
– When the pt. has mastered the task, examiner change the
principle of sorting
– The procedure repeated several times, measures the
capacity for abstract thinking and flexibility.
– Person with frontal lobes or to the caudal damage and
person with schizophrenia give abnormal responses.

• MEMORY: types

1) Immediate memory: reproduction of perceived material
within a period up to 30 sec. after presentation.

2) Recent memory: concerns events over the past few hours or
days, can be tested by asking patients ‘what they had for
breakfast’ etc.

3) Resent past memory: concern the retention of information
over the past few months.

4) Remote memory: is the ability to remember the events in
the distance past.

• Memory theories have described 3 more parts:
– Episodes for specific events eg. Telephone message,
– semantic for knowledge and facts eg. First president or
etc, and
– implicit for automatic skill eg. Speaking grammatically or
driving car
• Testing :
– Wechsler memory scale: the scale yield memory questions
which is corrected for age and generally approximate the
WAIS IQ
– Benton visual retention test: sensitive to short term
memory loss.

– Presentation of each geometric figure for 10 sec., after
which the pt. attempts to draw the figure.

• ORIENTATION:
– For person or place is rarely disturbed in brain damage
pt who are not psychotic or severely demented

• Temporal Orientation Schedule
Administration
– What is today’s date?
– What day’s of the is it?
– What time is it now?

• PERCEPTUAL &PERCEPTUOMOTOR PERFORMANCE:
– Many pt. with brain disease shows an impaired ability to
analyze complex stimulus constellation or an in ability to
transfer their perception into appropriate motor action

– Double simultaneous stimulation is tested by lightly
touching one of the pt.s cheeks with one hand and
simultaneously touching the back of one of pt.s hand
with the other

– A pt. with brain dysfunction is unable to recognize one
or both of the stimuli

HEMISPARIC DOMINANCE AND
INTRAHEMISPHARIC LOCALIZATION
• HEMISPHERE DAMAGE
• LEFT SIDE RIGHT SIDE
Aphasia Visuospatial deficits

Right left disorientation Impaired visual perception

Finger agnosia Neglect

Dysgraphia Dysgraphia (spacial neglact)

Dyscalculia(number alexia) Dyscalculia(spacial)

Constructional apraxia(details) Constructional apraxia(Gestalt)

Limb apraxia Dressing apraxia

Anosognosia

• Bender visual Motor Gestalt Test:
– This test of visuomotor co-ordination is useful for both
children and adult.
– The test material consist of 9 separate designs.
– Each design is printed against a white back ground on a
separate card .
– Presented with paper, pt are ask to copy each design
with the card in front of them
– There is no time limit
– This test is used most frequently with adults as a
screening device for sign of organic dysfunction

• Complex visual discrimination:
– Judgment of line orientation test, has been found to
demonstrate failing performance in an impressive proportion
of pt. with right hemisphere disease

– Test requires matching the slope of visually presented lines
or pairs of lines

– The pt. points to or verbally
identifies the line of the display

– As with facial recognition, pt with rt. hemisphere lesion are
frequently defective in visuospacial test.

LANGUAGE
• The affective part of speech that conveys mood is called
prosody and is controlled by the non-dominant hemisphere.

• Fluency is tested by asking pt. to give all the words they can
think of beginning with the given letter of the alphabet

• Pt. with a lt. hemisphere disease fail this test

• Reading and writing are also associated with dominant
hemisphere

• And are tested by asking read write

• Dyslexia and dysgraphia are suspected

ATTENTOIN AND CONCENTRATION
• This impairment is reflected in an oscillation in
performance level for continuous or repeated activity

• Some evidence indicates that the instability in
performance is related to an electro-encephalographic
abnormality

• The reaction time needed to respond to stimulus is
impaired in 40-45% of brain damage patient

• And is sensitive indicator of cerebral integrity.

COMPREHENSIVE TESTING
• Luria-Nebraska neuropsychological battery:

– Developed at the uni. Of Nebraska

– The test assesses a wide range of cognitive function;
memory; motor function; rhythm; tactile; auditory and
visual function; receptive and expressive speech; writing:
spelling; reading; and arithmetic

– The test is extremely sensitive for identifying specific
types of problems like dyslexia and dyscalculia

RELIABILITY AND VALIDITY
• The reliability and validity of this test may be
affected by many factors like; mood states,
motivation, effort and cooperation

• Results may be confounded by medication
effects ; anticonvulsants and antipsycotic

THERAPEUTIC DISCUSSION
• A discussion of results of test with the pt. and family, is an
imp. Component of neuropsychological examination

• This will provide therapeutic opportunity to educate them
and clarify individual and relationship issues .

• It is useful to review the goals of examination with the pt. and
family or caregivers.

• This includes information about the pt.’s diagnosis with
emphasis upon the natural course and prognosis as well as
compensation and coping strategies.

• It is imp. To relate the impact of the results to the pt.’s current
living circumstances, future goals and course

Clinical neuropsychological testing

Clinical neuropsychological testing

More Related Content

What's hot

Viewers also liked

Similar to Clinical neuropsychological testing

More from Shilpa Prajapati

Recently uploaded

Clinical neuropsychological testing