Neuropsychoclinical assessments

1. NEUROPSYCHOLOGICAL ASSESSMENTS
DR. Ashwini Padmashali
Asst Professor
Dept of Psychiatry
USM-KLE IMP
Belagavi

2. INTRODUCTION
• Clinical Neuropsychology is a speciality in psychology that
examines the relationship between behaviour and brain
functioning.
• Neuropsychological assessment refers to the standardized
measurement of cognition and behavior.
• Cognition and behavior – are terms which refer to the highest
aspects of human brain function.
• It includes capacities – intellect, memory, speech, perception,
attention and concentration, problem-solving, decision
making, planning & personality changes.

3. PURPOSE OF NEUROPSYCHOLOGICAL
ASSESSMENT
• Lesion Location
• Diagnosis
• Level of Functioning- Strengths/Weakness
• Rehabilitation recommendations
• Prognosis

5. SELECTED NEUROPSYCHOLOGICAL DEFICITS ASSOCIATED
WITH LEFT OR RIGHT HEMISPHERE DAMAGE
LEFT HEMISPHERE RIGHT HEMISPHERE
Aphasia Visuospatial Deficits
Right Left Disorientation Impaired Visual Perception
Finger Agnosia Neglect
Dysgraphia (Aphasic) Dysgraphia (Spatial, Neglect)
Dyscalculia (Number Alexia) Dyscalculia (Spatial)
Constructional Apraxia (Details) Constructional Apraxia (Gestalt)
Limb Apraxia Dressing Apraxia
Anosognosia

6. COGNITIVE DOMAINS
• Level of Consciousness, Orientation and handedness
• Attention
• Memory
• Language
• Executive Function
• Processing Speed
• Visuo-perceptual function
• Sensori-motor abilities
• Intelligence

8. Attention
• Digit Span Test
• Serial Subtraction Test
• Reverse Order
Days/Months
• Trail A test
• Digit Vigilance Test
• Subtest of WAIS-IV

12. MEMORY
• PGI –Memory scale
• WMS –IV
• Rey Auditory Verbal Learning Test
• Benton Visual Retention Test
• California Verbal Learning Test

13. RAVLT
• The Rey Auditory Verbal Learning test uses a list-learning format to
examine verbal abilities including immediate memory, efficiency of
learning, effects of interference, and recall following short and long delay
periods.
• Participants are read a list of 15 words aloud by the person administering
the set.
• The entire test takes 10-15 minutes to administer and includes five
presentations of a 15 word list (list A), followed by a free recall of a second
word list (list B).
• Finally there is a sixth recall trial of the first list (List A). The test may also
assess delayed recall with a seventh recall trial administered after a 20-30
minute delay. Recognition is tested by asking which of 30 words were read
aloud from list A and which were not.
• The words are read at a rate of one word per second. The overall goal of
the task is to repeat all of the words the participant can remember in any
order.

14. BVRT
• The Benton Visual Retention Test (or simply Benton
test or BVRT) is an individually administered test for people
aged from eight years to adulthood that measures visual
perception and visual memory.
• It can also be used to help identify possible learning
disabilities among other afflictions that might affect an
individual's memory.
• The individual examined is shown 10 designs, one at a
time, and asked to reproduce each one as exactly as
possible on plain paper from memory.
• The test is untimed, and the results are professionally
scored by form, shape, pattern, and arrangement on the
paper.

15. LANGUAGE
• 6 Components
 Verbal Fluency Test
 Boston Naming Test
 Boston Diagnostic Aphasia Examination
 Multilingual Naming Test
 Token Test

16. BNT
• The BNT contains 60 line drawings graded in difficulty.
• Patients with anomia often have greater difficulties
with the naming of not only difficult and low frequency
objects but also easy and high frequency objects.
• Naming difficulties may be rank ordered along a
continuum.
• Items are rank ordered in terms of their ability to be
named, which is correlated with their frequency.
• This type of picture-naming test is also useful in the
examination of children with learning disabilities and
the evaluation of brain-injured adults

17. BOSTON NAMING TEST

18. BDAE
• The BDAE evaluates language skills based on
perceptual modalities (auditory, visual, and gestural),
processing functions (comprehension, analysis,
problem-solving), and response modalities (writing,
articulation, and manipulation).
• Administration time ranges from 20 to 45 minutes for
the shortened version but it can last up to 120 minutes
for the extended version of the assessment.
• There are five subtests which include: conversational &
expository speech, auditory comprehension, oral
expression, reading, and writing.
• In the extended version all questions are asked while in
the shortened version only a few questions are asked
within each subtest.

19. EXECUTIVE FUNCTION
• Wisconsin Card Sorting Test
• Color Stroop Test
• Color Trail Making Test
• Trail Making Test (Trail B)
• Letter and Category Fluency Test
• Category Test

20. WCST
• The WCST is a neuropsychological test of ‘set shifting’, i.e.
the ability to display flexibility in the face of changing
schedules of reinforcement.
• A number of stimulus cards are presented to the
participant. The participant is told to match the cards, but
not how to match; however, he or she is told whether a
particular match is right or wrong.
• The original WCST used paper cards and was carried out
with the experimenter on one side of the desk facing the
participant on the other.
• The test takes approximately 12–20 minutes to carry out
and generates a number of psychometric scores, including
numbers, percentages, and percentiles of: categories
achieved, trials, errors, and perseverative errors.

24. VISUOSPATIAL FUNCTION
• Rey-Osterreith Complex Figure Test
• Benton Facial Recognition Test
• Test of Constructional Praxis

25. ROCFT
• Three conditions are most commonly used in the ROCF.
• Copy: In the Copy condition, the examinee is given a piece of paper and a pencil, and
the stimulus figure is placed in front of them. They reproduce the figure to the best of
their ability. The test is not timed, but the length of time needed to copy the figure is
observed. Some administrators use a series of colored pencils, in order to preserve a
record of the order in which design elements were reproduced. However, because of
concerns that the use of color changes the nature of the test and makes it easier for
the subject to remember the figure, the current test manual suggests that this should
not be done. Instead, the evaluator should take notes on the process the examinee
uses. Once the copy is complete, the stimulus figure and the examinee's copy are
removed from view.
• Immediate recall: After a short delay, the examinee is asked to reproduce the figure
from memory.
• Delayed recall: After a longer delay (20–30 minutes), the examinee may again be asked
to draw the figure from memory. Examinees are not told beforehand that they will be
asked to draw the figure from memory; the Immediate and Delayed Recall conditions
are therefore tests of incidental memory. Each copy is scored for the accurate
reproduction and placement of 18 specific design elements. Additionally, the test
administrator can note their qualitative observations regarding the examinee's
approach to the task and the effectiveness of any apparent strategy use

27. SENSORIMOTOR ABILITIES
• Grooved Pegboard
• Finger Oscillation/Finger Tapping
• Grip Strength

28. INTELLIGENCE
• Wechsler Adult Intelligence Scale (WAIS-IV)
• BKT

29. PSYCHOLOGICAL FACTORS
• BDI
• GDS
• MMPI
• TOMM

30. SCREEN TOOL TO ASSESS GLOBAL
COGNITION
• MMSE
• HMSE
• Hindi Cognitive Screening Test
• Montreal Cognitive Assessment

31. NEUROPSYCHOLOGICALASSESSMENT
BATTERY
• Luria- Nebraska Neuropsychological Battery
• Halstead Reitan Battery
• PGI Battery of Brain Dysfunction

32. LOBE FUNCTION TESTS
FRONTAL LOBE
• 1. Attention/working memory: Digit span
• 2. Set Shifting: Trail making test A
• 3. Trail B Test
• 4. Sequencing test (Programming)
A. Motor Luria Test- “fist-edge-palm”
Examiner demonstrates and patient performs 3 series
with examiner and 3 series alone.

33. FRONTAL LOBE
• Score: a. 6 correct consecutive series:3
b. Atleast 3 correct consecutive series:2
c. Fails alone, but performs 3 correct
consecutive series with the examiner:1
d. Cannot perform 3 correct consecutive
series even with the examiner:0
B. Graphic Luria Test
Implication: Frontal Lobe Lesions

34. FRONTAL LOBE
• 5. Verbal Similarities Test: Test verbal abstract thinking,
analysis of relationships, formation of verbal concepts
and logical thinking. Subjects have to conceptualize the
links between two objects from the same category.
Directions: Give 5 pairs of objects like ‘car-airplane’ and
ask the patient how these are alike.
Scoring- Abstract similarity-2
Relevant similarity-1
Differences/Failure to respond-0

35. • 6. Verbal Fluency Test
Directions-Patients are asked to state words starting from ‘s’,
except proper nouns in 60 s.
Scoring: >9 words:3; 6-9 words:2; 3-5 words:1; <3
words:0
• 7. Conflicting instructions:
Direction-Patient is asked to tap twice when examiner taps
once and vice versa. Examiner demonstrates 3 trials of 1-1-1
and 2-2-2. Then test in the following manner- 1-1-2-1-2-2-2-
1-1-2
Scoring: a. No error:3
b. 1-2 errors:2
c. >2 errors:1
d. Patient taps like the examiner at least 4 consecutive
times:0

36. • 8. Inhibitory control: GO-NO-GO Test
Directions-Patient is asked to tap once when examiner taps
once and stop when examiner taps twice
Scoring: a. No error:3
b. 1-2 errors:2
c. >2 errors:1
d. Patient taps like the examiner atleast 4
consecutive times:0
• 9. Proverb Interpretation: Tests general knowledge and
abstract thinking
Scoring: Grade response as 0-concrete, 1-semiabstract, 2-
abstract,
Maximum points-10, Score <5 is abnormal

37. • 10. Environmental autonomy:
Directions-Patients hands kept supine on a rest.
Examiner touches and places his hands close to
patients hands. If patient takes the hand, instruct not
to do so and repeat the act.
Scoring: a. Patient does not take the examiners hands:3
b. Hesitates and asks what he/she has to do:2
c. Takes the hands without hesitation:1

38. 4 CATEGORIES OF NEUROPSYCHOLOGICAL
ASSESSMENT
• 1st- Analysis of overall performance; or how well
people do from test to test along with how they
perform in comparison to average score.
• 2nd- Left-Right comparisons. How well a person
performs on specific tasks that deal with the left
and right side of the body.
• 3rd- Pathognomic signs or specific test results that
directly relate to distinct disorder.
• 4th- Differential patterns, which are strange test
scores that are typical for specific diseases or
types of damage.

39. Conditions Commonly Referred for
Neuropsychological Assessment
• Neurological conditions such as stroke,
• Epilepsy, multiple sclerosis (MS), brain
• Tumors, Parkinson’s disease
• Suspected dementia
• Head trauma
• Attention-Deficit Disorders
• Learning Disorders
• Neuropsychiatric disorders
• Toxic exposures
• Medical conditions such as metabolic disorders, HIV infection,
liver disease, renal disease, etc.

46. 2. Simultagnosia-
Direction- ask patients to encircle all “A” in following
picture

50. 7. Finger agnosia
Direction- 3 steps

52. 9. Cortical sensation
Stereognosis
• Appreciation of size and shape- put familiar objects like coin, key etc in hand with
• eye closed and ask to identify
• o Graphesthesia
• Ability to recognise letters and numbers in palm or dorsum of foot with pencil or
• blunt pin ( with eye closed)
• o Two point discrimination
• With a divider, eye closed touch two points simultaneously and ask pt to tell how
• many pins were pricked to him.
• Finger tip- normal 2-4 mm
• Palm- normal 8-12 mm
• Dorsum of foot- normal 30-40 mm
• Significance- localizes to contra lateral parietal lobe but only in presence of normal
• primary sensations.

53. OCCIPITAL LOBE
Prosopagnosia- show photographs of familiar faces

54. 2. Visual object agnosia- show photographs of
familiar objects

55. THANK YOU