Neuropsychological testing of cognitive domains

NEUROPSYCHOLOGICAL
TESTING OF COGNITIVE
DOMAINS
DR. DOHA RASHEEDY ALI
ASSISSTANT PROFESSOR OF
GERIATRICS AND GERONTOLOGY
FACULTY OF MEDICINE
AIN SHAMS UNIVERSITY

SIX PRINCIPAL DOMAINS OF
COGNITIVE FUNCTION
1. complex attention
2. executive function
3. learning and memory
4. Language
5. perceptual–motor function
6. social cognition
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders,
Fifth Edition. Arlington, VA, American Psychiatric Association, 2013.

Perminder S. Sachdev, Deborah Blacker, Dan G. Blazer, Mary Ganguli, Dilip V. Jeste,
Jane S. Paulsen & Ronald C. PetersenClassifying neurocognitive disorders: the DSM-5
approach Nature Reviews Neurology 10, 634–
642 (2014) doi:10.1038/nrneurol.2014.181

COMPLEX ATTENTION
Sustained attention: maintenance of attention overtime
divided attention: attending to 2 tasks in the same time period
selective attention: maintenance of attention despite distracting stimuli
Processing speed: quantifying time needed for task performance

TESTING FOR ATTENTION
1. Ask the patient to summarize what you have just said.
2. Ask the patient to repeat a phone number or address you have just
said.
3. Mental calculation
4. Sequential Operations Series (SOS)
1. Months backward test
2. Days of the week backward test
3. Alphabet backwards
4. Serial 7 subtraction
5. The Digit Span subtest of the WMS-III consists of two parts: Digits
Forward and Digits Backward.
6. Trail Making Test A, B.
7. Test of Everyday Attention (TEA)
8. d2 Test of Attention
9. Other letter cancellation test( other than d2)
10. Stroop test
11. The Wisconsin card sorting test (WCST)

AFFECTION OF ATTENTION IN NEURO COGNITIVE
DISORDERS

THE DIGIT SPAN
subtest of the WMS-III consists of two parts: Digits Forward and Digits Backward
For each part, the test administrator says a series of numbers at the rate of about one per
second.
Following presentation, the examinee either repeats the numbers in the order they were
presented (Digits Forward) or in reverse order (Digits Backward).
For both Digits Forward and Digits Backward, the test begins with series of two
numbers.
For Digits Forward, the test continues to a maximum of eight numbers, and for Digits
Backward the test continues to a maximum of seven numbers.
Examinees are given two trials at each series length, and the test continues until both
trials of a series length are failed.
One point is awarded for each trial that the examinee answers correctly.
The total raw score for Digit Span is the sum of the trials answered correctly for both
Digits Forward and Digits Backward. The maximum possible score for the Digit Span
subtest is 30 (16 points for Digits Forward and 14 points for Digits Backward).

DIGITS FORWARDS
ScoreColumn BColumn AItem
(3)2-8-12-6-5A
(4)1-9-5-21-5-2-3B
(5)5-2-1-4-32-4-7-6C
(6)8-5-3-1-4-74-2-1-9-3-7D
(7)6-8-1-4-7-2-53-6-4-8-5-2-9E
(8)2-8-5-9-7-3-1-47-5-8-2-9-6-1-3F
(9)4-2-5-8-1-3-9-7-65-8-6-4-2-7-3-1-9G
TotalForward Score

DIGITS BACKWARDS
scoreColumn BColumn AItem
(2)2-82-1A
(3)3-2-85-8-4B
(4)2-9-4-14-8-9-1C
(5)3-5-9-7-66-8-7-2D
(6)4-3-1-9-2-55-8-1-7-4-6E
(7)5-3-2-4-1-68-5-3-6-2-9F
(8)6-8-4-7-5-3-9-21-7-4-3-8-9-5-2G
TotalBackward Score

NORMS OF DS IN ELDERLY
Choi HJ, Lee DY, Seo EH, et al. A Normative Study of the Digit Span in an
Educationally Diverse Elderly Population. Psychiatry Investigation. 2014;11(1):39-
43. doi:10.4306/pi.2014.11.1.39.

POSNER TASK
Spatial orientation occurs when attention is drawn to a specific location.
Attention can be drawn to a location due to the appearance of a stimulus. In
the Posner task, this drawing of attention to a location is called cueing.
•In this implementation, there are 100 trials.
•75% of the trials are valid.
•Not all trials have a cue
•Note, at the end of the experiment, you can show your response times
•In this example, you will need to respond to a green circle with the word
"go" in it. When it appears in the left yellow box, you press the key "a" on
your keyboard. When it appears in the right yellow box, you press the key
"l" on your keyboard. In some trials, the "go" circle will be preceded by an
"x", which you should not respond to (this is the cue).
•http://www.psytoolkit.org/experiment-library/experiment_cueing.html

TRAIL MAKING TEST A,B
Both parts of the Trail Making Test consist of 25 circles distributed over a sheet
of paper. In Part A, the circles are numbered 1 – 25, and the patient should draw
lines to connect the numbers in ascending order.
In Part B, the circles include both numbers (1 – 13) and letters (A – L); as in Part
A, the patient draws lines to connect the circles in an ascending pattern, but
with the added task of alternating between the numbers and letters (i.e., 1-A-2-
B-3-C, etc.).
The patient should be instructed to connect the circles as quickly as possible,
without lifting the pen or pencil from the paper. Time the patient as he or she
connects the "trail.“
If the patient makes an error, point it out immediately and allow the patient to
correct it.
Errors affect the patient's score only in that the correction of errors is included
in the completion time for the task.
It is unnecessary to continue the test if the patient has not completed both parts
after five minutes have elapsed.

SCORING:
Results for both TMT A and B are reported as the number of seconds
required to complete the task; therefore, higher scores reveal greater
impairment.
Average Deficient Rule of Thumb
Trail A 29 seconds > 78 seconds Most in 90
seconds
Trail B 75 seconds > 273 seconds Most in 3 minutes
Corrigan JD, Hinkeldey MS. Relationships between parts A and B of the Trail Making Test. J Clin Psychol.
1987;43(4):402–409.
Gaudino EA, Geisler MW, Squires NK. Construct validity in the Trail Making Test: what makes Part B harder? J
Clin Exp Neuropsychol. 1995;17(4):529-535.
• Lezak MD, Howieson DB, Loring DW. Neuropsychological Assessment. 4th ed. New York: Oxford University
Press; 2004. •
Reitan RM. Validity of the Trail Making test as an indicator of organic brain damage. Percept Mot Skills.
1958;8:271-276.

ORAL TRAIL MAKING
TEST (OTMT)
short test of basic auditory attention and set-shifting.
It is an oral version of the Trail Making Test (TMT) and was first
described by Ricker and Axelrod in 1994.
The oTMT removes the visual and graphomotor components of the
written TMT. As with the TMT, there are 2 parts: A and B.
In part A, the patient counts out loud from 1 to 25 as quickly as
possible.
In part B, the patient is instructed to alternate between numbers and
letters (e.g. 1-A-2-B-3-C) until he/she reaches 13.
If the patient makes a mistakes on either task, they are directed back
to the last correct item (for part A) or item pair (for part B) and must
continue from there

TEST OF EVERYDAY ATTENTION (TEA)
There are eight subtests of the TEA:
1. Map search - Subjects have to search for symbols on a coloured
map. The score is the number out of 80 found in 2 minutes. This
subtest is age-sensitive and usable with almost all brain-damaged
patients, including those with Alzheimer’s disease. It measures
selective attention and loads on the same factor as the Stroop Test
and the d2 cancellation test.
2. Elevator counting - Subjects are asked to pretend they are in an
elevator whose door-indicator is not functioning. They therefore
have to establish which ‘door’ they have arrived at by counting a
series of tape-presented tones. This is an established measure of
sustained attention sensitive to right frontal lesions.
3. Elevator counting with distraction - Subjects have to count the low
tones in the pretend elevator while ignoring the high tones. This
was designed as a subtest of auditory selective attention.

1. Visual elevator - Here, subjects have to count up and down as they
follow a series of visually presented ‘doors’ in the elevator. This
reversal task is a measure of attentional switching, and hence of
cognitive flexibility. It is self-paced and loads on the same factor as the
number of categories on the Wisconsin Card Sorting Test.
2. Auditory elevator with reversal - The same as the visual elevator
subtest except that it is presented at fixed speed on tape.
3. Telephone search - Subjects must look for key symbols while
searching entries in a simulated classified telephone directory.
4. Telephone search dual task - Subject must again search in the
directory while simultaneously counting strings of tones presented by a
tape recorder. The combined performance on sub-tests 6 and 7 gives
a measure of divided attention - a ‘dual task decrement’.

Author(s)
Ian H Robertson
Ian Nimmo-Smith
Tony Ward
Valerie Ridgeway
Publication Year
1994
Age Range
18 years to 80 years
Administration
Individual - 45 to 60 minutes

D2 TEST OF ATTENTION
The d2 Test of Attention is a neuropsychological measure of selective and
sustained attention and visual scanning speed.[
It is a paper and pencil test that asks participants to cross out any letter "d"
with two marks around above it or below it in any order.
The surrounding distractors are usually similar to the target stimulus, for
example a "p" with two marks or a "d" with one or three marks.
The original version of the test was created by Brickenkamp (1981) in
Germany as a cancellation task

SINGLE LETTER OR SYMBOL
CANCELLATION TEST (SLCT)

NORMS
S.M.D. Brucki, R. Nitrini, Cancellation task in very low educated people /
Archives of Clinical Neuropsychology 23 (2008) 139–147

The test is simple to score and interpret.
A suggested cutoff score (omissions of 4 or more).
The test is placed at the patient’s midline and the time it takes for
the patient to complete the test is recorded.
SINGLE LETTER OR SYMBOL
CANCELLATION TEST (SLCT)

D- CAT TEST(CANCELLATION TEST
The D-CAT test sheet consists of 12 rows of 50 digits. Each row contains 5
sets of numbers from 0 to 9, arranged in a random order:
Any one digit appears five times in each row, along with randomly determined
neighbors.
The D-CAT as a whole consists of three such sheets, as described by Hatta et
al. (2001, 2006).
Participants were instructed to search for specified target number(s) and to
delete each one with a slash mark, as quickly and accurately as possible, until
the experimenter provided a signal to stop. The experimenter instructed
participants to start searching at the left end digit in the uppermost row, and to
then move onto the next row when required.
There are 3 trials in total, the first involving a single target number (6), a
second with two target numbers (9 and 4), and a third with three (8, 3, 7).
One minute was allowed for each trial, with the total time required to complete
the D-CAT being roughly 3 minutes.
During the second and third trials, it was stressed that all of the target

Three D-CAT measures were calculated and analyzed
according to the test manual:
Total Performance, Omission ratio, and Reduction ratio.
Total Performance refers to the total number of digits the
participant inspected (rather than the digits deleted).
This index pertains mainly to cognitive components such as
information processing speed, focused attention, and sustained
attention.
Omission ratio primarily reflects sustained and selective
attention. It is calculated using the formula (number of missed
targets) ÷ (number of digits inspected) × 100.
Reduction ratio is calculated using the formula (number of
digits inspected in Trials 2 and 3) ÷ (number of digits inspected
inTrial 1).

Takeshi HATTA1), Kazuhito YOSHIZAKI2), Yasuhiro ITO3),
Mitsuhito MASE4), and Hidehiro KABASAWA5) Reliability and validity of the
digit cancellation test, a brief screen of attention. Psychologia, 2012, 55, 246–
256

Different examples
of cancellation
tests:

Della Sala, S, Laiacona, M, Spinnler, H & Ubezio, C 1992, 'A cancellation test: its reliability in assessing
attentional deficits in Alzheimer's disease' Psychological Medicine , vol 22, no. 4, pp. 885-901.,
10.1017/S0033291700038460

Della Sala, S, Laiacona, M, Spinnler, H & Ubezio, C 1992, 'A
cancellation test: its reliability in assessing attentional deficits in
Alzheimer's disease' Psychological Medicine , vol 22, no. 4, pp. 885-
901., 10.1017/S0033291700038460

STROOP TEST
The famous "Stroop Effect" is named after J. Ridley Stroop who
discovered this strange phenomenon in the 1930s. Here is your job:
name the colors of the following words. Do NOT read the
words...rather, say the color of the words. For example, if the word
"BLUE" is printed in a red color, you should say "RED". Say the colors
as fast as you can. It is not as easy as you might think!

WISCONSIN CARD SORTING
TEST(WCST)
In the example, there are four cards on screen. Your task is to figure out the
classification rule to sort the card (a grey rectangle) at the bottom left. You
just click the card that matches the rule, and you will get feedback about your
choice. At the end you see the count and percentage of your errors
There are different types of error reports:
1.Total number errors
2.Perseveration errors (when you keep applying the old rule)
3.Non-perseveration errors
The sum of perseveration and non-perseveration erros is the total number of
error.
Everybody will by definition make some mistakes, because you need some
feedback to figure out the rule. The point of the WCST is that certain patients
make unually many persevertion errors
In the first block, there are by definition no perseveration errors (because
there is no "previous task")
http://www.psytoolkit.org/experiment-library/experiment_wcst.html

EXECUTIVE FUNCTIONS
known as cognitive control and supervisory attentional system
• are a set of cognitive processes including:
1. attentional control
2. inhibitory control
3. working memory,
4. cognitive flexibility
5. reasoning
6. problem solving
7. planning

EF
1. Planning: find the exit out the maze, sequential pictures and
objects arrangement.
2. Decision making: performance of tasks that assess the
process of decision making in the face of competing
alternatives.
3. Working memory: holding information for a brief time while
manipulating information(digit span backwards, spell words
backwards)
4. Inhibition (overriding habits): choose the more complex,
effortful solution e.g. stroop effect, go no go test.
5. Mental flexibility: ability to shift between two tasks (trail
making B, wisconson card sorting test, verbal fluecy)
6. Feedback utilization:
3, 4, 5 needs attention

EF TESTING
1. WAIS-R Picture Arrangement
2. Tower of London Test (TLT or TOL)
3. Wisconsin Card Sorting Test (WCST)
4. Proverb Test
5. Similarities test
6. . Motor series “Luria” test (programming)
7. Go no go test (inhibitory control)
8. Frontal Assessment Battery
9. Frontal Behavioral Inventory (FBI)

PROVERB INTERPRETATION
TESTS
to assess abstract thinking (Brundage , 1996).
‫ميه‬ ‫مايبقى‬ ‫عمره‬ ‫الدم‬
Score
Related ‫فيه‬ ‫علشان‬ ‫اثقل‬ ‫الدم‬ ‫يكون‬ ‫الزم‬ ‫طبعا‬
‫دم‬ ‫كرات‬
Unrelated ‫حلو‬ ‫طرحة‬ ‫زمان‬ ‫عندى‬ ‫كان‬
Abstract adequate ‫الثدييات‬ ‫فصيلة‬ ‫من‬ ‫االنسان‬ ‫ان‬ ‫معناه‬
Abstract inadequate ‫الروابط‬ ‫اقوى‬ ‫هى‬ ‫االسرية‬ ‫الروابط‬
‫االجتماعية‬
Rejection ‫المثل‬ ‫هذا‬ ‫اعرف‬ ‫ال‬
‫هنختار‬ ‫معرفهوش‬ ‫لو‬
‫اتنين‬ ‫يشيلوها‬ ‫ودنين‬ ‫ام‬ ‫القفة‬
‫الندامة‬ ‫العجلة‬ ‫وفى‬ ‫السالمة‬ ‫التانى‬ ‫فى‬

FRONTAL ASSESSMENT
BATTERY
Frontal Assessment Battery
Purpose
The FAB is a brief tool that can be used at the bedside or in a clinic setting to assist in discriminating
between dementias with a frontal dysexecutive phenotype and Dementia of Alzheimer’s Type (DAT).
The FAB has validity in distinguishing Fronto-temporal type dementia from DAT in mildly demented
patients (MMSE > 24). Total score is from a maximum of 18, higher scores indicating better
performance.
1. Similarities (conceptualization)
“In what way are they alike?”
 A banana and an orange
(In the event of total failure: “they are not alike” or partial failure: “both have peel,” help the patient by
saying: “both a banana and an orange are fruit”; but credit 0 for the item; do not help the patient for
the two following items)
 A table and a chair
 A tulip, a rose and a daisy
Score (only category responses [fruits, furniture, flowers] are considered correct)
Three correct: 3 Two correct: 2 One correct: 1 None correct: 0
2. Lexical fluency (mental flexibility)
“Say as many words as you can beginning with the letter ‘S,’ any words except surnames or proper
nouns.”
If the patient gives no response during the first 5 seconds, say: “for instance, snake.” If the patient
pauses 10 seconds, stimulate him by saying: “any word beginning with the letter ‘S.’ The time allowed is
60 seconds.
Score (word repetitions or variations [shoe, shoemaker], surnames, or proper nouns are not counted
as correct responses)
> 9 words: 3 6 -9 words: 2 3 -5 words: 1 < 3 words: 0
3. Motor series “Luria” test (programming)
“Look carefully at what I’m doing.”
The examiner, seated in front of the patient, performs alone three times with his left hand the series of
“fist–edge–palm.”
“Now, with your right hand do the same series, first with me, then alone.”
The examiner performs the series three times with the patient, then says to him/her:
“Now, do it on your own.”
Score
Patient performs six correct consecutive series alone: 3
Patient performs at least three correct consecutive series alone: 2
Patient fails alone, but performs three correct consecutive series with the examiner: 1
Patient cannot perform three correct consecutive series even with the examiner: 0
4. Conflicting instructions (sensitivity to interference)
“Tap twice when I tap once.”
To ensure that the patient has understood the instruction, a series of 3 trials is run: 1-1-1.

FRONTAL BEHAVIORAL
INVENTORY (FBI)

SIMILARITIES SUBTEST, WECHSLER ADULT
INTELLIGENCE SCALE (WAIS)
Testing similarities is a way of measuring some level of higher
order conceptual thinking. It involves the ability to abstract
meaning from a priori unrelated verbal information. Patients are
asked, in a free response, how two words are alike. A set of
items typically includes those with both simple and more
abstract relationships. For example, a simple relationship may
be that both items are a “parts of the body” (nose and tongue);
a more complicated example could be that the two items both
represent the “beginning stages of life” (bud and baby).
It contains 18 items. Items are scored on a 0-2 point scale. A
mean score range of about 18-28 for is expected for normals,
across the lifespan. Raw scores are converted to standard
scores, based upon the WAIS-IV scoring system, with a mean
of 10 and a standard deviation of 3.

Haruo Hanyu Æ Tomohiko Sato Æ Akira Takasaki Æ, Tomotaka Akai Æ Toshihiko
Iwamoto, Frontal lobe dysfunctions in subjects with mild cognitive
Impairment. J Neurol (2009) 256:1570–1571

Language is the ability to encode ideas into words or
symbols for communication to someone else and involves
speaking, comprehending, reading, and writing.
Language should be differentiated from speech, which is the
motor aspect of spoken language production

TESTING FOR LANGUAGE
1. Naming: either objects or pictures
2. repetition
3. Fluency This category can be semantic, such as animals or fruits,
or phonemic, such as words that begin with letter p
4. Comprehension is tested by
• asking the patient to follow a series of one-, two-, and three-step
commands
• or asking for an interpretation of a story by providing a short scenario
followed by a question. An example of story interpretation is, "A tiger
and lion fought in the jungle. The tiger was eaten by the lion. Who
won?"
5. Reading by having the patient read commands and follow them similar
to one of the items in the MMSE
6. Writing: tested by asking the patient to write a sentence, The
sentence should be examined for grammar, spelling errors, phrase
length, and punctuation.

Expressive language
Grammar and syntax
Receptive language

BOSTON NAMING TEST- 60
ITEM
There are 60 items, with each item worth one point. Max
score is 60 points.
Multiple types of errors, including “wrong part” and “multiple
attempts (where the correct response is not the last attempt)
are coded.
Response latencies (e.g. 5, 10, and 15 seconds) are often
recorded.
Patients are allowed 20 second to respond, after which they
are given a semantic prompt, followed by a phonemic cue. If
the correct name is given after the prompt only, this is
indicated as +1 (for each name) to the score (e.g. 56/60, + 2
with prompts).

CONTROLLED ORAL
WORD ASSOCIATION
TEST (COWAT)
Patients are given 1 minute to generate as many words as
possible with a starting letter (e.g., ‘F’, or ‘A’). The same 1
minute protocol is carried out for several (often 3) phonetic
subcategories (i.e., letters). A common version, FAS, includes
a total of 3 trials, with the letters ‘F’, ‘A’, and ‘S’. It is thought
to assess aspects of both language and executive or frontal-
lobe function

KAT 1,2,3
Robert C. Marshall and Heather Harris Wright.Developing a Clinician-Friendly Aphasia Test.American
Journal of Speech-Language Pathology, November 2007, Vol. 16, 295-315.

Major disorder
Pt prefer to call you with your description rather than your
name e.g. my son instead of Ahmed
Grammar error
Echolalia
Automatism
mutism
Mild disorder
Word finding difficulty
Minor grammar error
EFFECTS OF NCD
ON LANGUAGE

SUMMARY OF LANGUAGE IMPAIRMENTS IN ALZHEIMER'S
DEMENTIA AND PRIMARY PROGRESSIVE APHASIA

Types:
1. Verbal memory
2. Auditory memory
3. Visual memory
4. Procedural memory
Recall:
1. Immediate recall ( working memory)
2. Recent recall (free recall, cued recall, recognition)
3. Long term recall

IMMEDIATE RECALL ( WORKING
MEMORY)
1. dialing a phone number I was just told
2. solving this equation in my head
3. copying a figure I have just seen

CERAD-WORD LIST
MEMORY TEST
The patient has 3 learning trials to learn 10 words, during
which patients sequentially read one word aloud every 2
seconds. Patients are then asked for both delayed recall and
forced-choice recognition after a time-delay.

LOGICAL MEMORY
TEST (I AND II)
This subtest is also known as the Immediate and Delayed
Paragraph Recall test.
The test has 2 parts. In part I, the patient is asked to freely recall
as many details from 2 short narratives as possible, immediately
after each paragraph is read aloud. In part II, the patient is asked
to freely recall these details after a 20- 30 minute delay. After the
delayed free recall, there is a recognition-memory task, where the
patient is asked 15 “yes/no” questions about the content of each
paragraph.

REY AUDITORY VERBAL
LEARNING TEST (RAVLT)
A 15-item word list (A) is presented, with 5 learning trials.
Responses are recorded in the order provided by the patient.
A summary score is calculated for the total number of words
recalled across the 5 trials. Then, a second 15-word list (B) is
presented to the patient, followed by a 6th presentation of the
initial word list (A). If immediate recall for A on this trial is
less than 13, then a 50-word recognition list is given in a
forced-choice manner. These 50 words include all 30 words
on lists A and B, and words that are either semantically
related, phonologically related, or both, to a subset of words
on Lists A and B. Alternatively, delayed recall of List A at 30
minutes or more can be administered to assess retention.

THE BENSON BEDSIDE MEMORY TEST
TO ASSESS VERBAL MEMORY (LEZAK
ET AL., 2004)
Frank Benson (personal communication, dbh) used eight words
in an informal examination of memory (see Table 11.2). early
recall measured after first trial
If less than 8, the eight words are read to the patient with recall
after each for up to four trials.
delayed recall is obtained after a 10 min delay followed by a
category-cued recall for any omissions, followed by multiple
choice prompting if necessary. Although this task takes only
minutes it is sensitive to delayed recall impairment

EFFECTS OF NCD ON LEARNING AND
MEMORY

1.VISUAL PERCEPTION
Visual Recognition of;-
1. Objects
2. figures and designs
3. Faces
4. Angulation
Visual Organisation:
to perceive:-
Distorted visual stimuli * The Dot-Line Test
Ambiguous visual stimuli
Fragmented visual stimuli * part whole perception
Incomplete visual stimu

VISUAL RECOGNITION
Line bisection
Facial recognition tasks
Color recognition

PART WHOLE PERCEPTION FOR
VISUAL ORGANISATION:

2. VISUO- CONSTRUCTION/
CONSTRUCTIONAL PRAXIA
ability to organize and manually manipulate spatial information to
make a design.
VC may be considered multifactorial in nature. That is, many different
cognitive functions, such as visuospatial skills, motor programming,
and executive functioning, are required.
1. visual construction (Morris et al., 1989) to assess constructional
praxia
2. Stick design test
3. Clock drawing test
4. Block design
5. Copying complex design

COPY DESIGN SUBSET OF CERAD
There are four designs, a circle (2 points), a diamond (3 points), overlapping
rectangles (2 points), and a cube (4 points). Scores for each item are
summed to give a total possible score of 11
1. Normal≥ 9
2. Abnormal ≤8
Morris JC, Heyman A, Mohs RC, Hughes JP, van Belle G, Fillenbaum G, et al.
The Consortium to Establish a Registry for Alzheimer’s Disease (CERAD).
Part 1. Clinical and Neuropsychological Assessment of Alzheimer’s
Disease. Neurology. 1989;39:1159–1165

COMPLEX FIGURE TEST
(CFT)1: COPY TRIAL

STICK DESIGN TEST
Visuo -constructional ability is an important domain for assessment in cognitive
function participants arrange wooden match sticks to conform to standard stimulus
patterns. the examiner demonstrates how to arrange the matches to copy the
stimulus, explicitly noting in the process the need to correctly orient the match
heads .The matches are the collected and handed to the participant who is told to
make an exact copy of the stimulus.

SCORING SYSTEM:
Criteria for Item1 (square)were as follows :
Four sided figure (yes equal 1, no equal 0)
Figure rests on a side (yes equal 1, no equal 0)
Match heads are correctly oriented (yes equal 1, no equal 0).
Criteria for Item 2 (triangle with stem):
A three-sided figure is present(yes equal 1, no equal 0)
The base of the triangle is closest to the participant (yes equal 1, no equal 0)
Match heads are oriented correctly (yes equal 1, no equal 0).
Criteria for Item 3 (chevron):
All sticks angled in a “V” configuration (yes equal 1, no equal 0);
Apex points away from participant (yes equal 1, no equal 0);
Criteria for Item 4 (rake):
Two middle sticks are aligned head to toe (yes equal 1, no equal 0)
Side sticks angle outward from the top match head (yes equal 1, no equal 0)
Total possible score = 12.

VISUOSPATIAL
ORIENTATION TEST
visuospatial orientation test adapted from The Rowland Universal Dementia
Assessment Scale (RUDAS) (Storey et al., 2004).Body parts orientation.
I am going to ask you to identify/show me different parts of the body. (Correct
= 1, Incorrect = 0).
Once the person correctly answers 5 parts of this question, do not continue as
the maximum score is 5.
(1) show me your right foot …….1
(2) show me your left hand …….1
(3) with your right hand touch your left shoulder …….1
(4) with your left hand touch your right ear …….1
(5) which is (point to/indicate) my left knee …….1
(6) which is (point to/indicate) my right elbow …….1
(7) with your right hand point to/indicate my left eye .……1
(8) with your left hand point to/indicate my left foot …….1

MOTOR PRAXIA
Wave goodbye
How to use a hammer

EFFECTS OF NCD ON
PERCEPTUAL MOTOR

SOCIAL
COGNITION
T H E S E S Y M P T O M S C A N T A K E T H E F O R M O F R E D U C E D A B I L I T Y T O :
1. inhibit unwanted behaviour
2. recognize social cues
3. read facial expressions
4. express empathy
5. motivate oneself
6. alter behaviour in response to feedback
7. or develop insight.
D E F I C I T S I N S O C I A L C O G N I T I O N W E R E U S U A L L Y R E F E R R E D T O A S P E R S O N A L I T Y C H A N G E I N P R E V I O U S D I A G N O S T I C C R I T E R I A .

SOCIAL COGNITION/ BEHAVIORAL,
PERSONALTY CHANGE
1. Recognition of emotion
2. Showing empathy
3. Socially accepted behavior (dressing, sex, politeness,
religion)
4. Theories of mind Consider other’s mental state
(thoughts, attitudes, desires)
Affected in FTD not Alz except 2nd
order false beliefs can be affected in
ALZ

THEORIES OF MIND
has been studied with advanced mentalizing measures, such as:
1. the ability to explain the behaviour of a character in social
situations by referring to complex mental states – false beliefs,
bluffs, lies – as tested by strange stories (Happe´ , 1994) and by
faux pas stories (Stone, Baron-Cohen, & Knight, 1998),
2. and the ability to understand cognitive and emotional mental
states from pictures of eyes, as tested by the Eyes Test (Baron-
Cohen, Wheelwright, Hill, Raste, & Plumb, 2001).
3. ToM-precursor, the Eye-Direction Detection (Baron-Cohen S,
Campbell R, Karmiloff-Smith A, Grant J, Walker J (1995) Are
children with autism blind to the mentalistic significance of the
eyes? Br J Dev Psychol 13, 379-398.

FIRST , SECOND ORDER
First-order false-belief tasks involve attribution about other’s false
belief with regard to real events; deceptive box test, sally Anne test
Deceptive box
https://www.youtube.com/watch?v=41jSdOQQpv0
whereas, second-order false-belief tasks are related with what
people think about other people’s thoughts. In second-order false-
belief tasks, the patient is required to attribute the false belief of one
person based on the thoughts of another (Perner & Wimmer, 1985).
Third or higher order: assessed by 12 strange stories, faux pas test

SALLY–ANNE TEST
to measure a person's social cognitive ability to attribute
false beliefs to others.[1] The flagship implementation of the
Sally–Anne test was by Simon Baron-Cohen, Alan M. Leslie,
and Uta Frith (1985)

DECEPTIVE BOX TEST
The participant is shown a closed box, whose content has
been substituted without his/her knowledge and s/he is
asked to say what it contains; then the box is opened, the
real content is shown and the box is closed again. The
participant is asked to predict what another person would
say if shown the closed box. ( Perner J, Leekam SR, Wimmer
H (1987)).

2ND ORDER FALSE
BELIEFS
John Marry test

READING THE MIND
THROUGH EYES
https://www.questionwritertracker.com/quiz/61/Z4MK3TKB.ht
ml
36 pictures to read

• Mild: 1–2 standard deviation (SD) range (between
the 3rd and 16th percentiles)
•Major: Below 2 SD or 3rd percentile
• These should not be rigidly used!
• Consider premorbid level, sensitivity of tests
etc.
• Major and Mild exist on a continuum
MILD VS MAJOR NCD
COGNITIVE TESTING

Neuropsychological testing of cognitive domains

Neuropsychological testing of cognitive domains

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