Neuropsychological Evaluation
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작성자 관리자 작성일13-05-13 09:04 조회12,021회 댓글0건관련링크
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Updated: Apr 2, 2013
Overview
Neuropsychological evaluation (NPE) is a testing method through which a neuropsychologist can acquire data about a subject’s cognitive, motor, behavioral, linguistic, and executive functioning. In the hands of a trained neuropsychologist, these data can provide information leading to the diagnosis of a cognitive deficit or to the confirmation of a diagnosis, as well as to the localization of organic abnormalities in the central nervous system (CNS). The data can also guide effective treatment methods for the rehabilitation of impaired patients.
NPE provides insight into the psychological functioning of an individual, a capacity for which modern imaging techniques[1, 2] have only limited ability. However, these tests must be interpreted by a trained, experienced neuropsychologist in order to be of any benefit to the patient. These tests are often coupled with information from clinical reports, physical examination, and increasingly, premorbid and postmorbid self and relative reports. Alone, each neuropsychological test has strengths and weaknesses in its validity, reliability, sensitivity, and specificity. However, through eclectic testing and new in situ testing, the utility of NPE is increasing dramatically.[3, 4]
Major Domains of Neuropsychological Functioning
NPE is useful for measuring many function categories, including the following:
- Intellectual functioning
- Academic achievement
- Language processing
- Visuospatial processing
- Attention/concentration
- Verbal learning and memory
- Visual learning and memory
- Executive functions
- Speed of processing
- Sensory-perceptual functions
- Motor speed and strength
- Motivation/symptom validity
- Personality assessment
Examples of Commonly Used Neuropsychological Tests
Table 1. Examples of Commonly Used Neuropsychological Tests[5, 6, 7, 8] (Open Table in a new window)
| Domain | Neuropsychological Test |
| Intellectual functioning | Wechsler Scales Wechsler Adult Intelligence Scale-Revised (WAIS-R) Wechsler Adult Intelligence Scale-III (WAIS-III) Wechsler Intelligence Scale for Children-IV (WISC-IV) Stanford-Binet Intelligence Scale-IV |
| Academic achievement | Wechsler Individual Achievement Test (WIAT) Woodcock-Johnson Achievement Test |
| Language processing | Boston Naming Test Multilingual Aphasia Examination Boston Diagnostic Aphasia Examination Token Test |
| Visuospatial processing | Rey-Osterrieth Complex Figure – Copy condition WAIS Block Design Subtest Judgment of Line Orientation Hooper Visual Organization Test |
| Attention/ concentration | Digit Span Forward and Reversed Trail Making Tests Cancellation Tasks (Letter and symbol) Paced Auditory Serial Addition Test (PASAT) Vanderbilt Assessment Scale Behavior Assessment System for Children (BASC) Serial Sevens |
| Verbal learning and memory | Wechsler Memory Scale (WMS) Logical Memory I and II - Contextualized prose Verbal Paired-Associates WMS-III Verbal Memory Index Rey Auditory Verbal Learning Test - Rote list learning (unrelated words) California Verbal Learning Test - Rote list learning (related words) Verbal Selective Reminding Test - Selective reminding (unrelated words) Hopkins Verbal Learning Test |
| Visual learning and memory | WMS Visual Reproduction I and II WMS-III Visual Memory Index Rey-Osterrieth Complex Figure - Immediate and delayed recall Nonverbal Selective Reminding Test Continuous Recognition Memory Test Visuo-Motor Integration Test - Block design |
| Executive functions | Wisconsin Card Sorting Test Category Test Stroop Test Trail Making Test-B WAIS Subtests of Similarities and Block Design Porteus Maze Test Multiple Errands Test (MET) Serial Sevens Mini-Mental Status Exam |
| Speed of processing | Simple and Choice Reaction Time Symbol Digit Modalities Test - Written and oral |
| Sensory-perceptual functions | Halstead-Reitan Neuropsychological Battery (HRNB) Tactual Performance Test and Sensory Perceptual Examination |
| Motor speed and strength | Index Finger Tapping Grooved Pegboard Task Hand Grip Strength Thurstone Uni- and Bimanual Coordination Test |
| Motivation | Rey 15 Item Test Dot Counting Forced-Choice Symptom Validity Testing |
| Personality assessment | Minnesota Multiphasic Personality Inventory (MMPI) Millon Clinical Multiaxial Inventory Beck Depression Inventory (BDI) Rorschach Test Myers-Briggs Type Indicator (MBTI) Thematic Apperception Test for Children or Adults |
Referrals for Neuropsychological Evaluation
NPE is used to quantitatively measure the cognitive and behavioral capabilities of a patient. The data from neuropsychological tests can then be compared with normative data based on a number of different demographic criteria, including (but not limited to) age, race, gender, and socioeconomic status. NPE can include testing of intelligence, attention, memory, and personality, as well as of problem solving, language, perceptual, motor, academic, and learning abilities.
Whom to refer for NPE
Neuropsychological testing provides diagnostic clarification and grading of clinical severity for patients with obvious or supposed cognitive deficits. Often these include patients with a history of any of the following problems:
- Failure to achieve developmental milestones
- Learning or attention deficits[9, 10]
- Exposure to drugs, alcohol, or maternal illness in utero
- Exposure to chemicals, toxins, or heavy metals
- Neurodegenerative diseases
- Cerebral palsy
- Genetic disorders including, but not limited to, trisomies, monosomies, and trinucleotide repeat disorders
- Psychiatric disorders
NPE is of limited value if a patient is severely compromised, as in advanced dementia or early in recovery from serious brain injury (eg, TBI, stroke, anoxia, infection), although brief serial assessment with measures such as the Galveston Orientation and Amnesia Test, high-velocity lead therapy (HVLT), digit span, and motor speed and dexterity is very useful in tracking recovery. NPE's value is also limited if a patient has other serious medical complications or psychiatric disorders.
Information Obtained From Neuropsychological Reports
Neuropsychological tests are a series of measures that identify cognitive impairment and functioning in individuals. They provide quantifiable data about the following aspects of cognition:
- Reasoning and problem-solving ability
- Ability to understand and express language
- Working memory and attention
- Short-term and long-term memory
- Processing speed
- Visual-spatial organization
- Visual-motor coordination
- Planning, synthesizing, and organizing abilities
Established Applications of Neuropsychological Evaluation
Applications of NPE include the following:
- Provide a differential diagnosis of organic and functional pathologies
- Assess for dementia versus pseudodementia[11, 12, 13, 14]
- Determine the presence of epilepsy versus somatoform disorder (that is, nonepileptic seizures or pseudoseizures)
- Determine the presence of traumatic brain injury (TBI) sequelae[16] versus malingering or unconscious highlighting
- Distinguish between cognitive deficiency caused by indifference (as is occasionally seen in depression patients) and that caused by other diseases and disorders
- Guide rehabilitation programs and monitor patient progress
- Guide the therapist in referring to specialists
An NPE also provides data to guide decisions about the patient's condition, such as the following:
- Competency to manage legal and financial affairs
- Capacity to participate in medical and legal decision making
- Ability to live independently or with supervision
- Ability to return to work and school affairs
- Candidacy for transplantation[17]
In addition, data from an NPE can be used to guide the following assessments and procedures:
- Evaluation of the cognitive effects of various medical disorders and associated interventions
- Assessment of tests for diabetes mellitus, chronic obstructive pulmonary disease (COPD), hypertension, human immunodeficiency virus (HIV) infection, coronary artery bypass graft (CABG), and clinical drug trials
- Assessment of CNS lesions and/or seizure disorders before and after surgical interventions, including corpus callosotomy, focal resection (eg, topectomy, lobectomy), and multiple subpial transection
- Monitoring of the effects of pharmacologic interventions
- Documentation of the cognitive effects of exposure to neurotoxins
- Documentation of adverse effects of whole brain irradiation in children
- Comparison with guidelines for electroconvulsive therapy (ECT) influenced by standardized evaluation of memory
- Standard protocols for assessment of specific disorders, such as dementia of the Alzheimer type (DAT), multiple sclerosis (MS), TBI, and stroke[11, 12, 13, 14, 15, 16, 17, 18]
Developmental disorders (eg, specific learning disabilities) require detailed assessment of cognition, academic achievement, and psychosocial adjustment for proper identification and as a guide to their management. Academic placement in special education and resource classrooms may be needed.
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