Outline–HealthNeuropsychology概述健康与神经心理学实用教案

1、Outline Health & NeuropsychologyIQ and Neuropsychological TestingMalingeringFunctions of interest to neuropsychologistsLateralityVisual PerceptionLanguageMemoryAttention & Executive Control第1页/共56页第一页，共57页。Neuropsychological testing Basic ideas: Human mind is most complex system we know of i

2、n the universe. Human brain is also very complicated. As a result, there are many ways that things can go wrong. Many combinations of behavioral and mental impairment following an insult to the brain.第2页/共56页第二页，共57页。Goals of neuropsychological assessmentDiagnosis What happened? What went wrong as a

3、 result?第3页/共56页第三页，共57页。Goals of neuropsychological assessment Diagnosis Description Cognitive and behavioral deficits that result第4页/共56页第四页，共57页。Goals of neuropsychological assessment Diagnosis Description Tracking changes in patients performance over time, to monitor healing/worsening and effect

4、s of treatment第5页/共56页第五页，共57页。Psychometric assessment - advantages Standardized: Repeatable instructions, presentation, and tasks Norms第6页/共56页第六页，共57页。Psychometric assessment - advantages Standardized Intensive: Multiple measures within and among wide range of domains第7页/共56页第七页，共57页。Psychometric

5、assessment - advantages Standardized Intensive Sensitive Valid indicators of skills, capable of detecting abilities and deficits第8页/共56页第八页，共57页。Psychometric assessment advantages Standardized Intensive Sensitive Scaled Hierarchical items start/stop rules第9页/共56页第九页，共57页。Psychometric assessment adva

6、ntages Standardized Intensive Sensitive Scaled Precise Allows reliable, exacting quantification of relative abilities Allows comparison within/over time第10页/共56页第十页，共57页。Psychometric assessment Interpretation Quantitative observations:Many tests give standardized scale scores (like Wechsler tests) b

7、ased on norms Actuarial results (e.g., Boston Aphasia Battery) profile of subtest scores indicates nature of disorder Cut-off scores used to make decisions第11页/共56页第十一页，共57页。Psychometric assessment Interpretation Neuropsychologists also make up tests as needed these typically are not standardized, s

8、o interpretation may be problematic. Example: line-crossing task used to detect “neglect” following right-hemisphere brain damage第12页/共56页第十二页，共57页。第13页/共56页第十三页，共57页。Line-crossing task to detect neglect What do we know about this test? What cognitive operations are involved in test performance? Why

9、 do neglect patients fail at this test? Is this test valid? Reliable?第14页/共56页第十四页，共57页。IQ and neuropsychological testing IQ is frequently of interest to clinicians testing a BD patient. Often difficult to use a regular IQ test with patients e.g., they may not understand instructions, or may not be

10、able to move their right hand第15页/共56页第十五页，共57页。IQ and neuropsychological testing We sometimes try to estimate pre-morbid IQ on the basis of education, job, or other evidence Individual IQ subtests are often used to assess broader cognitive skills without producing a full IQ score第16页/共56页第十六页，共57页。

11、Estimating pre-morbid IQ Clinical approaches Educational level Vocabulary skills Occupational background, farm size Functional capacities: self-care, finances, drivers license, food preparation, parenthood, daily activities第17页/共56页第十七页，共57页。Estimating pre-morbid IQ Clinical approaches Actuarial &am

12、p; psychometric approaches Demographic Formulas Reading level Subtest pattern第18页/共56页第十八页，共57页。Neuropsychological test batteries Test batteries are large sets of tests that tap a variety of skills and abilities Developed before the era of scanning, in part to help locate site of brain damage Wide v

13、ariety, large number of tests thought necessary because human behavior is so complex第19页/共56页第十九页，共57页。To use test batteries or not? On the plus side: Many batteries have known psychometric properties (e.g., reliability, validity). Use of standardized procedure permits comparison of one patient with

14、 others, even if the others are tested by different clinicians. Tests cover a wide range of cognitive functions and behaviors第20页/共56页第二十页，共57页。To use test batteries or not? On the minus side: Test-centered rather than patient-centered Time-consuming Patient may fail a test for many different reason

15、s Batteries are developed for general purposes may lack flexibility to assess any given patients idiosyncratic deficits. May reduce clinicians potentially useful curiosity, lead to “cookie-cutter reports.”第21页/共56页第二十一页，共57页。Halstead Reitan Neuropsychological Tests Ward Halstead Ph.D. psychologist,

16、taught in U Chicago Medical School Through 1940s, devised and tried out many tests for use with brain-damaged patients With his student Ralph Reitan, settled on a battery of tests that allowed comprehensive evaluation of BD patients第22页/共56页第二十二页，共57页。Reitans four-fold approach Inferential decision-

17、making using the HRNTB based on: Level of performance Pattern of performance Specific behavioral deficits Comparison of two sides of the body (right-left comparisons)第23页/共56页第二十三页，共57页。Reitans four-fold approach Level of performance Comparison of individual with normative groups of impaired and non

18、-impaired persons 第24页/共56页第二十四页，共57页。Reitans four-fold approach Level of performance Pattern of Performance Examination of intra-test performance and subtest scores第25页/共56页第二十五页，共57页。Reitans four-fold approach Level of performance Pattern of Performance Specific Behavioral Deficits (Pathognomonic

19、Signs) Sensitivity to deviant or deficient performance which, of itself, points to impairment第26页/共56页第二十六页，共57页。Reitans four-fold approach Level of performance Pattern of Performance Specific Behavioral Deficits Comparison of Two Sides of the Body Looking for discrepancies in test performance which

20、 may reveal weakness or lateralized impairment 第27页/共56页第二十七页，共57页。Halstead-Reitan Neuropsychological Tests Category testTests abstraction and reasoning Tactual performance testManual dexterity, spatial memory, tactile discrimination Seashore rhythm test & Speech-sounds perception test Attention

21、, concentration, auditory discrimination Finger tapping test Motor speed and manual dexterity第28页/共56页第二十八页，共57页。Halstead-Reitan Neuropsychological Tests Trail making (see below) Reitan-Indiana Aphasia Screening Examination Reitan-Klove Sensory Perceptual ExaminationVersion of standard neurological

22、screening test for sensory processes Strength of Grip TestUses hand dynamometer Lateral Dominance Examination第29页/共56页第二十九页，共57页。Malingering Faking a disorder or deficit. Important for legal and financial reasons people sometimes fake a deficit in order to collect insurance payments, or to fraudulen

23、tly obtain narcotics第30页/共56页第三十页，共57页。Malingering In general, tests to catch malingering are based on the fact that malingerers dont know what real deficits look like they often show too much loss of function. Munchausen Syndrome psychopathology involves faking illness, but not for money or drugs R

24、arely treated successfully第31页/共56页第三十一页，共57页。Functions of interest to neuropsychologists1. Laterality2. Visual Perception3. Language4. Memory5. Attention & Executive Control第32页/共56页第三十二页，共57页。1. Laterality Compares functions of the L and R hemispheres of the cortex Especially important if neur

25、osurgery is planned: where are language functions? Language functions are in left hemisphere in most people, bilateral in some Annett Handedness Questionnaire第33页/共56页第三十三页，共57页。Annett Handedness QuestionnairePlease indicate which hand you habitually use for each of the following: (R, L or E)1. Writ

26、ing2. Throwing a ball3. Holding a racquet 4. Striking a match5. Cut with scissors6. Threading a needle7. At top of broom8. At top of shovel9. To deal cards10. To hammer a nail11. To hold a toothbrush12. To unscrew a lidThere are several ways to score this test第34页/共56页第三十四页，共57页。2. Visual Perception

27、Visual field deficits informal assessment: clinician moves fingers into patients field of vision from the side. Patient announces when he/she can see fingers. Assessed more precisely using special optometry equipment.第35页/共56页第三十五页，共57页。2. Visual PerceptionAgnosia inability to recognize familiar obj

28、ects visually. Objects can be recognized on basis of sound (e.g., lawnmower) Meaning of objects has not been lost its a deficit of visual recognition. To test ask patient to name various objects第36页/共56页第三十六页，共57页。Figure/ground discrimination separate figure from background第37页/共56页第三十七页，共57页。The em

29、bedded figures test task is to find all the objects in this figure.第38页/共56页第三十八页，共57页。The objects in the embedded figures test stimulus第39页/共56页第三十九页，共57页。Visual agnosias visual object agnosia inability to identify common visual objects prosopagnosia inability to recognize familiar faces color agno

30、sia inability to discriminate between colors and to name colors simultanagnosia visual perception of simultaneously presented objects is impaired第40页/共56页第四十页，共57页。Visual Memory Rey-Osterrieth figurecomplicated, abstract figure (next slide)patient looks at it briefly then asked to reproduce the figu

31、re from memory scoring is quite complex assesses visual memory, visual construction skill第41页/共56页第四十一页，共57页。The Rey-Osterrieth Complex Figure (Osterrieth, 1946)第42页/共56页第四十二页，共57页。3. Language A very important function for humans, typically mediated by left hemisphere Expressive and receptive langua

32、ge can be independently lost or spared Batteries include Boston Diagnostic Aphasia Examination and Western Aphasia Battery (developed at UWO School of Medicine)第43页/共56页第四十三页，共57页。Boston Diagnostic Aphasia ExaminationOral Expression word repetition, body part naming, visual confrontation namingWriti

33、ngAuditory comprehension: Body part identificationUnderstanding written language: Word picture matching.第44页/共56页第四十四页，共57页。3. Language Task-specific tests used with patients having comparatively isolated dysfunctionsGraded Naming Test or Boston Naming Test - both assess ability to name objects.Toke

34、n Test - detects non-obvious loss of receptive languagePyramid & Palm Trees Test - tests the understanding of words第45页/共56页第四十五页，共57页。Graded Naming Test examples test has 30 of these, presented in order of increasing difficultyBoston Naming Test examples第46页/共56页第四十六页，共57页。PyramidPalm TreeFir T

35、ree3 Picture Version3 Word VersionPyramid and Palm Trees Test which one of the two lower items goes with the upper item?第47页/共56页第四十七页，共57页。4. Memory Amnesia is loss of episodic (personal) memory, which may include knowledge of public people/events Two distinct kinds of amnesia:Retrograde loss of me

36、mory for events from patients pastOld things in memory cannot be retrievedAnterograde loss of ability to store new memories.New things cannot be put into memory第48页/共56页第四十八页，共57页。Retrograde amnesiaBoston Remote Memory test 2 types of questionsEasyHard 2 types of materialName famous faces (hints giv

37、en if needed)Events asked to recall information about them第49页/共56页第四十九页，共57页。Anterograde amnesia Warringtons Recognition Memory Test50 faces and 50 words presented separately2AFC test administered immediately after learning phase Mild impairment in young patients not detected Severely impaired patients may perform at chance. Then, its hard to tell whats wrong with their memory第50页/共56页第五十页，共57页