Basic issues in neuropsychological assessment

1
Basic issues in neuropsychological assessment

• Clinical-experimental approach

2

• Neurological assessmet for evaluation of
  consciousness and general mental state
• Glasgow Coma Scale
• Mini-Mental State Examination

3

• Clinical-experimental approach
• Lurias diagnostic evaluation
• Examples of other neuropsychological
  investigations in reference to Luria (A.L.
  Christensen, M. Maruszewski)
• K. Goldstein and M.Scheerer evaluation of
  concrete vs abstract behaviour

4

• Psychometric methods
• Luria-Nebraska Neuropsychological Battery (LNNB)
  
• Halstead-Reitan Neuropsychological Battery (HRNB)
  
• Right Hemisphere Language Battery (RHLB)

5
Glasgow Coma Scale

• Best eye response (E)
• There are 4 grades starting with the most severe
• No eye opening
• Eye opening in response to pain. (Patient
  responds to pressure on the patients fingernail
  bed if this does not elicit a response,
  supraorbital and sternal pressure or rub may be
  used.)
• Eye opening to speech. (Not to be confused with
  an awaking of a sleeping person such patients
  receive a score of 4, not 3.)
• Eyes opening spontaneously

6
Glasgow Coma Scale

• Best verbal response (V)
• There are 5 grades starting with the most severe
• No verbal response
• Incomprehensible sounds. (Moaning but no words.)
• Inappropriate words. (Random or exclamatory
  articulated speech, but no conversational
  exchange)
• Confused. (The patient responds to questions
  coherently but there is some disorientation and
  confusion.)
• Oriented. (Patient responds coherently and
  appropriately to questions such as the patients
  name and age, where they are and why, the year,
  month, etc.)

7
Glasgow Coma Scale

• Best motor response (M)
• There are 6 grades starting with the most severe
• No motor response
• Extension to pain (abduction of arm, internal
  rotation of shoulder, pronation of forearm,
  extension of wrist)
• Abnormal flexion to pain (adduction of arm,
  internal rotation of shoulder, pronation of
  forearm, flexion of wrist)
• Flexion/Withdrawal to pain (flexion of elbow,
  supination of forearm, flexion of wrist when
  supra-orbital pressure applied  pulls part of
  body away when nailbed pinched)
• Localizes to pain. (Purposeful movements towards
  painful stimuli e.g., hand crosses mid-line and
  gets above clavicle when supra-orbital pressure
  applied.)
• Obeys commands. (The patient does simple things
  as asked.)

8
Interpretation

• Generally, brain injury is classified as
• Severe, with GCS 8
• Moderate, GCS 9 - 12
• Minor, GCS 13
• Individual elements as well as the sum of the
  score are important. Hence, the score is
  expressed in the form
• "GCS 9 E2 V4 M3 at 0735".

9
Mini-Mental State Examination

• The MMSE test includes simple questions and
  problems in a number of areas
• the time and place of the test
• repeating lists of words
• arithmetic such as the serial sevens language use
  and comprehension
• basic motor skills.

10
Interpretation

• Any score over 27 (out of 30) is effectively
  normal.
• Below this, 20-26 indicates some cognitive
  impairment
• 10-19 moderate to severe cognitive impairment
• Below 10 very severe cognitive impairment

11
Neuropsychological assessment
12
Lurias diagnostic evaluation

• Terms of functional systems (blocks) and primary
  secondary and third-rate brain areas
• Part of A.R. Luria's legacy was the premium that
  he placed on the observation of a patient
  completing a task intraindividual differences

13
Anne-Lise Christensen

• Lurias Neuropsychological Investigation (1975)
• Preliminary conversation
• Motor functions
• Acoustico-motor organization
• Higher cutaneous and kinesthetic functions
• Higher visual functions
• Impressive speech
• Expressive speech
• Writing and reading
• Arthmetical skills
• Mnestic processes
• Intellectual processes

14
K. Goldstein and M. Scheerer

• Abstract and Concrete Behavior. Experimental
  Study With Special Tests (1941).

15
K. Goldstein and M. Scheerer

• The Goldstein-Scheerer Cube Test
• The Gelb-Goldstein Color Sorting Test
• The G.G.W.S. Object Sorting Test
• The Weigl-Goldstein-Scheerer Color Form Sorting
  Test
• The Goldstein-Scheerer Stick Test

16
Luria-Nebraska Neuropsychological Battery (LNNB)

• motor functions,
• rhythm,
• tactile functions,
• visual functions,
• receptive speech,
• expressive speech,
• writing,
• reading,
• arithmetic,
• memory,
• intellectual processes,
• pathognomic,
• left hemisphere and
• right hemisphere.

17
Halstead-Reitan Neuropsychological Battery (HRNB)