Neuropsychological Assessment

1. NEUROPSYCHOLOGICAL
ASSESSMENT
DR. SUNIL SUTHAR
DM GERIATRIC MENTAL HEALTH

2. Clinical neuropsychology is a specialty in psychology that examines the relationship
between behavior and brain functioning in the domains of cognitive, motor, sensory,
and emotional functioning.
Sadock, Benjamin J. Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 10th Edition. Wolters Kluwer Health.

3. PURPOSES OF NEUROPSYCHOLOGICAL ASSESSMENT
Lesion location
Diagnosis
Level of functioning- strengths/weaknesses
Rehabilitation recommendations
Prognosis

4. HEADINGS
• Lobes of brain and their functions
• Various Cognitive Domains and their assessment tools
• Screening tools to assess Global Cognition
• Neuropsychological Assessment Battery
• Psychometric Issues

6. 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

7. COGNITIVE DOMAINS
Level of consciousness and orientation, Handedness
Attention
Memory
Language
Executive Function
Processing Speed
Visuo-perceptual Function
Sensorimotor abilities
Intelligence

8. • sustained attention, divided attention, selective attention,
processing speedComplex attention
• planning, decision making, working memory, responding to
feedback/ error correction, overriding habits/ inhibition,
mental flexibility
Executive function
• immediate memory, recent memory [including free recall,
cued recall, and recognition memory], very-long-term
memory [semantic; autobiographical], implicit learning)
Learning and
memory
• expressive language [including naming, word finding, fluency,
and grammar, and syntax] and receptive languageLanguage
• includes abilities subsumed under the terms visual perception,
visuoconstructional, perceptual-motor, praxis, and gnosisPerceptual-motor
• recognition of emotions, theory of mindSocial cognition

10. ATTENTION
Digit Span test
Serial Substraction
Reverse order Days/months
Trail A test
Digit Vigilance Test
Subtest of WMS-IV & WAIS-IV

11. MEMORY
• PGI-Memory Scale
• WMS-IV
• Rey Auditory Verbal Learning Test
• Benton Visual Retention Test
• California Verbal Learning Test

12. LANGUAGE
Naming, Fluency, Comprehension(auditory), Repetition, Reading,
Writing
Verbal Fluency Test - Category/Semantic Fluency & Lexical Fluency
Boston Naming Test
Boston Diagnostic Aphasia Examination
Multilingual Naming Test
Token Test

14. EXECUTIVE FUNCTION
Wisconsin Card Sorting Test
Color Stroop Test
Color Trail Making Test
Trail Making test (Trail B)
Letter & Category fluency test
Category Test
CDT

15. VISUOPERCEPTUAL / VISUOSPATIAL FUNCTION
• Rey–Osterrieth complex figure test (ROCF)
• Benton Facial Recognition Test
• Test of Constructional Praxis
• CDT

16. SENSORIMOTOR ABILITIES
• Grooved Pegboard
• Finger Oscillation
• Finger Tapping
• Grip Strength

17. INTELLIGENCE
Wechsler Adult Intelligence Scale (WAIS-IV)

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

19. SCREENING TOOL TO ASSESS GLOBAL COGNITION
• Mini Mental State Examination (MMSE)
• Hindi Mini Mental State Examination (HMSE)
• Hindi Cognitive Screening Test (HCST)
• Montreal Cognitive Assessment (MoCA)
• Saint Louis University Mental State Examination (SLUMS)
• Addenbrooke's Cognitive Examination -Revised (ACE-R)
• CDT
• IQCODE

20. MMSE

22. NEUROPSYCHOLOGICAL ASSESSMENT BATTERY
• Luria-Nebraska Neuropsychological Battery
• Halstead Reitan Battery
• PGI Battery of Brain Dysfunction (PGIBBD)
• PGI Battery for Assessment of Mental Efficiency in the Elderly (Age≥55Yrs)
• NIMHANS neuropsychological battery for elderly (NNB-E)
• AIIMS comprehensive neuropsychological battery in Hindi (adult form)

23. HALSTEAD-REITAN NEUROPSYCHOLOGICAL BATTERY
1. Category Test
2. Tactual Performance Test
3. Rhythm Test
4. Finger-oscillation Test
5. Speech sound perception test
6. Trail Making Test
7. Critical flicker Frequency
8. Time sense Test
9. Aphasia Screening Test
10.Sensory Perceptual Tests

24. PGI BATTERY OF BRAIN DYSFUNCTION (PERSHAD & VERMA)
1. PGI Memory Scale
2. Revised Bhatia Short Scale of Intelligence
3. Verbal Adult Intelligence Scale
4. Nahor Benson Test
5. Bendor Visual Motor Gestalt Test

25. AIIMS COMPREHENSIVE NEUROPSYCHOLOGICAL
BATTERY IN HINDI (SURYA GUPTA ET AL)
1. Motor Scale
2. Tactile Scale
3. Visual Scale
4. Receptive Speech Scale
5. Expressive Speech Scale
6. Reading Scale
7. Writing Scale
8. Arithmetic Scale
9. Memory Scale
10.Intellectual Process Scale
A. Pathognomonic Scale
B. Left Hemisphere Scale
C. Right Hemosphere
Scale
Total 160 items, 10 basic
scales, Time-3hrs

26. NIMHANS NEUROPSYCHOLOGICAL BATTERY FOR
ELDERLY (NNB-E) (R. TRIPATHI ET AL)
• Episodic Memory –Word List & Story recall test
• Attention - Span task & Picture cancellation test
• Construction Ability – Stick Construction test
• Executive Functions – Digit span, Corsi block-tapping test, Fluency, Go/No-Go
task, Tower of Hanoi
• Language – Picture naming test, Semantic verbal Fluency Test

27. DEMENTIA
• -
Neuropsychological assessment
Normal Aging Fluid Intelligence, Memory Retrieval, Speed of
Processing, Executive task , Visuomotor speed
MCI Performance between 1 to 2 SD
Alzheimer's Disease Memory
DLB Visuospatial difficulties, Apraxia
PDD Retrieval difficulty, processing speed, Executive
function
Vascular Dementia Patchy involvement, asymmetric sensory
motor function
FTD Executive Function, Language
NPH Processing speed, Retrieval difficulty
HAND Processing speed, attention, executive
functions

28. PSYCHOMETRIC ISSUES
• Validity
• Reliability
• Sensitivity & specificity
• Predictive Value
• Normative Data (Education, Gender, Culture etc.)
Other issues-
• Hearing Impairment
• Visual Impairment
• Weakness (Hemiparesis)

29. Normative (bell) curve which compares z-scores, T-scores, percentiles, and Wechsler IQ scores.