Unformatted text preview: Clinical Clinical Neuropsychology
Specific instruments Role of Clinical Role of Clinical Neuropsychologists Examine brainbehavior relationships
Assess range of cognitive functions Quantify degree of impairment in specific areas
Specify rehabilitation, accommodations needed
Identify functional strengths Areas assessed by clinical Areas assessed by clinical neuropsychologists
1. Cognition a.
d. Receptive: Selection, classification, integration
Memory and learning (storage/retrieval)
Thinking (organization/reorganization of info)
Expressive function (communicating or acting on info) 2. Emotions
3. Executive functions (how behavior is expressed) Sources of pathology
Sources of pathology Traumatic Brain Injury (TBI) Cerebrovascular Accident (CVA) Motor vehicle accident, gunshot wound, fights
Primary cause of brain pathology 1524 year olds
Primary cause of brain pathology in elderly Infection
Anoxia/Hypoxia (drowning, anesthesia complications, smoke inhalation, carbon monoxide) Assessment Methods
Assessment Methods Clinical Interview Screening Instruments (e.g., MiniMental Status Exam, Cognistat) As possible; may require collateral reports, records Allows for quick determination of significant functional impairment Assessment Battery/Specific Instruments Dozens of instruments; select those most relevant to presenting symptoms, assessment question (e.g., return to work, selfcare) The MiniMental State Exam
5 ( ) What is the (year) (season) (date) (day) (month)?
5 ( ) Where are we (state) (country) (town) (hospital) (floor)?
3 ( ) Name 3 objects: 1 second to say each. Then ask the patient
all 3 after you have said them. Give 1 point for each correct answer.
Then repeat them until he/she learns all 3. Count trials and record.
Attention and Calculation
5 ( ) Serial 7’s. 1 point for each correct answer. Stop after 5 answers.
3 ( ) Ask for the 3 objects repeated above. Give 1 point for each correct answer.
2 ( ) Name a pencil and watch.
1 ( ) Repeat the following “No ifs, ands, or buts”
3 ( ) Follow a 3stage command:
“Take a paper in your hand, fold it in half, and put it on the floor.”
1 ( ) Read and obey the following: CLOSE YOUR EYES
1 ( ) Write a sentence.
1 ( ) Copy the design shown.
_____ Total Score Cognistat
Cognistat Neuropsychological Conditions Neuropsychological Conditions and their Assessment Aphasias (Expressive, Receptive)
Memory impairment (Anterograde amnesia)
Frontal lobe deficits Boston Diagnostic Aphasia Examination
Boston Diagnostic Aphasia Examination BROCA’S APHASIA
B.L.: Wife is dry dishes. Water down! Oh boy! Okay Awright. Okay ...Cookie is down...fall, and girl, okay, girl...boy...um... Examiner: What is the boy doing? B.L.:Cookie is...um...catch Examiner: Who is getting the cookies? B.L.: Girl, girl Examiner: Who is about to fall down? B.L.: Boy...fall down! WERNICKE’S APHASIA
H.W.:First of all this is falling down, just about, and is gonna fall down and they're both getting something to eat...but the trouble is this is gonna let go and they're both gonna fall down...but already then...I can't see well enough but I believe that either she or will have some food that's not good for you and she's to get some for her too...and that you get it and you shouldn't get it there because they shouldn't go up there and get it unless you tell them that they could have it. and so this is falling down and for sure there's one they're going to have for food and, and didn't come out right, the uh, the stuff that's uh, good for, it's not good for you but it, but you love it, um mum mum (smacks lips)...and that so they've...see that, I can't see whether it's in there or not. Examiner:Yes, that's not real clear. What do you think she's doing? H.W.:But, oh, I know. She's waiting for this! Examiner:No, I meant right here with her hand, right where you can't figure out what she's doing with that hand. H.W.:Oh, I think she's saying I want two or three, I want one, I think, I think so, and so, so she's gonna get this one for sure it's gonna fall down there or whatever, she's gonna get that one and, and there, he's gonna get one himself or more, it all depends with this when they fall down...and when it falls down there's no problem, all they got to do is fix it and go right back up and get some more. Neuropsychological Evaluation Neuropsychological Evaluation considerations with aphasia Return to work
Able to learn and perform different type of work
Needs in terms of:
Rehabilitation (Cognitive or otherwise) Occupational placement/support Daily living support Memory/Learning Memory/Learning MAOI antidepressant x antihistamine = “hypertensive crisis”
Hippocampal damage Hippocampus (part of limbic system)
Transfer from working memory into long
Damage results in Anterograde Amnesia– inability to store new memories/learn new information
(as in the movie “Memento”) Assessment of Hippocampal Assessment of Hippocampal damage for this patient
Neuropsychological Screening Normal on most
Very poor on memory California Verbal Learning Test Read list of 15 words, patient recalls
List of different words, patient recalls (for interference effects)
Delayed recall of original words
Examine rate of acquisition of words, interference effects, intrusions, perseverations
Very poor performance; little evidence of new learning
Implications for work; Family life (care of young child); Self
1. Frontal Lobe Injury
Frontal Lobe Injury Common in motor vehicle collisions
Acceleration/deceleration (skull against brain, brain against skull)
Damage may be diffuse or focal
Common features: Impulsivity, Disinhibition
Impaired organization, planning
Concrete (versus abstract) thinking
Emotion dysregulation Assessing Complex Attention
Assessing Complex Attention Digit Symbol Test ...
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- Fall '11
- Neuropsychology, clinical neuropsychology, frontal lobe injury, boston diagnostic aphasia, Diagnostic Aphasia Examination, Cognistat