Neuropsychological Assessment Procedures Research Articles

Adaptation, calibration, and validation of a cognitive assessment battery for telephone and video administration.

Events such as global pandemics can force rapid adoption of new modes of assessment. We describe the evaluation of a modified neuropsychological assessment for web and telephone administration. Telephone and video conferencing-based neuropsychological assessment procedures were developed and implemented within an ongoing observational study, the Successful Aging following Elective Surgery II (SAGES) study (N = 420 persons). Repeated cognitive assessments were used (N = 2008 observations). Analyses using latent variable psychometric methods were used to compare the measurement modes, and a nested validation sub-study (N = 100 persons) was used to test for measurement equivalence. We used item response theory methods to calibrate data collected by different assessment modes. Measurement equivalence was assessed with Bland-Altman plots and regression analysis. Only small differences were detected between in-person and video modes of assessment. The largest difference among factor loadings was shared for the Boston Naming Test and Visual Search and attention test, but the effects were very small (Cohen's q = 0.06) and not statistically significant (95% confidence interval on q, -0.06, +0.18). In terms of item difficulty differences between in-person and video, the Digit Span Backwards test was less difficult by video with a small-to-moderate effect size (Cohen's d of -0.28, 95% CI, -0.54, -0.01). The contrast of in-person and telephone assessment was larger, with telephone assessment being less difficult than in-person (largest shift in item difficulty for digit span backwards, d = -1.12 95% CI -1.35, -0.90). Calibrated scores from telephone and videoconference demonstrated good agreement (r = 0.72, 95% CI 0.61, 0.80), and the differences could be corrected with latent variable measurement models. Videoconference based neuropsychological assessment can be as precise as in-person. Calibration of ability estimates using latent variable measurement models can address measurement differences and generate scores without evidence of systematic bias.

French neuropsychological procedure consensus in epilepsy surgery

IntroductionNeuropsychological assessment is an integral component of the surgical procedure in patients with epilepsy. As no French consensus for neuropsychological assessment was available, the main goal of this work was to define French neuropsychological procedure consensus in regard to literature review. MethodA panel of expert in neuropsychology was created within the framework of the French League Against Epilepsy. A systematic search of publications from 1950 to 2017 listed in PubMed database was conducted leading to a classification of articles according to their level of scientific evidence. French neuropsychological procedure consensus was then carried out with an expert panel of expert. ResultsLow scientific evidence of neuropsychological data was reported. A panel of expert proposed a comprehensive neuropsychological assessment procedure including the exploration of intellectual efficiency, long-term memory, short-term and working memory, attention, executive functions, processing speed and motor skills, language, visual processing, praxis, psychobehavioral, and social cognition. DiscussionA common procedure for assessing cognitive and psychobehavioral function is now available in patients with epilepsy undergoing surgical evaluation have been established, they may help to improve the quality of care and the patient experience. This work highlights the need of furthers investigations and the necessity to develop specific tools with normative data.

Current limitations of neuropsychological tests and assessment procedures

Objective: Neuropsychological tests are used for a wide variety of purposes: assessing basic cognitive abilities or disabilities; determining cognitive patterns associated with brain disorders or injury; exploring brain-behavior relationships; and, in some cases, addressing psycho-legal issues. This paper will focus on the limitations of current neuropsychological tests for these purposes.Method: Current limits of neuropsychological tests and assessment procedures are reviewed and recommendations for improvements are made. The relationship between the conceptual basis of neuropsychological tests and modern theories of brain functional organization is discussed. In addition, psycho-legal concerns are briefly outlined.Conclusions: Existing tests and techniques can be improved. Normative data for some neuropsychological tests are based on small samples or have limited validity or reliability data. A variety of neuropsychological tests are available but particular cognitive domains are underrepresented, particularly those involving high-level cognitive skills and social skills. Progress is being made in the availability of tests in multiple languages, but the restricted range of languages and cultural influences demands more attention. Standard test procedures often deviate from real-world activities. In this modern age, some tests have become too familiar because of the Internet. Understanding of complex neural networks activated by cognitive tasks is only beginning to be appreciated. Procedures for determining psycho-legal issues need improvements in some areas.

El legado de Luria y la neuropsicología escolar

Resumen: Se revisa la historia de la neuropsicología aplicada al trabajo con los niños. Diversos autores se han mostrado partidarios de aplicar la neuropsicología a los centros educativos, especialidad que algunos han llamado “neuropsicología escolar”. Desde que inicialmente así se la denominó (Hynd y Obrzut, 1981), han tenido lugar notables avances respecto al campo e identidad profesional de esta especialidad. La obra de Luria continúa teniendo una gran influencia internacional. Luria ha contribuido a la comprensión neuropsicológica del individuo y de la práctica profesional. Como actividad profesional, la neuropsicología escolar se ocupa de la evaluación, diagnóstico e intervención en estudiantes que tienen dificultades en sus aprendizajes y/o muestran trastornos de comportamiento en su centro escolar. En los últimos años se viene recomendando una evaluación neuropsicológica comprehensiva de cara a la intervención en el centro escolar. Existen procedimientos más nuevos de evaluación neuropsicológica infantil, los cuales representan aplicaciones innovadoras del modelo conceptual de Luria. La investigación y avances de los estudios de neuroimagen nos permiten conocer mejor los cambios del cerebro en desarrollo. The Luria’s legacy and school neuropsychology Abstract: This article reviews the history of neuropsychology applied to work with children. Several authors have advocated for the application of neuropsychology to the school centres, a specialty some have called “school neuropsycology”. Since the term was initially introduced (Hynd & Obrzut, 1981), considerable advances have arisen regarding the field and professional identity of this specialty. Luria’work continues to have a strong international influence. Luria has served for neuropsychological understanding of the individual and for the professional practice. As professional activity, the school neuropsychology focuses in assessing, diagnosing, and intervening with students who are experiencing learning difficulties and/or behaviour disorders in academic setting. In recent years, a comprehensive neuropsychological assessment for intervention is recommended within a school setting. Newer neuropsychological assessment procedures for children represent innovative applications of Luria’s conceptual model. Research and advances in neuroimaging allow us to view how the developmental brain changes.

Cognitive functioning in older adults with early, late, and very late onset alcohol dependence.

Alcohol dependence in older adults is associated with cognitive impairment. Age of onset of alcohol dependence is an important criterion to distinguish subgroups of alcohol-dependent people. Little is known about the influence of the age of onset of alcohol dependence on cognitive functioning. The primary aim of this study was to examine if older alcohol-dependent people with early, late or very late onset of alcohol dependence differ in terms of cognitive dysfunction. A total of eighty-five older alcohol-dependent people who were admitted to an inpatient detoxification program, were categorized into three age of onset groups: early onset (< 25 years: N = 27, mean age 57.7 ± 7.4), late onset (25-44 years: N = 28, mean age 61.1 ± 6.7) and very late onset (≥ 45 years: N = 30, mean age 65.6 ± 6.5). A neuropsychological test battery (Kaufman-Short Neuropsychological Assessment Procedure (K-SNAP), Trail Making Test (TMT) and Stroop Color Word Test) was administered to assess cognitive functioning. Differences between groups were examined with analyses of variance (ANOVAs). There were no significant differences in performance on any of the neuropsychological measures between the three age of onset groups. However, compared to a non-alcohol-dependent norm group, all three age of onset groups performed below average. The results suggest that older adults who start drinking heavily (very) late in life have similar cognitive impairments compared to their peers who have been drinking for decades. This emphasizes the vulnerability of the aging brain to the toxic effects of alcohol.

Homicide by an older adult offender: assessment, formulation and treatment

Senior individuals are far more commonly the victims of aggression than the perpetrators, but a small minority of older adults do commit crimes. This paper describes the case of a male older adult who battered his wife to death and presented with amnesia about the attack. It describes the neuropsychological, risk and personality assessment procedures adopted to assess functioning, evaluate risk of re‐offending and formulate about the offence. It proposes formulations for the offence and illustrates the treatment provided to ameliorate distress and enhance memories of what had taken place. Finally it highlights areas for future research and service development. With a growing older adult population, the need for specialist assessment and risk management of older adults who offend is likely to increase, so more resources should be allocated to meeting the needs of such individuals.

The New Gold Standard

Assessment of Malingered Neuropsychological Deficits. Glenn J. Larrabee (Ed.). 2007. New York: Oxford University Press, 540 pp., $69.50 (HB)Developments in the area of malingering detection parallel several of Thomas Kuhn's observations concerning the nonlinear trend of progress in the history of science (Kuhn, 1962). For example, the naive assumption that traditional neuropsychological assessment procedures would straightforwardly generalize to compensation-seeking populations characterized an earlier status quo, a period Kuhn referred to as normal science. The central fallacy of this assumption was the idea that litigants and other claimants did not, as a group, behave differently from those seen in strictly clinical settings. The untenable presumption that astute clinicians were generally capable of forming accurate judgments about the validity of effort on the basis of observation was another received belief that characterized this now archaic era of practice.

Cognitive function following stroke and vascular cognitive impairment

This review of the cognitive status following stroke and vascular cognitive impairment starts by questioning the concept of vascular dementia and related concepts. Our position is that in many cases these labels promote a superficial conceptualization of an inherently complex and heterogeneous phenomenon hampering a more detailed understanding. After stroke or disease of the cerebral vasculature, the cognitive and emotional outcome is dependent on a combination of three factors with the relative importance differing between causes. First, focal damage may lead to selective impairments that are dependent on the localization of the (grey matter) lesion. Second, diffuse neuronal dysfunction produces a more uniform profile of a decrease in mental speed, memory problems, and reduced executive functioning. Third, cognitive outcome is further modulated - notably in terms of severity - by patient variables such as age, sex, premorbid level of functioning, and comorbidity (e.g. hypertension). The complex character of the cognitive repercussions of stroke can be better harnessed by employing modern neuropsychological assessment procedures. This allows both a detailed categorization of the patients for the selection and effectiveness of therapeutic intervention, as well as the construction of reliable prognostic models.

Real-World Cognitive--and Metacognitive--Dysfunction in Schizophrenia: A New Approach for Measuring (and Remediating) More "Right Stuff"

While the role of impaired cognition in accounting for functional outcome in schizophrenia is generally established by now, the overlap is far from complete. Moreover, little is known about the potential mechanisms that bridge between cognition and functional outcome. The aim of this article is to aid in closing this gap by presenting a novel, more ecologically valid approach for neuropsychological assessment. The new approach is motivated by the view that metacognitive processes of self-monitoring and self-regulation are fundamental determinants of competent functioning in the real world. The new approach incorporates experimental psychological concepts and paradigms used to study metacognition into current standard neuropsychological assessment procedures. Preliminary empirical data that support and demonstrate the utility of the new approach for assessment, as well as remediation efforts, in schizophrenia are presented and discussed.

Specialist neuropsychological assessment procedures for children and adolescents

This paper provides an introduction to specialist developmental neuropsychological assessment for clinical or research purposes. In particular, the review considers how to identify groups likely to require specialist neuropsychological testing. Furthermore, it discusses measurement issues, such as the non-specific abilities that are utilized in the course of various assessments. These abilities are not the target functions; but children's capacity in such abilities may confound the test results; and as such it is important to be aware of these hidden test requirements. A variety of published tests and measures are described in detailed tables (including target function, reference population and test age range). Also the paper considers issues relating to individual brain functions such as implicit versus explicit memory, expressive and receptive language, sustained and selective attention, spatial and motor skills. It raises the notion that there is a lack of specificity in the executative function (EF) concept – which is particularly important as EF functions are implicated in so many neurodevelopmental disorders. Finally, the paper highlights the difficulties in capturing social cognition with formal neuropsychological assessment.

Assessment and Development of Executive Function (EF) During Childhood

This review paper outlines the issues associated with the assessment of executive function (EF) in children and adolescents, and describes the developmental profile of executive processes across childhood. At the outset, EF is defined, and cognitive and behavioral impairments associated with executive dysfunction (EDF) are described. A developmental model of EF is proposed incorporating four discrete but inter-related executive domains (attentional control, cognitive flexibility, goal setting, and information processing) which operate in an integrative manner to enable “executive control”. Characteristics that constitute traditional EF measures are discussed, as are the problems associated with test interpretation. The ecological validity of EF tests and neuropsychological assessment procedures are examined, and adjunct methods of measurement are presented to enable a more comprehensive and valid assessment of EF. Based on developmental and normative studies, the maturation of executive domains is mapped. Attentional control appears to emerge in infancy and develop rapidly in early childhood. In contrast, cognitive flexibility, goal setting, and information processing experience a critical period of development between 7 and 9 years of age, and are relatively mature by 12 years of age. A transitional period is thought to occur at the beginning of adolescence, and shortly after “executive control” is likely to emerge. In order to confirm our current understanding of EF development and further enhance our understanding of brain-behavior relationships, longitudinal studies incorporating structural and functional neuroimaging are required.

Development of a simplified version of the multiple errands test for use in hospital settings

Problems with executive functioning may have catastrophic consequences following brain injury. Valid neuropsychological assessment procedures are required if the nature and extent of these are to be understood. However, some existing measures do not adequately reflect how executive impairments are manifested in the context of everyday functioning. Shallice and Burgess (1991) described one procedure, the Multiple Errands Test (MET), which did attain this goal. While successful, it was designed for people who performed within or above the normal range when tested using existing psychometric measures: however, it is acknowledged that many patients seen in routine clinical practice perform below normal limits. Furthermore, while the procedure was carried out in a public place a range of constraints may prevent this with some patients. In this paper the utility of a simplified MET designed for use within a hospital environment is explored. Twenty neurologically healthy participants and 20 people with acquired brain injury took part. People with acquired brain injury were clearly discriminated from healthy controls through the number of errors made. Furthermore, one category of error proved highly predictive of difficulties attributable to executive dysfunction observed in the context of everyday living. While one other test correlated almost as well with these difficulties, it was argued that MET methodology is more advantageous to clinicians regarding assessment and rehabilitation.

The Kaufman Short Neuropsychological Assessment Procedure and the Halstead--Reitan Neuropsychological Battery: a comparison using participants referred by vocational rehabilitation

The Kaufman Short Neuropsychological Assessment Procedure and the Halstead--Reitan Neuropsychological Battery: a comparison using participants referred by vocational rehabilitation

Cognitive disorders in patients with occlusive disease of the carotid artery: a systematic review of the literature.

We present a systematic review of the literature on the prevalence, nature, severity, course, and causes of cognitive deficits in patients with occlusive disease of the carotid artery prior to surgery (if surgery was under discussion). Searches were carried out on Medline and Psychlit from 1980 to 1999 using neurovascular and psychological index terms, and papers and books were checked for further references. Studies describing neuropsychological assessment of groups of patients with carotid obstruction were included. Eighteen studies were found. We extracted from the papers data on study design, demographic characteristics of patients, clinical diagnosis, carotid obstruction, cerebral imaging, time interval between ischemic episode and neuropsychological assessment, neuropsychological assessment procedures, integration and interpretation of test performances, and conclusions of authors. Fourteen studies concluded that there are cognitive deficits both in patients with symptomatic and in those with asymptomatic carotid obstruction; four studies denied cognitive impairment. There were no differences in patient characteristics, study design, or neuropsychological assessment procedures between the 14 studies that found deficits and the 4 that did not. There are indications for a mild, diffuse detrimental effect of carotid occlusive disease on cognitive functioning. However, methodological problems prevent a definitive conclusion. Further research is needed to confirm these findings and to ascertain the neurovascular risk factors for and the natural course of cognitive impairment in patients with carotid occlusive disease.

Neuropsychological assessment of a potential ''euthanasia'' case: a 5 year follow up

McMillan reported a neuropsychological assessment procedure which was used to determine whether or not there was evidence for sentience in a young woman who had been rendered tetraplegic and anarthric as a result of a road traffic accident. An application to court had been made to withdraw feeding and this was supported by medical evidence which gave the view that the individual was functioning little beyond vegetative state, had a poor quality of life and had little prospect of further recovery. Evidence for an ability to communicate reliably was found including for a wish to continue living, and as a consequence the application to court was withdrawn. This paper describes further recovery 2-4 years after the original assessment (i.e. 4-6 years post-injury). At follow-up, she remained dependent for all care, but was now feeding orally and was talking. She could learn new information, some of which she retained for at least 12 months and had greater insight into her condition. She now reported low mood and some pain. As before, she consistently reported a wish to live. The implications of the follow-up are discussed in the context of assumptions made about quality of life and decision making about euthanasia in brain injured people who are severely disabled, but are not in a vegetative state.

Spanish applications of Luria's assessment methods.

Luria's neuropsychology has been particularly influential in the Spanish-speaking world. Its impact is observed with regard to not only assessment, but also rehabilitation, and, especially, neuropsychological theorization. In this article, Luria's approach to neuropsychological assessment is examined. A distinction between Luria's neuropsychological tests and Luria's neuropsychological approach is introduced. It is pointed out that, according to Luria, the specific tests used in the neuropsychological assessment are secondary; the theory supporting the neuropsychological testing is of primary importance. The development of neuropsychology in the Spanish-speaking world is briefly presented, and the use of Luria's neuropsychological assessment procedures in Latin America and Spain is analyzed. Finally, neo-Lurianism in the Spanish-speaking world is considered.

Neuropsychological assessment of the college football player.

The application of neuropsychological assessment procedures to the evaluation of athletes has recently become an area of intense interest and debate and has led to the development of research initiatives at both the amateur and the professional level. However, to date, only a handful of research studies have been completed that have addressed the special issues that accompany the use of neuropsychological assessment instruments with athletes. This article reviews the past use of psychological testing in sports and presents a model of neuropsychological assessment that is currently being utilized in the National Football League. In addition, the extension of this approach to major college football is discussed and test-retest data from a sample presented to provide the basis for comparison of athletes who have suffered a concussion. Recommendations of a national panel of neuropsychologists who are involved in the evaluation of athletes are presented in hopes of encouraging new research initiatives in this area.

Validity of the Kaufman Short Neuropsychological Assessment Procedure (KSNAP)

The sensitivity and specificity of the Kaufman Short Neuropsychological Assessment Procedure (KSNAP; Kaufman and Kaufman, 1994) with regard to the presence or absence of neurocognitive impairment were evaluated in a series of consecutive rehabilitation admissions; including 25 patients with left-hemisphere stroke (LS), 25 patients with right-hemisphere stroke (RS), and 25 control patients with various conditions but without stroke or other cerebral involvement (NS). The KSNAP demonstrated limited ability to discriminate patients with left, but not right, strokes from control participants. Number Recall was the only subtest that discriminated left from right stroke participants. In terms of the accuracy of the KSNAP with regard to the identification of cognitive status in stroke patients, overall specificity was good (92%) but sensitivity was poor (47%). It is concluded that great caution is needed when using the KSNAP for screening purposes, especially with inpatient stroke rehabilitation patients.

An interview with Alan Kaufman

Dr. Alan Kaufman is one of the leading figures in intellectual and achievement testing alive today. With his wife Dr. Nadeen Kaufman, he has constructed the Kaufman Assessment Battery for Children (the K ABC), the Kaufman Adolescent and Adult Intelligence Scale (the KAIT), the Kaufman Brief Intelligence Test (the KBIT), the Kaufman Test of Edu cational Achievement (K-TEA), and most recently, the Kaufman Survey of Early Academic and Language Skills (K-SEALS), the Kaufman Short Neuropsychological Assessment Procedure (K-SNAP), and the Kaufman Functional Academic Skills Test (K-FAST). Dr. Kaufman is currently Research Professor at the University of Ala bama. He has recently published Intelligent Testing with the WISC-III, and he is the author of the 1990 text, Assessing Adolescent and Adult Intelligence. The interview was conducted by phone to assist the third author with his master's thesis and to assist the first and second author with their re search in the assessment of learning disabilities. 1. Q. What new areas of assessment (for example, adaptive behavior or social skills) are you currently working on? A. The most recent things Nadeen and I have developed are the KAIT (Kaufman Adolescent and Adult Intelligence Test), which came out in 1993, and some brief instruments. We recently published the K-FAST (Kaufman Functional Academic Skills Test), which is a functional academic skills test for ages 15 and above. Another new test is the K-SNAP (Kaufman Short Neurological Assessment Procedure) (which is a brief neuropsychological assessment procedure), for ages 11 and above. So, basically, Nadeen and I have been concentrating in the area of adolescent and adult assessment. We are still mostly looking at cognitive abilities, but are also branching out a little bit with the K-FAST into other areas. We are looking at func

Cognitive functioning of adult survivors of cerebral hypoxia.

What should clinical neuropsychologists look out for when asked to assess someone with hypoxic brain damage? To determine whether there are typical cognitive profiles of hypoxic patients, all referrals for a neuropsychological assessment made to the author over a period of 16 years were scanned to identify those with a primary diagnosis of cerebral hypoxia as recorded in the hospital notes. From a total sample of 567 patients, 18 (3.17%) had sustained primary cerebral hypoxia from a variety of causes including carbon monoxide poisoning, cardiac arrest, anaesthetic accident, respiratory failure following a pulmonary embolus, hanging and drowning. Not surprisingly, in view of the different degrees of brain damage, the cognitive functioning of the 18 patients was variable, with the greatest number showing deficits of memory and executive functioning (n = 6). Three presented with an amnesic syndrome; two with memory, executive and visuospatial deficits; and three with visuospatial or visuoperceptual problems without severe memory impairments. The remaining four patients were very severely impaired intellectually (VSI), with widespread cognitive deficits precluding the use of neuropsychological assessment procedures designed for adults.