Outline–HealthNeuropsychology概述健康與神經心理學實用教案

1、Outline Health & NeuropsychologyIQ and Neuropsychological TestingMalingeringFunctions of interest to neuropsychologistsLateralityVisual PerceptionLanguageMemoryAttention & Executive Control第1頁/共56頁第一頁，共57頁。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頁/共56頁第二頁，共57頁。Goals of neuropsychological assessmentDiagnosis What happened? What went wrong as a

3、 result?第3頁/共56頁第三頁，共57頁。Goals of neuropsychological assessment Diagnosis Description Cognitive and behavioral deficits that result第4頁/共56頁第四頁，共57頁。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頁/共56頁第五頁，共57頁。Psychometric assessment - advantages Standardized: Repeatable instructions, presentation, and tasks Norms第6頁/共56頁第六頁，共57頁。Psychometric assessment - advantages Standardized Intensive: Multiple measures within and among wide range of domains第7頁/共56頁第七頁，共57頁。Psychometric

5、assessment - advantages Standardized Intensive Sensitive Valid indicators of skills, capable of detecting abilities and deficits第8頁/共56頁第八頁，共57頁。Psychometric assessment advantages Standardized Intensive Sensitive Scaled Hierarchical items start/stop rules第9頁/共56頁第九頁，共57頁。Psychometric assessment adva

6、ntages Standardized Intensive Sensitive Scaled Precise Allows reliable, exacting quantification of relative abilities Allows comparison within/over time第10頁/共56頁第十頁，共57頁。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頁/共56頁第十一頁，共57頁。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頁/共56頁第十二頁，共57頁。第13頁/共56頁第十三頁，共57頁。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頁/共56頁第十四頁，共57頁。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頁/共56頁第十五頁，共57頁。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頁/共56頁第十六頁，共57頁。

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頁/共56頁第十七頁，共57頁。Estimating pre-morbid IQ Clinical approaches Actuarial &am

12、p; psychometric approaches Demographic Formulas Reading level Subtest pattern第18頁/共56頁第十八頁，共57頁。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頁/共56頁第十九頁，共57頁。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頁/共56頁第二十頁，共57頁。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頁/共56頁第二十一頁，共57頁。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頁/共56頁第二十二頁，共57頁。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頁/共56頁第二十三頁，共57頁。Reitans four-fold approach Level of performance Comparison of individual with normative groups of impaired and non

18、-impaired persons 第24頁/共56頁第二十四頁，共57頁。Reitans four-fold approach Level of performance Pattern of Performance Examination of intra-test performance and subtest scores第25頁/共56頁第二十五頁，共57頁。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頁/共56頁第二十六頁，共57頁。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頁/共56頁第二十七頁，共57頁。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頁/共56頁第二十八頁，共57頁。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頁/共56頁第二十九頁，共57頁。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頁/共56頁第三十頁，共57頁。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頁/共56頁第三十一頁，共57頁。Functions of interest to neuropsychologists1. Laterality2. Visual Perception3. Language4. Memory5. Attention & Executive Control第32頁/共56頁第三十二頁，共57頁。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頁/共56頁第三十三頁，共57頁。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頁/共56頁第三十四頁，共57頁。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頁/共56頁第三十五頁，共57頁。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頁/共56頁第三十六頁，共57頁。Figure/ground discrimination separate figure from background第37頁/共56頁第三十七頁，共57頁。The em

29、bedded figures test task is to find all the objects in this figure.第38頁/共56頁第三十八頁，共57頁。The objects in the embedded figures test stimulus第39頁/共56頁第三十九頁，共57頁。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頁/共56頁第四十頁，共57頁。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頁/共56頁第四十一頁，共57頁。The Rey-Osterrieth Complex Figure (Osterrieth, 1946)第42頁/共56頁第四十二頁，共57頁。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頁/共56頁第四十三頁，共57頁。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頁/共56頁第四十四頁，共57頁。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頁/共56頁第四十五頁，共57頁。Graded Naming Test examples test has 30 of these, presented in order of increasing difficultyBoston Naming Test examples第46頁/共56頁第四十六頁，共57頁。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頁/共56頁第四十七頁，共57頁。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頁/共56頁第四十八頁，共57頁。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頁/共56頁第四十九頁，共57頁。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頁/共56頁第五十頁，共57頁