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Dementia
Published in Henry J. Woodford, Essential Geriatrics, 2022
Formal neuropsychological testing usually involves a series of tests that assess specific aspects of brain function. This process often takes far longer (typically two to three hours) than practical for a medical assessment, plus the results can only accurately be interpreted by a specialist with comparison to data for standard populations. A reasonable intermediate step between the MMSE or MOCA and formal neuropsychology is the Addenbrooke's Cognitive Examination third version (ACE-III).20 This series of questions incorporates attention, memory and visuospatial tests along with more elaborate tests of a wider range of specific cognitive domains (including executive function) to give a score out of 100. The higher the score, the better the cognition, with a cut-off point below 87 suggesting significant impairment. Subtle deficits will only be detected with more complex testing. In late dementia, all areas of cognition will become impaired and the discriminatory ability to diagnose specific dementia syndromes will become diminished. Another option is the Free-Cog test that performs similarly to the MMSE, MOCA or ACE-III but is not subject to any copyright restrictions.21
Monitoring Disease Activity in Multiple Sclerosis
Published in Richard K. Burt, Alberto M. Marmont, Stem Cell Therapy for Autoimmune Disease, 2019
For clinical trials, it has been important to include measures that are sensitive to change and, specifically, the changes related to MS. Tests used in trials are variable and thus comparison is difficult. Because the patient population is heterogenous in severity and type of cognitive dysfunction, patient selection and selection of measures used to assess for progression is crucial. Performance will fluctuate over time due to measurement error or disease activity. Many neuropsychological measures are subject to practice effect. This must be incorporated into planning the clinical trial. Finally, tools that detect impairment may not be sensitive to change in the condition. Because of the wide patient variability, the use of one test for cognitive assessment is limited. More extensive neuropsychological testing provides data about diverse areas of cognitive dysfunction, but is time consuming and may blur a significant cognitive change in one area. For large studies, a limited but directed cognitive battery might be most appropriate.43
The Role of the Neuropsychologist in Life Care Planning
Published in Roger O. Weed, Debra E. Berens, Life Care Planning and Case Management Handbook, 2018
Additionally, as documented in Lezak et al. (2004), neuropsychological testing can be helpful in discriminating psychiatric versus neurological symptoms, identifying possible neurological disorders, distinguishing between neurological disorders, and providing input regarding localization of lesion sites, at least to a hemispheric level. While the role of neuropsychological evaluation in lesion localization has largely been supplanted by advanced neuroimaging, a neuropsychological evaluation of cognitive abilities and skills that is well-done can provide the foundation for not only accurate diagnosis but also useful recommendations for treatment, which can be applied clinically. Recommendations may include individual psychotherapy, family psychotherapy, psychiatric interventions, behavioral interventions, training and coaching, special education services, and specialized needs such as services provided by other professionals (e.g., occupational therapy, neuro-ophthalmology, speech therapy, neurological consultations, dietary consultations).
Memory and Executive Functions Subserving Judgments of Learning: Cognitive Reorganization After Traumatic Brain Injury
Published in Neuropsychological Rehabilitation, 2022
Pradeep Ramanathan, Ran Liu, Ming-Hui Chen, Mary R. T. Kennedy
During the first session all participants underwent neuropsychological testing, which included eight subtests from three different neuropsychological test batteries, assessing memory, verbal learning, and executive function. The Visual Reproduction I and II and Digit Span subtests of the Wechsler Memory Scale, 3rd edition (WMS-III, Wechsler, 1987) were used to assess short-term, long-term, and working memory. The California Verbal Learning Test, 2nd edition (CVLT-II, Delis et al., 2000) measures verbal learning after short and long delay, cued and free recall. The Trail Making, Verbal Fluency, Design Fluency, and Tower tests of the Delis-Kaplan Executive Function Systems (D-KEFS, Delis et al., 2001) captured a wide range of EFs, including: initiation, inhibition, sustained and alternating attention, switching, verbal and non-verbal aspects of cognitive fluency and flexibility, sequencing, speed of processing, working memory, planning, rule learning, and problem solving. Participants took 15-minute breaks about every 45 min; average session completion time was 112 min for controls and 138 min for participants with TBI. See Table 1 for the descriptive statistics for the psychometric test variables.
Distinct Latent Profiles of Working Memory and Processing Speed in Adults with ADHD
Published in Developmental Neuropsychology, 2021
Sophie I. Leib, Richard D. Keezer, Brian M. Cerny, Lindsey R. Holbrook, Virginia T. Gallagher, Kyle J. Jennette, Gabriel P. Ovsiew, Jason R. Soble
One reason that individuals may perform normally on tests of mental focus and manipulation (e.g., Digit Span) or PS during the evaluation but validly complain about difficulty focusing or slow processing in everyday scenarios on structured questionnaires, for example, is the context of the evaluation. Neuropsychological testing is conducted in a quiet, distraction-free environment that does not mimic most real-world occupational or academic environments. Additionally, Kennedy and colleagues found that although ADHD patients performed in the average range on auditory working memory tests, they were more likely than controls to have greater discrepancy between verbal intellectual abilities and working memory (Kennedy et al., 2019). This further underscores the need for a nuanced approach to assessing an entire neurocognitive profile for relative strengths and weakness to inform precise treatment planning. Although the current study did not investigate the discrepancy between verbal reasoning and WM/PS, future work may expand on class membership to explore intra-individual variability across intelligence domains.
Diffusion tensor imaging findings and neuropsychological performance in adults with TBI across the spectrum of severity in the chronic-phase
Published in Brain Injury, 2021
Katherine L. Zane, Jeffrey D. Gfeller, P. Tyler Roskos, Jeff Stout, Tony W. Buchanan, Thomas M. Malone, Richard Bucholz
Following the completion of a verbal and written consent process, a trained research assistant conducted a semi-structured interview to attain demographic data and health history. The neuropsychological testing was completed over two evaluation sessions (morning and afternoon) in the same day and lasted four to five hours in total. In addition, a majority of the participants underwent neuroimaging procedures, which were typically conducted one or two days following the neuropsychological testing. Examiners were not aware of the participant’s group status at the time of testing. Tests were administered and scored by trained examiners. Neuropsychological test scores were obtained using standard clinical procedures outlined in the test manuals and published guidelines for scoring. Normative-based scores were generated using normative data sets provided by the test developers. Demographically corrected scores were obtained as applicable.