Clinical Neuropsychology Flashcards
Paper 1 (223 cards)
1
Q
What is clinical neuropsychology
A
studies the relaitonship between brain function / dysfunction and behaviour
2
Q
Dysfunction can result from what three things
A
- Structural lesions (e.g. tumours, trauma)
- Metabolic issues (e.g. drug toxicity, liver failure)
- Neurochemical imbalances (e.g. Parkinson’s, schizophrenia)
3
Q
5 approaches to assessment
A
- Psychometric (most common). Uses standardised tests and normative data.
- Localisation. Historically used for identifying lesion sites before neuroimaging; now more focused on lateralisation or frontal lobe testing.
- Ecological. Looks at how deficits affect real-world functioning.
- Functional. Looks at how cognitive impairments affect specific functions or abilities (without necessarily simulating real-world tasks).
- Observational, Self-report & Interviews
Complements psychometric testing with qualitative insights.
4
Q
Explain how neuropsychological thinking developed on the models underlying assessment
+ key refereance influenced this change
A
Historically: localisation of function (e.g., Broca’s area for speech and Wernicke’s for language comprehension)
Now understand brain functions are distributed across systmes and so damage to any part alters function in different ways.
Luria (1973) - integrated view, the brain works as a functional system meaning multiple areas of the brain works together in a co-ordinated way to produce complicated behavioural output. Therefore damage to different parts of a system can disrupt the same function, but in different ways.
Neuropsychology is well placed to describe how pathology identified in scanning maniefests in cognitive functioning
5
Q
Neuropsychological functions and hemispheric specialisations
A
Left hemisphere: language, verbal skills.
Right hemisphere: visuospatial functions.
Most right-handers and many left-handers have language dominance in the left hemisphere, but a small percentage of left-handers have language functions in right hemisphere or represented bilaterally (shared across both hemispheres).
This makes test interpretation more difficult.
6
Q
two types of assessment strategies
and note the third combined strategy…
A
Fixed Battery (e.g., Halstead-Reitan): covers many domains; comprehensive but lengthy.
Flexible/Hypothesis Testing: tailored to referral questions; efficient but might miss unexpected issues.
Often a combined approach is used (screening test + targeted testing).
7
Q
broad overview of neuroscience testing process (4 broad steps)
A
- Clarify purpose: diagnostic, rehabilitative, legal?
- Review case history (notes) and previous investigations.
- Conduct interview & observations.
- Administer tests, ensuring:
Inclusion of relevant domains:
Intellectual ability (current & premorbid)
Memory, language, attention
Executive function, perception, praxis
Mood & behaviour
Use of culturally appropriate normative data.
8
Q
Name some information it would be useful to gether pre-assessment
A
- Demographics: age, sex, education, handedness, language, culture.
- Educational history: prior assessments, fluency in English, school performance.
- Medical history: imaging, prior assessments, psychiatric history.
- Injury history: trauma specifics, seizures, oxygen deprivation, surgeries.
- Testing considerations: medication, vision/motor issues, fatigue, mood.
9
Q
key domains to interview patients and families on (4)
A
- Work & daily function
- Social interactions
- Personality & emotional changes
- Motor, language, memory, executive and spatial functions
10
Q
describe 6 things to observe during testing
A
- Motor: gait, tremor, coordination, handwriting, clumsiness, slowness
- Language: amount of speech, fluency, understanding of instructions, ability to read/ follow written instructions, word-finding difficulties, unusual structure of speech
- Memory: Ability to recall basic information (age, d.o.b), orientation, recall of the session
- Spatial and visual awareness: neglect, visual tracking
- Personality/Behaviour: anxiety, insight, impulsivity, appropriateness
- Performance style: organisation, error-checking, impulsivity, concentration, perseveration
11
Q
good neuropsychological report should include
A
Clearly state the purpose and context of assessment.
Describe the patient’s presentation and cooperation.
Be evidence-based, with objective findings and normative data.
Organise results by functional domain (not by test).
Include influencing factors (e.g. medication, mood).
Be structured, accessible, and clear on implications.
Suggested Structure:
Reason for referral
History (medical, family, educational)
Behavioural observations
Test results & interpretation (by domain)
Conclusions & recommendations
Appendix (summary scores, raw data if needed)
12
Q
3 things neuropsychologists do
A
Conduct psychometric and functional assessments to understand behaviours that changed.
Design and deliver neurorehabilitation (psychoeducation about cognitive strategies, goal setting and cognitive strategy implementation, environmental modification).
Provide therapy (individual, family-based).
13
Q
apraxia is a diagnosis by …
A
exclusion
Apraxia is now recognised as a key part of different neurodegenerative disorders (Stoll et al., 2025)
13
Q
define apraxia
A
an impairment of the ability to carry out purposeful movements by an individual who has normal primary mototr skills and normal comprehension of the acts to be carried out
14
Q
when does apraxia (and aphasia) often occur
A
following left hemisphere injury, particulalry stroke (note double dissociation so can have one without the other)
15
Q
Exaplain Ideomotor apraxia
A
- Failure to execute gestures despite understanding
- Seen in 50–80% of dominant MCA stroke cases (Basso et al., 1987; Donkervoort et al., 2006)
- Lesions: left parietal, premotor, basal ganglia
- Error types: Spatial: wrong hand posture, Temporal: poor timing/sequence
- Content: irrelevant movements, perseveration
16
Q
Explain ideational apraxia
A
- Trouble performing complex multi-step actions
- Misuse or misselection of tools
- Lesions: parieto-temporal, frontotemporal (Stoll et al., 2024)
- Note conceptual apraxia sometime included here or held separate. This is the impairment of object or action knowledge (e.g., misuse objects)
17
Q
explain limb (kinetic) apraxia
A
this is an alternative way to classify apraxia: inaccurate or clumsy distal limb movements
- Meaningful gestures
Unable to produce meaningful gestures on demand (e.g., wave goodbye) - Can train gestures, but tend not to generalise so focus on useful ones
- Imitation of meaningless gestures
Person understands request to copy gesture, but gesture is spatially wrong. Impact in physiotherapy for example
Use of single tools and objects - Can fail for two reasons. 1. Loss of knowledge of the special function of the tool (e.g., use toothbrush on shoe), 2. Know the function of an object but can’t adapt action to constraints of the time (e.g., knows a knife cuts but cannot do the sawing motion)
- Multi-step actions with several tools and objects
- Sequencing of actions and maintenance of overall goal can lead to errors (even can successfully use a single object). Test by making a cup of tea or cutting paper with scissors
18
Q
explain orofacial apraxia
A
another alternative classification: impairment of skilled movments involving face, mouth, tongue
Difficulty performing facial / oral gestures on command. Rarely noticed by individual themselves but problem for speech therapy for example.
19
Q
4 Testing conditions for apraxia
2 things to hold in mind
two types of movement
A
- to verbal command
- by imitation of the examiner
- in response to a real, seen object
- when handling a real object
Hold in mind both meaningful and meaningless movements on left and ride sides
two types of movement:
transitive (so using objects) and intransitive (not using objects)
20
Q
Clinical tips when administering tests for apraxia
A
Be sure to video record to help scoring
Clinical judgement, expertise and supervision are important
21
Q
Name and reference the florida batteries for apraxia
A
- FAST-R (Florida Apraxia Screening Test); Rothi et al 1992
- FAB (Florida Assessment Battery); Rothi et al., 1992, 1997
- FABERS (Florida Apraxia Battery Extended and Revised Sydney); Power et al., 2010
22
Q
Name, reference and explain the apraxia test
A
Apraxia Test (Van Heugten et al., 1999; Zwinkels et al., 2004)
Devised to overcome lack of standardised measures
Object use and imitation of gestures (ideational and ideomotor)
3 sets of objects, show me how you would use…
1. Presented by verbal request (key, saw, toothbrush)
2. Presented visually (spoon, hammer and scissors)
3. Handed to patient (eraser, comb, screwdriver)
Imitation of gesture
23
Q
Name some specific apraxia tests (e.g., face apraxia
A
Face Apraxia assessed via Bizzozero et al., 2000 – useful has normative data allowing for age and education
Naturalistic assessment (Rothi et al., 1997) - e.g., video patients eating on ward
Cologne Apraxia Screening (CAS)
Dovern et al 2012 say this is a reliable and valid screening tool better than the AST
TULIA (Test of Upper Limb Apraxia)
Dovern et al 2012 say this is a good comprehensive test
24
explain the management and treatment of apraxia
Management – environmental adaptation
Treatment – attempts to improve impaired movement by preventing the person persisting with ineffective movements and teaching more effective movements
Effectiveness of treatments vary but there is little generalisation (Goldenburg et al., 1998)
25
EDI consideration for apraxia
ensure gestures tested are culturally relevant (considering age demographics, culture etc)
26
broadly name why you might be asked to complete a neuropsychological assessment (4) / the aims of the assessment are
Diagnose brain damage/dysfunction.
Understand functional impacts.
Guide treatment and rehabilitation.
Aid legal and educational decisions.
27
What do we need to know in setting out to do an neuropsychological assessment
Differential diagnosis - MH vs meds side effects vs brain damage
Natural history - rates of recovery
Description of problem and functional impact
Medical history
Personal history
28
4 things to consider when administering neuropsychological tests to ensure reliability and validity
tests are inherently reliable (e.g., we don't use polygraph)
standard procedures - how we get to be reliable
assessment environment meets sufficient quality
Adjustment made for sensory disabilities (e.g., wearing glasses and hearing aides)
29
Cross Cultural Neuropsychology
People of different cultures will process information differently and so will approach neuropsychological tests differently – this then requires an understanding of cultural diversity
Neuropsychological assessments should be conducted in the persons first language unless they are very proficient in the language normally used by the examiner
Cross cultural studies have suggested that educational level is a key variable in predicting performances
30
Explain with references the conept of intelligence
“The capacity of the individual to act purposefully, think rationally and to deal effectively with his environment” Wechsler, 1944
Started with Stanford-Binet test to determine children's educational needs at school
Then Spearman's g was the one to give a number to inteligence
Intelligence now understood as a composite of specific abilities and not a single unit
31
WAIS-IV structure
Full Scale IQ (FSIQ) based on 4 indices:
Verbal Comprehension Index (VCI): Similarities, Vocabulary, Information (Comprehension - supplementary)
Perceptual Reasoning Index (PRI): Block Design, Matrix Reasoning, Visual Puzzles (Figure Weights, Picture Completion - supplementary)
Working Memory Index (WMI): Digit Span, Arithmetic (Letter Number Sequencing - supplementary)
Processing Speed Index (PSI): Symbol Search, Coding (Cancellation - supplementary)
32
WAIS-IV aims
“comprehensive and contemporary norms as well as improving the psychometric properties, clinical utility and user-friendliness of the test”
- greater emphasis on fluid intelligence, working memory and processing speed
-
33
why do we test intelligence
Differential diagnosis
Identify learning/intellectual disabilities
Understand strengths/weaknesses
Predict future functioning
Compare with other cognitive domains
Inform therapy
34
general ability index of WAIS_IV
Combination of Verbal Comprehension and Perceptual Reasoning Index
Useful for estimating general ability whilst reducing complication of specific impairment in processing speed or working memory
- However, the FSIQ is considered most valid measure of overall cognitive ability
35
brief WAIS administration guidelines
Use reversal/discontinuation rules.
Record timing, queries, spoiled responses.
Multiple responses: Clarify intended answer.
Score best valid response unless spoiled. Spoiled - elaboration reveals a misconception about the item
36
testing WAIS with people with special needs
Consider adaptations for:
Motor impairments: Avoid speeded tests
Hearing/visual/language impairments
Cultural/educational factors
Clearly document any modifications.
Use clinical judgment for interpreting modified results.
37
Name 8 parts of the geniculate striate pathway
1. Retina
( including Rods, Cones and Ganglion Cells)
2. Optic Nerve
3. Optic Chiasma
4. Optic Tract
5. Lateral Geniculate Nucleus (LGN)
6. Optic Radiation
6a . Primary Visual Cortex (V1)
7. Temporal lobe (Ventral route)
8. Parietal Lobe (Dorsal route)
38
explaining the geniculate striate pathway:
1. Retina (including rods, cones and ganglion cells)
Light enters the eye and is detected by photoreceptors (rods and cones) in the retina, located at the back of each eye. Visual signals are processed by retinal neurons and passed to ganglion cells. The ganglion cells enhance the contours between areas of shade or colour to ‘sharpen the image’
39
explaining the geniculate striate pathway:
(2) Optic nerve
Axons of the retinal ganglion cells bundle together to form the optic nerve (one for each eye), which carries visual information toward the brain.
40
explaining the geniculate striate pathway:
(3) Optic chiasma
At the optic chiasma, some fibers cross over:
– Nasal (inner) retinal fibers from each eye cross to the opposite side
– Temporal (outer) fibers stay on the same side. This allows visual info from the right field of view to go to the left hemisphere and vice versa.
41
explaining the geniculate striate pathway:
(4) Optic tract
After the chiasma, the reorganized fibers continue as the optic tract, now carrying information from the opposite visual field (e.g., left optic tract = right visual field from both eyes).
42
explaining the geniculate striate pathway:
(5) Lateral geniculate nucleus (LGN)
The optic tract projects to the LGN in the thalamus, which acts as a relay and processing center for visual information. The LGN has six layers and preserves retinotopic (spatial) organization.
43
explaining the geniculate striate pathway:
(6) Optic radiation
From the LGN, visual information is sent via optic radiation (also called geniculocalcarine tract) to the visual cortex. These fibers fan out and pass through the temporal (Meyer's loop) and parietal lobes.
44
explaining the geniculate striate pathway:
(6a) Primary visual cortex (V1)
Optic radiations terminate in the primary visual cortex (also called striate cortex, area V1) in the occipital lobe. Here, basic features of vision (edges, contrast, motion, orientation) are processed. V1 maintains precise mapping of the visual field.
45
explaining the geniculate striate pathway:
(7) Temporal lobe (Ventral route)
(8) Parietal lobe (Dorsal route)
Ventral Stream (The What pathway), Object recognition, color, form, and faces
Dorsal Stream (the Where/How pathway). Spatial awareness, motion detection, depth, and how to interact with objects
46
Main brain cortical regions processing vision - name the two
ventral pathway - what
dorsal pathway - where / how
47
ventral pathway
- purpose
- processes
- brain areas involved
- damage can cause
Purpose: Identifies what objects are.
Processes: Shape, color, texture, faces, object identity.
Brain Areas Involved:
V4 (temporal Lobes) – Processes colour and detailed (complex) form.
Inferior Temporal Cortex (IT) – Specialized for recognizing complex objects and faces.
Damage Can Cause:
Visual agnosia (inability to recognize objects)
Prosopagnosia (face blindness)
48
dorsal pathway
- purpose
- processes
- brain areas involved
- damage can cause
Purpose: Determines where objects are and how to interact with them.
Processes: Spatial location, depth, motion, movement coordination.
Brain Areas Involved:
V5/MT (Parietal lobes) – Motion perception.
Posterior Parietal Cortex – Spatial awareness, attention, visually guided movement.
Damage Can Cause:
Hemispatial neglect
Optic ataxia (inability to use vision to guide movements)
Motion blindness (akinetopsia)
49
Explain blindsight
Blindsight: The ability to respond to visual stimuli without consciously perceiving them, typically due to damage to the primary visual cortex (V1).
Visual information bypasses the damaged cortex through alternative pathways like the superior colliculus, allowing for unconscious processing.
Individuals can detect or locate objects in their blind field, even though they report being unable to see them.
1917 – Ridoch observed cortically blind patients who could grasp objects in motion, 1973 – Popel asked patients with blind sight to point towards flashing lights – with success, 1986/90 – Weiskrantz study of DB; patient unable to see left field of vision but could make eye movements to a light flashed there and reach out and point to stimuli
50
name two monocular disturbances affecting the geniculate-striate pathway
Macular degeneration
optic nerve
51
explain macular degeneration
Degeneration of the macula in the retina
Two types: Wet and Dry AMD
Wet: Caused by abnormal blood vessel growth behind the retina → leads to bleeding and scarring
Develops rapidly
Treatable in early stages with anti-VEGF injections (e.g., Lucentis, available on the NHS)
Less common (~10% of cases)
Dry: Develops slowly, causing gradual loss of central vision
Vision becomes blurred, and colours fade, like an old photo
No medical treatment available
Magnifiers and visual aids can help with reading and detailed tasks
Most common form (≈90% of cases)
Clinical features
Central field loss (central scotoma); reading and face recognition are impaired
Age related, women > men
Increasing risk: Some genetic component and smoking
Reducing risk: sunglasses, some vitamins and mineral
52
explain damage to the optic nerve
Damage before or at the optic chiasma
Monocular blindness; loss of vision in one eye leads to impaired stereopsis (depth perception)
53
name 4 binocular / field disturbances affecting the geniculate striate pathwat
1. optic chiasma (midline)
2. optic tract (also optice radiation or visual cortex)
3. upper optic radiation (parietal lobe)
4. lower optic radiation (Meyer's loop - temporal lobe)
54
explain optic chiasma disturbances
Loss of temporal (peripheral) fields in both eyes
clinical features
Bitemporal hemianopia; often caused by pituitary tumors pressing on chiasma or Nasopharygeal Carcinoma, Third Ventrical Tumour
55
explain optic tract disturbances
Loss of contralateral visual field
clinical features
Homonymous hemianopia (e.g. right-sided lesion → loss of left visual field in both eyes)
56
explain upper optic radiation disturbances
Loss of lower quadrant visual field (contralateral)
clinical features
Inferior quadrantanopia ("pie on the floor"). Loss of quarter of visual field in lower quadrant
57
explain lower optic radiation disturbances
Loss of upper quadrant visual field (contralateral)
clinical features
Superior quadrantanopia ("pie in the sky")
Loss of quarter of visual field in upper quadrant
58
name 2 higher-order cortical visuoperceptual disturbances (also has a reference)
apperceptive visual agnosia, Lissuer 1890
associative visual agnosia, Lissuer 1890
59
explain appercetive visual agnosia
Damage to right parietal
Recognition impaired, Cannot form a coherent visual perception; cannot copy or match objects
Types:
Simultanagnoia: Inability to perceive more than one object at a time, despite normal visual fields and acuity.
Can recognize individual elements but not the whole scene (piecemeal perception).
Difficulty with visual motion and scene integration.
Cause: bilateral lesions of the occipitoparietal region
When combined with eye movement incoordination and optic ataxia, it's part of Balint’s syndrome.
Perceptual Classification - Warrington and Taylor, 1973
Impaired ability to classify objects despite intact visual perception of individual elements (e.g., color, shape).
struggle to recognize and categorize objects as part of larger classes (e.g., distinguishing between types of animals or tools).
60
explain associative visual agnosia
Disconnection between perception and meaning (e.g., R/L occipital–temporal disconnection)
Can copy/draw objects but cannot name or assign meaning to them
Types
Visual Object: Difficulty in identifying objects, even if their parts or features are visible. Can’t recognize objects by sight alone, but might be able to identify them through touch or other sensory information.
Prosopagnosia: Face blindness (more often R occipitoparietal and occipitotemporal lesion)
Test: matching of facial pictures and identification of famous faces
Optic Aphasia: The person has difficulty naming the object but can describe its function or purpose.
61
what is macular sparing
phenomenon where the macula (central vision area) is spared despite damage to the occipital cortex, often seen in homonymous hemianopia following a stroke or posterior cerebral artery damage.
62
what is synaesthesia
A condition where stimulation of one sensory modality (e.g., hearing) leads to involuntary experiences in another (e.g., seeing colors), such as hearing sounds and perceiving them as specific colors.
63
what is scotomas
Blind spots or areas of partial vision loss in the visual field, caused by conditions like macular degeneration, optic neuropathy, or brain lesions.
64
clinical implications and reflections on visuo-perceptive disorders
* Patient Adjustment: Visual field deficits (e.g. hemianopia) can lead to disorientation, reading difficulties, and loss of independence (e.g. driving). Face blindness (prosopagnosia) may impact social interactions.
* Neuropsychological Assessment: Detailed mapping of visual fields, object/face recognition tasks, copying, naming, matching, and real-world observation are key.
* Rehabilitation Strategies: Use of compensatory strategies: Visual scanning training for field loss, Environmental adaptations, Assistive technology for reading/recognition , Cognitive rehabilitation techniques.
65
name 3 tests for visuoperceptual disorders
visual object and space perception battery (VOSP), Warrington and James
Cortical Vision screening test (CORVIST), James and Warrington
Benton Test of Face Recognition, Arthur Benton
66
Visual Object and Space Perception Battery (VOSP) - Elizabeth Warrington and Merle James.
Assesses object recognition and spatial perception. Evaluates the ability to identify objects and navigate space, often used for detecting visual agnosia.
67
Cortical Vision Screening Test (CORVIST) Merle James and Elizabeth Warrington.
Screens for cortical visual impairment (CVI), where brain damage affects visual processing despite normal vision. Assesses higher-level visual processing abilities.
68
Benton Test of Face Recognition Arthur Benton.
Tests face recognition abilities, useful for diagnosing prosopagnosia. Involves face matching and identification.
69
brief definition what is attention
allocation of limited processing resources
attention is a cognitive process matching data from the environment to the needs of the organism
as attention is involved in many cognitive functions, impairment can affect t processes such as perception, memoru and voluntary action
70
4 types of attention
sustained - reading a book
selective - focusing on one specific thing and ignoring other things in the environment
alternating - switching attention
divided - driving a car whilst simultaneously listening to gps instructions
71
explain and name three theories of selective attention
Broadbent's filter theory - like a bottleneck, only one message passes through and unattended to information is blocked early. Selection of information is based on physical characteristics (e.g., voice, pitch)
Treisaman's attenuation theory - unattended information is weakened, not blocked. Allows important information (eg, your name) to break through
Deutsch and Deutsch late selection theory - all stimuli fully processed for meaning, selection occurs just before conscious awareness or response
72
Petersen and Posner 2012 three systems theory of attention
altering system - readiness to respond in brain stem
orientating system - to engage move and disengage in space. frontal and parietal lobe
executive system - monitoring and resolving conflict amongst thoughts, feelings and responses. As attention is not unlimited we need a system to control where it is directed
73
explain bottom up versus top down processing in attention
bottom-up (ventral attentional system)
- processing of sensory infromation
- parietal and temporal cortices + brain stem
- e.g., weapons effect
Top-down (dorsal attentional system)
- attentional orientation is under control os person
- goal driven attentional control
- mediated primarily by frontal cortex and basal ganglia
74
default mode network
self referential thought
attentional control, relaxation, worry and rumination in anxiety
75
Salience network
Cingulo-opercular network (CON)
error detection
updates for task demands
76
fronto-parietal network
supports goal drive, top-down attentional control
77
How to assess attention
problem with it and 3 types of assessment of attention
Mental construct so can only be measured indirectly through inferring performance on a specific task
3 types
1. Observational rating scales
2. Observation in functional tasks (e.g., making a cup of tea)
3. Neuropsychological assessment (Test of everyday attention)
78
Factors to consider in assessing attention
age
brain injury
MH - depression & anxiety
fatigue
medication
important to establish underlying impairment as this informs rehab
79
test of attentional span
Information held in mind - digit span
80
Tests of processing speed
taking in verbal and visual information
digit symbol and coding subtests
81
Tests of vigilance / sustained attention
ability to respond over time
conner continuous performance test
sustained attention to response task
82
tests of more complex or executive aspects of attention (e.g., divided and switching)
trail making task
stroop
83
explain the test of everyday attention
battery of tests to understand attention - high ecological validity
- telephone search whilst counting (divided attention)
- lottery (sustained)
- map search (selective)
- elevator test (attentional switching)
84
why do we rehab attention
underpins other aspects of cognitive functioning
social and occupational impact
attention "gates" activity in primary sensory areas of brain
good predictor of recovery in other capacities
85
3 levels of neuropsych rehab for attention
1. Enhancement or reinstitue basic functions - generaliseability?
2. Compensatory strategies - ATTEND
3. environmental aids
86
clinician's guide to neurorehab of attention
check other factors (sleep, meds)
metacognitive strategies for functional activities
computer tasks not recommended
no auditory or mindfulness tasks!
environmental adaptations
no evidence for TMS yet
take a holistic model - what are the goals and take a biopsychosocial adressing what matters most
87
What is Neglect?
Neglect is a condition where individuals fail to report, respond to, or orient to novel or meaningful stimuli presented to the side of the body opposite to the brain lesion.
## Footnote
This failure cannot be explained by sensory or motor defects.
88
What is a typical example of Neglect?
After a stroke that primarily impacts the right hemisphere of the brain, the patient may fail to attend to stimuli on the left side (contralesional space).
89
What is the incidence of Neglect after a right hemisphere stroke?
82% of patients show neglect symptoms in the initial phase.
90
What is the incidence of Neglect after a left hemisphere stroke?
65% of patients show neglect symptoms in the initial phase.
91
What percentage of right hemisphere stroke patients experience neglect after 3 months?
17%
92
What percentage of left hemisphere stroke patients experience neglect after 3 months?
5%
93
What is chronic neglect?
Chronic neglect refers to continued neglect symptoms after 3 months, which predicts poor long-term outcomes and rehabilitation results.
94
What are the risks associated with neglect in elderly patients?
Increased risks of tripping or falling, potentially resulting in serious injuries like broken bones.
95
What percentage of individuals with TBI experience neglect symptoms?
30%
96
What is Motor Neglect?
Motor Neglect is when the individual fails to use or move a part of their body.
97
What is Personal Neglect?
Personal Neglect is when the individual fails to recognize or attend to their own body.
98
What is Spatial Neglect?
Spatial Neglect is when the individual does not pay attention to the space on the opposite side of the lesion (contralesional space).
99
What is Hemianopia?
Hemianopia involves a visual field loss, often due to damage to the optic nerve or its pathway.
100
How can you differentiate Neglect from Hemianopia?
Individuals with hemianopia are aware of their visual loss, while those with neglect are unaware of the side they neglect.
101
What is the Attention Hypothesis in relation to Neglect?
Neglect occurs due to deficits in attention, primarily from damage in the right hemisphere of the brain.
102
What does the Arousal Model suggest about Neglect?
Neglect arises due to deficits in alertness or wakefulness, leading to impaired attention to stimuli.
103
What is the Representational Hypothesis regarding Neglect?
Neglect results from dysfunction in the brain’s internal spatial representation system.
104
What is the Disconnection Hypothesis related to Neglect?
Chronic neglect may be due to impaired communication between the hemispheres via the corpus callosum.
105
What is implicit awareness in Neglect?
People with neglect can process neglected information at an implicit (unconscious) level.
106
What are common neuroanatomical correlates of Neglect?
Lesions in the right posterior parietal cortex, often from strokes in the middle cerebral artery territory.
107
What is the Behavioral Inattention Test?
A test that includes pen-and-paper tasks and real-life activities to assess neglect.
108
What does the Catherine Bergego Scale assess?
Everyday neglect experiences, like missing food on the left side of the plate.
109
What is Leftward Scanning Training?
A rehabilitation method where patients are trained to scan the left side of a page before reading.
110
What are Prism Lenses used for in rehabilitation?
To shift the visual field and help individuals with neglect become more aware of their neglected side. - trial only included 7 people...
111
What is Limb Activation in the context of Neglect rehabilitation?
Encouraging the use of the neglected limb to improve daily activities.
112
What techniques are used to modulate alertness in Neglect patients?
Techniques like the ATTEND task, which involve external auditory cues.
113
What pharmacological approaches have shown promise for Neglect?
Stimulant medications that improve attention and reduce neglect symptoms.
114
What role does Virtual Reality play in Neglect rehabilitation?
It is a promising rehabilitation tool, but requires more research to confirm efficacy.
115
How does the assessment environment affect the conduct of the assessment?
The setting affects reliability and validity due to factors like fatigue, sedation, or distractions in inpatient settings and lack of privacy or appropriate space in home visits.
## Footnote
Environmental factors can significantly impact test performance and engagement.
116
What are Performance Validity Tests (PVTs)?
Psychological tools used to determine if test performance reflects true cognitive abilities or is compromised due to insufficient effort or exaggeration.
## Footnote
PVTs help ensure the validity of neuropsychological assessment results.
117
What is the Test of Memory Malingering (TOMM)?
A visual recognition test where individuals identify simple pictures among distractors; poor performance suggests suboptimal effort.
## Footnote
TOMM is used to detect non-credible performance.
118
What are clinical red flags in cognitive assessment?
* Failing very easy items
* Below-chance performance on forced-choice tasks
* Similar performance on easy vs. difficult tasks
* Better recall than recognition
## Footnote
These indicators may suggest invalid test performance.
119
What are the cognitive side effects of medications?
* Attention impairment
* Memory impairment
* Processing speed reduction
## Footnote
Psychotropic medications like benzodiazepines and anti-seizure medications can cause these effects.
120
How does depression affect cognitive functioning?
* Reduced motivation
* Rumination
* Slowed thinking
* Poor concentration
* Impaired memory
## Footnote
Sleep disturbances and reduced hippocampal volume can also contribute to cognitive decline.
121
What effects does anxiety have on cognitive testing?
High anxiety impairs memory, word retrieval, and attention; low anxiety can improve alertness.
## Footnote
Assessment strategies should consider these effects to optimize performance.
122
What is Fujii's ECLECTIC model?
A framework for considering cultural factors in assessment, including Education, Culture, Language, Economics, Communication style, Testing situation, Intelligence conception, Context of immigration.
## Footnote
This model helps address individual differences affecting assessment.
123
What should not be overinterpreted in assessment scores?
Small score differences and results should be viewed in the context of behavior and history.
## Footnote
It's important to avoid making diagnoses solely based on test results.
124
What is the difference between normative data and clinical data?
* Normative data: Scores from a large, representative population used for comparison
* Clinical data: Scores from specific diagnostic groups
## Footnote
These data sets help clinicians assess performance.
125
Define content validity.
Content validity refers to whether a test covers all relevant content areas.
## Footnote
For example, a memory test should include both recall and recognition.
126
What is reliability in psychological testing?
Reliability refers to the consistency of test results under similar conditions.
## Footnote
A good test yields similar results over time and across different forms.
127
What does temporal stability refer to?
The stability of test results over time; similar scores should be obtained if cognitive function hasn’t changed.
## Footnote
Consideration of practice effects is crucial.
128
What is the significance of factor structure in tests?
Factor structure refers to how test items group together to measure broader abilities, aiding in performance interpretation.
## Footnote
Valid factor structures support meaningful composite score interpretation.
129
What does Cronbach's Alpha measure?
Internal consistency of items within a single construct; a high alpha (≥ 0.8) indicates reliable measurement.
## Footnote
Each subscale should ideally have its own Cronbach's alpha.
130
Fill in the blank: The _______ model addresses cultural factors affecting assessment.
also what does this acronym stand for
ECLECTIC
E - education and literacy
C - culture
L - language
E - economics
C - communication style
T - testing situation
I - intelligence conception
C - context of immigration
131
True or False: Malingering is a mental disorder.
False
## Footnote
Malingering is a deliberate, conscious behavior often identified in forensic or clinical assessments.
132
What percentage of the brain is made up by the frontal cortex?
About 37%
## Footnote
The frontal cortex is the largest of the brain's lobes.
133
What are the main functions of the frontal cortex?
Movement, language, emotion, cognition, personality, and executive functioning
## Footnote
These functions are crucial for daily activities and interactions.
134
At what age does the development of the frontal cortex typically complete?
Mid-20s
135
What is the primary function of the Primary Motor Cortex?
Controls voluntary muscle movements
## Footnote
Particularly those requiring fine motor control.
136
What does the Premotor Cortex do?
Plans and coordinates complex movements
## Footnote
Involves external sensory cues and sequences of actions.
137
Where is Broca’s Area located and what is its function?
Inferior frontal gyrus; controls speech production and language processing
138
What higher-order cognitive functions are associated with the Prefrontal Cortex?
Executive functions (planning, inhibition, decision-making)
## Footnote
Examples include organizing a trip and resisting impulsive comments.
139
What are the primary functions of the Dorsolateral Prefrontal Cortex (DLPFC)?
* Working memory * Planning and organisation * Problem-solving * Abstract reasoning * Cognitive flexibility
140
What functions are associated with the Orbitofrontal Cortex (OFC)?
* Social behaviour * Emotion-related learning * Decision-making based on reward/punishment * Impulse control
141
What functions does the Mesial / Medial Prefrontal Cortex control?
* Motivation * Emotional regulation * Self-awareness * Social and moral judgement
142
What are common clinical features of Prefrontal Lobe Cortex damage?
* Disinhibition * Impulsivity * Distractibility * Poor judgment * Lack of initiation (apathy) * Emotional flatness or extreme changes * Lack of empathy/sympathy * 'Reversed' personality * Perseveration * Concreteness
143
What is Aphemia?
Inability to speak (mutism or foreign accent), intact comprehension
## Footnote
Typically caused by a small lesion in Broca’s area.
144
What is Broca’s Aphasia characterized by?
Loss of speech production (non-fluent), effortful speech with good comprehension
145
What does Transcortical Motor Aphasia involve?
Difficulty producing spontaneous speech; preserved repetition and comprehension
146
What is Aprosodia?
Loss of prosody (speech melody, emotional tone of voice)
## Footnote
Typically associated with the right frontal lobe.
147
What is a common memory issue associated with frontal lobe dysfunction?
Impaired Free Recall with Intact Recognition
## Footnote
Difficulty retrieving information without cues.
148
What is Executive Dysfunction?
Deficits in organizing, decision-making, and goal-directed behaviour
149
What can cause Frontal Lobe Dysfunction?
* Brain Neoplasms (Tumours) - may go undiagnosed as mental health issues, have to get pretty large before they are picked up
* Traumatic Brain Injury (TBI) - phineas gage, personality changes after rod thorugh skull. Closed TBI - shaken baby syndrome
* Stroke
* Neurodegenerative Diseases
150
What are the symptoms of Frontal Lobe strokes?
Muscle weakness, speech and language problems, decline in cognitive skills and behaviour, personality changes
151
What features characterize Frontotemporal Dementia (bvFTD)?
* Apathy and indifference * Depression * Euphoria * Compulsive shallow humour * Loss of empathy
152
What is crucial for the clinical application of frontal lobe dysfunction?
Frontal lobe dysfunction is often missed, especially when mistaken for psychiatric or behavioural issues. Cruical to
* Gather collateral info * Use structured interviews * Recognize relationship dynamics deterioration
153
True or False: Damage to the frontal lobe always reduces intelligence.
False
disrupts goal directed behaviour, personality and EF changes
symptoms may be subtle or misdiagnosed
154
Fill in the blank: The group of complex mental processes and cognitive abilities that control skills required for goal-directed behaviour is known as _______.
executive function
155
frontal variant alzhemiers
atypical presentation, personality changes
156
parkingsons' / huntington's
another frontal lobe neurodegenerative diease
motor and executive decline
157
multiple sclerosis
another frontal lobe neurodegenerative disease
may include frontal cognitive symptoms
158
Generic assessment of memory protocol
medical and social history
interview patient and informant - check on memory in the interview (simple orientation, more complex memory for conversations already had)
observation
neuropsychological assessment
questionnaires
use supervision
159
Name some memory questionnaires
everyday memory questionnaire
memory functioning questionnaire
multifactorial memory questionnaire - many translations available
prospective and restrospective memory questionnaire - many translations available
160
Explain types of memory
Declarative
- episodic (WM and Long term)
- semantic
Procedural
161
working memory and how we assess
temporary storage and maintenance of internal representations - guide future behaviour, mediate in service of higher level cognitions
measured with digit span
162
episodic long term memory and key assessment concepts
a more permanent form of memory which can enable memories to be retrieved after long periods (Morris 2002)
key ax concepts
- immediate
- delayed
- verbal
- remote
- autobiographical
163
semantic memory and key assessment concepts
person's general knowledge about the world
key ax concepts
- object based
- language / meaning based
- personal information
164
wechsler memory scale IV
what, benefits and subtests
range of memory tests covering WM, immediate and delayed verbal and visuo-spatial memory
Co-normed with Wechsler Adult IQ IV - so can calculate memory weakness against general ability
Good validity, many translations
Auditory
Logical 1 & 2
Verbal paired associates 1 & 2
Visual memory index
Designs 1 & 2
Visual reproductions 1 & 2
Visual working memory
Spatial addition
Symbol Span
165
BRIT Memory and Information Processing Battery II
what, benefits and subtests
Range of memory tests covering WM, immediate and delayed verbal and visuospatial memory
British version of Weschler
Parallel forms, up to date norms, older adult norms, shorter but not co-normed
Episodic memory tasks
working memory
digit span
long-term memory
immediate story recall
delayed story recall
list learning
immediate figure recall
delayed figure recall
166
Rivermead behavioural memory test 3
what, benefits and subtests
Ecologically valid test covering immediate and delayed verbal and visuospatial memory, also prospective memory
less demanding so covers greater severity range
verbal immediate and delayed - story immediate then delayed
name and face memory - visua and verbal associative
visual (face) recognition memory
visual and verbal (multimodal ) memory - picture recognition delayed recall
visuospatial memory - belongings
visuospatial memory - route findings and object location (route and messages, OT video)
prospective memory - e.g., for appointment or session ending
orientation
visuospatial memory and temporal order memory - 'novel task' immediate and delayed recall
167
cultural difference in episodic memory
sense of self promoted in western cultures (e.g., I won the x-factor)
western cultures may be motivated to remember specific episodes and details that consolidate their unique identity
western cultures tend to use superordinate level analysis (furniture not desk lamp)
these memories may be less prioritised in cultures such as east asia, instead may be more interested with social roles and relationships
age - older people recognise natural food vs processed food
168
name 2 short batteries for episodic memory tests (ie not the long ones explained in lectures
Doors and People
Autobiographical memory interview
169
name 2 episodic verbal learning tests
california verbal learning test
auditory verbal learning test
170
name a visuospatial memory test
Reay complex figure
171
definition of executive functioning
Group of complex mental processes and cognitive abilities (WM, inhibition, reasoning) that control skills
172
definition of frontal lobe syndrome
broad term used to describe the damage of higher functioning processes of the brain such as motivation, planning, social behaviour and language / speech production
173
Neuropsychology assessment of frontal lobe syndrome - two types of approaches with the advantage and disadvantage of each
Process approach (Luria) - observation of types of errors made by the person when doing a particular task; these can provide subtle indications of brain damage / impairment
- helpful as gets at what is going on BUT can be subjective and not so good when establishing group profiles
Neuropsychometric approach (Reitan, Wechsler) - uses test scores related to specific functions, based on tests that have criterion referenced normative data
- helpful as reliability of testing and objectivity BUT does not indicate why a person performed poorly on a test
174
Neuropsychological ax of executive function general principles
always interview person + informant
select tests and number to suit person
use at least 3 EF tests (or a battery) - as lack of correlation
supplement with questionnaires where appropriate
decide battery vs single test approach
175
Name and explain the main EF test battery
Delis-Kaplan EF System (D-KEFS)
sorting test
trail making
verbal fluency
design fluency
colour-word interference (Stroop)
tower test
20 questions test
word context test
proverb test
176
what does BADS assess and name sub tests
- what questionnaire goes with it nicely
Executive function. Note Robin has made a computerised version
rule shift cards test
action program test
key search test
temporal judgement test
zoo map test
modified six elements test
DEX (Dysexecutive questionnaire)
177
battery appraoch vs single tests for EF
battery appraoch has all tests with normative data on one population so better when comparing tests
with single test you can combine your tests to tailor then for a particular person
178
what is executive fluency and how do we assess and aspects of this we may assess
the ability to think flexibily to mentally generate material without complete structure
* verbal fluency
* visuospatial fluency
179
EF - how to assess verbal fluency
FAS letter fluency - controlled oral word association test - produce as many words beginning with FAS with rules
along a similar line - semantic fluency neaming as many animals or names beginning with a particular letter
D-KEFS has a subtest with parallel forms
## Footnote
Note measure number but also rules breaks
180
EF - how to assess visuospatial fluency
D-KEFS design fluency
181
what is response inhibtion
name two tests
the ability to inhibit a pre-potent response, in this context referring to a rapid mental process
Stroop (D-KEFS)
Hayling test
182
what is rapid mental flexibility and how to test
the ability to rapidly shift a thought pattern or pattern of action in respnse to achieve a specific goal or in response to a cue
trial making test (D-KEFS)
183
what is problem solving mental flexibility and how to test
the ability to think flexibly when solving problems - this requires generating solutions and being mentally flexible when arriving at solutions
- brixton spatial anticipation test
- winconsin care sorting
- rule shift card test (BADS)
184
what is problem solving - planning and how to test
the ability to mentally plan sequences of action when engaging in problem solving
requires appraisal of starting state, generation of sequence of action, implement action, monitor whether action works
stocking of cambridge test
tower of Hanoi (D-KEFS)
185
what is heuristics judgement under uncertainty and how to test
making a judgement where you may not be able to provide answer with certainty, so use sinple notions or rules
cognitive estimates
temporal judgement (BADS)
186
what is decoding non-literal meaning and how to test
understanding the hidden or symbolic meaning of a statement beyond its literal meaning
D-KEFS proverbs test
187
what is strategy generation and how to test
developing specific strategies to help solve problems or provide a means to execute a response
hayling test - anomalous completion task
key search task
188
name 2 ecologically valid multi-tasking and planning tasks
zoo map test (BADS)
multiple errands task (BADS)
189
name questionnaires you could use to assess executive function (3)
DEX - Dysexecutive Questionnaire
BRIEF - Behavioural rating inventory of EF - adult version
FrSBE - frontal systems behaviour scale
190
culture and executive functioning
education and occupation an important source of bias
east asian children outperform western children - classroom teaching style may help to explain this?
approaches to problem solving may differ (literal vs object based)
191
What is the definition of intelligence according to the APA?
Intelligence is multi-faceted, involving reasoning, learning, adapting, and problem-solving
## Footnote
The concept of intelligence has evolved over time with various theorists contributing different perspectives.
192
Who proposed the general intelligence factor ('g')?
Spearman (1904)
## Footnote
Spearman's work laid the foundation for understanding intelligence as a single underlying factor.
193
What was the significance of Binet & Simon's work in 1905?
Developed the first child-focused intelligence test, leading to Stanford-Binet
## Footnote
This test was crucial in the evolution of intelligence assessment.
194
What did Wechsler create in 1939?
Tests aligned with real-world function, including the WISC launched in 1949
## Footnote
Wechsler's tests were designed to better reflect how intelligence is used in everyday life.
195
What are the two types of intelligence differentiated by Cattell-Horn-Carroll?
* Fluid intelligence (novel problem-solving)
* Crystallized intelligence (learned)
## Footnote
This distinction helps in understanding different aspects of cognitive ability.
196
What are some controversies surrounding intelligence testing?
* Cultural bias
* Misuse in exclusionary/diagnostic contexts
* Test developers’ financial motivations
## Footnote
These issues highlight the complexities and potential ethical concerns in intelligence assessment.
197
What does intelligence testing NOT measure directly?
* Attention
* Fatigue
* Emotional state
## Footnote
Although these factors can impact performance, they are not directly assessed by intelligence tests.
198
What should be prioritized before a Paediatric Cognitive Assessment?
* Understand the referral question and hypotheses
* Check for feasibility
* Ensure child assent/consent
* Contracting: Explain purpose in developmentally appropriate language
## Footnote
These steps are essential for effective assessment and to ensure the child's comfort and understanding.
199
What are some sources of information for preparing a Paediatric Cognitive Assessment?
* Clinical interviews (child, parents, teachers)
* Medical notes, EHCPs, prior assessments
* School reports, SATs/GCSEs
* Multi-agency liaison (e.g., CAMHS, Social Services)
## Footnote
Gathering comprehensive information helps in formulating a clearer understanding of the child's needs.
200
What is the age range for administering the WISC-V?
6:0–16:11
## Footnote
This age range ensures that the test is suitable for the cognitive development stages of children.
201
How long does it take to administer the WISC-V?
Approximately 65 minutes
## Footnote
The test includes 10 subtests that contribute to 5 index scores.
202
What are the five index scores of the WISC-V?
* VCI (Verbal Comprehension)
* VSI (Visual Spatial)
* FRI (Fluid Reasoning)
* WMI (Working Memory)
* PSI (Processing Speed)
## Footnote
These indices provide a comprehensive view of different cognitive abilities.
203
What does FSIQ stand for and how is it derived?
Full Scale IQ, derived from 7 subtests
## Footnote
FSIQ provides an overall measure of intelligence based on multiple cognitive domains.
204
What are Ancillary indices in the WISC-V?
* GAI (General Ability Index) – excludes WMI/PSI
* NVI (Non-Verbal Index) – useful when language is a concern
## Footnote
These indices offer additional insights into a child's cognitive abilities.
205
What are some engagement strategies for administering the WISC-V?
* Prepare the environment
* Encourage effort; provide frequent praise
* Watch for signs of disengagement
* Use rest breaks, fiddle toys, or change task order
## Footnote
These strategies help maintain the child's focus and comfort during testing.
206
What is a key principle in scoring and interpreting the WISC-V?
Accuracy is critical – double-check scoring
## Footnote
Ensuring accuracy helps in providing a valid assessment of the child's cognitive abilities.
207
What should be noted in qualitative data during assessment?
Child’s behaviours, affect, task approach
## Footnote
Observing these aspects can provide context to the scores obtained.
208
What is the difference between statistical and clinical significance?
* Statistical difference: unlikely to occur by chance
* Clinical difference: rare in population (base rate ≤5% typically seen as meaningful)
## Footnote
Understanding these differences helps in interpreting test results appropriately.
209
True or False: WISC-V can be used to diagnose ADHD or Autism.
False
## Footnote
While WISC-V can highlight cognitive profiles associated with these conditions, it is not a diagnostic tool.
210
What cognitive profile might WISC-V reveal in a child with ADHD?
Low PSI
## Footnote
This can indicate difficulties with processing speed, which is often observed in ADHD.
211
What profile might WISC-V reveal in a child with Autism?
Verbal–non-verbal split
## Footnote
This split can help identify specific cognitive strengths and weaknesses in children with Autism.
212
What is the definition of Attainment?
Educational achievement in areas like reading, writing, and maths.
## Footnote
Attainment is used by clinical psychologists to clarify discrepancies between reported and observed performance.
213
What is the age range for administering the WIAT-III?
Ages 4–25.
## Footnote
The WIAT-III tests 16 subskills across 4 domains.
214
List the four domains tested by the WIAT-III.
* Oral Language
* Reading
* Written Language
* Mathematics
## Footnote
Each domain includes specific subtests tailored to the referral question.
215
What are the typical number of subtests targeted during WIAT-III administration?
3–5 subtests.
## Footnote
This is to test hypotheses based on the referral question.
216
What is an important consideration for a child during the WIAT-III administration?
Ensure child has their usual aids (glasses, overlays, pencil grips).
## Footnote
Adaptations may also be considered for mobility or attention needs.
217
True or False: Scoring errors are uncommon when administering the WIAT-III.
False.
## Footnote
It's important to follow the scoring manual carefully to avoid common scoring errors.
218
What type of analysis is used in the WIAT-III for Dyslexia assessment?
Ability-achievement discrepancy analysis.
## Footnote
This involves predicting WIAT scores from WISC FSIQ and comparing actual vs. predicted scores.
219
What are common indicators of Dyslexia when using the WIAT-III?
* Discrepancy between intelligence and attainment
* Non-phonetic spelling errors
* Relative strengths in comprehension vs. decoding
* Family history
## Footnote
Most sensitive measures include pseudoword decoding, phoneme elision, rapid naming, and verbal working memory.
220
What should be prioritized in feedback after administering the WIAT-III?
* Align with referral questions
* Highlight both strengths and challenges
* Adapt for different audiences (child, parents, school)
## Footnote
Delivery tips include avoiding jargon and using metaphors.
221
Fill in the blank: Common recommendations based on WISC-V include _______.
[chunking, extra time, multimodal learning, tech aids].
## Footnote
These strategies are tailored to support the child's learning needs.
222
List some common recommendations based on the WIAT-III.
* Differentiated curriculum
* EHCP application
* Referral to EP
* Dyslexia programmes (e.g. Nessy, Toe by Toe)
## Footnote
These recommendations are designed to support the child's educational development.
