Neuropsychological testing & neuroimaging

Question 1

Standardized MSE

Answer 1

brief (<10 mins) mental status examinations to detect the presence of cognitive impairment (e.g. MoCA, MMSE)

Question 2

Abbreviated battery

Answer 2

test that takes around 20-40 mins (e.g. ImPACT, RBANS)

Question 3

Comprehensive neuropsychological battery

Answer 3

lengthy test (4-6 hours) for profiling

Question 4

Evolution of the role of neuropsychological testing from 40s-80s to 90s

Answer 4

having to identify presence and location of brain damage; invention of CT and MRI; descriptive, psychometric assessment of ecologically relevant cognitive functions

Question 5

Examples of tests for working memory

Answer 5

reorder digits, mental arithmetic

Question 6

Examples of tests for cognitive flexibility

Answer 6

alternating sequences, concept sorting, rule changes

Question 7

Examples of tests for response inhibition

Answer 7

stroop, go-no/go

Question 8

Examples of tests for episodic memory

Answer 8

delayed recall of word lists, stories, shapes, designs

Question 9

Examples of tests for processing speed

Answer 9

shape matching, symbol decoding

Question 10

Examples of tests for language

Answer 10

verbal fluency, object naming

Question 11

Examples of tests for visuospatial

Answer 11

complex figure copy, line orientation

Question 12

5 properties of neuropsychological tests

Answer 12

standardized, reliability, norm-referenced (using reference values), criterion validity, ecological validity

Question 13

Criterion validity

Answer 13

degree to which test performance relates to brain function

Question 14

2 ways to test criterion validity

Answer 14

lesion studies; functional neuroimaging

Question 15

Ecological validity

Answer 15

degree to which test scores relate to everyday function

Question 16

5 stages of interpretive procedure

Answer 16

test validity; estimated premorbid functioning; impaired (and normal) test scores; impaired (and preserved) abilities; etiology/prognosis and treatment/management

Question 17

2 steps in estimating premorbid function

Answer 17

make predictions based on age, education level, etc; performance-based ways to refine estimate (e.g. “hold” test)

Question 18

3 interpretive strategies

Answer 18

pattern analysis, process measures, contrast scores

Question 19

Pattern analysis

Answer 19

looking at different tests that assess the same kind of cognitive ability

Question 20

Provecss measures

Answer 20

looking at how someone goes about performing in a test

Question 21

8 indications for neuropsychological testing

Answer 21

differential diagnosis; monitor disease progression; clarify impact of disease/injury; determine rehabilitation needs; capacity for IADLs, work, study; surgical candidacy; legal competency; medicolegal

Question 22

Legal competency

Answer 22

whether someone is competent enough to stand trial, consent to healthcare procedures, sign a will, etc.

Question 23

Medicolegal

Answer 23

how much compensation victim of an accident or someone with a brain injury gets

Question 24

4 limitations of neuropsychological tests

Answer 24

most measure more than one cognitive ability (i.e. multifactorial); few validated tests for important abilities (e.g. social cognition); quiet and distraction-free setting (may limit ecological validity); cultural bias

Question 25

4 future innovations of neuropsychological tests

Answer 25

computer-adapted administration; adapting tests from translational neuroscience; improved ecological validity with virtual reality; concurrent measurement of hemodynamic, electrophysiological, and metabolic function

Question 26

3 main purposes of a neurological exam

Answer 26

lesion localization; diagnosis; triaging

Question 27

When is a neurological exam most useful?

Answer 27

disorders that involve focal lesions (e.g. stroke, tumor, MS flare-ups); disorders of the peripheral nerve and spinal cord

Question 28

6 components of a neurological exam

Answer 28

mental status; cranial nerves; motor system (tone, power, reflexes); coordination (balance, gait, cerebellar); involuntary movements; sensory (temperature, touch, vibration, position sense)

Question 29

How does computed tomography (CT) work?

Answer 29

rotates X-ray source and detector to reconstruct image based on the physical density of tissue (fat>tissue>bone)

Question 30

What are CT scans used for?

Answer 30

skull fracture, intracranial bleeds, mass lesions (e.g. tumors)

Question 31

Pros vs cons of CT scans

Answer 31

quick and inexpensive; radiation exposure

Question 32

How does MRI work?

Answer 32

measures radiofrequency signal produced during proton realignment after magnet perturbation

Question 33

What is MRI used for?

Answer 33

small/subtle lesions (better spatial resolution than CT), conditions affecting white matter

Question 34

Pros vs cons of MRI

Answer 34

spatial resolution and many contrast types available; slow and expensive, and contraindicated for patients with pacemaker, implants, metal

Question 35

Diffusion tension imaging

Answer 35

research tool (limited clinical use) wherein molecules of water flowing in one direction indicate an intact white matter track

Question 36

How does EEG work?

Answer 36

electrodes on surface of scalp detect electrical activity in cerebral cortex

Question 37

What is EEG used for?

Answer 37

epilepsy, delirium, encephalitis

Question 38

Pros vs cons of EEG

Answer 38

quick and inexpensive; hard to measure deep brain structures

Question 39

2 principles of fMRI

Answer 39

BOLD (blood oxygen level dependence) signal and subtraction methodology

Question 40

Magnetic resonance spectroscopy (MRS)

Answer 40

chemical composition of tissue within a voxel

Question 41

Positron emission tomography (PET)

Answer 41

cellular metabolism

Question 42

Single photon emission computed tomography (SPECT)

Answer 42

regional cerebral blood flow

Question 43

Magnetoencephalography (MEG)

Answer 43

magnetic field signature of cortical neuronal activity

Question 44

Functional near-infrared spectroscopy (fNIRS)

Answer 44

changes in hemoglobin concentrations via light absorption

Question 45

BOLD signal

Answer 45

regional increases in blood supply; delayed from neural activity

Question 46

Subtraction methodology

Answer 46

isolate pattern of activation in the brain associated with a task