TESTING IN HEALTH

PSYCHOLOGY AND
HEALTH CARE
NEUROPSYCHOLOGICAL
ASSESSMENT
NEUROPSYCHOLOGICAL ASSESSMENT
CLINICAL NEUROPSYCHOLOGY
Defined as the scientific discipline that studies the relationship
between behavior and brain functioning in the realms of cognitive,
motor, sensory, and emotional functioning (Spencer & Adams,
2016)

Clinical neuropsychology overlaps neurology, psychiatry, and

psychometric testing in the following ways:
• Neuropsychology and neurology both focus on sensations and
perceptions and on motor movements.
• Neuropsychology and psychiatry both study mood and
adaptations to psychosocial situations (Zane et al., 2016).
• Neuropsychology and psychometrics both use psychological
tests.
CLINICAL
NEUROPSYCHOLOGY

NEUROIMAGING
New method to see
diseases in the
brain among living
people.

Advances in functional
magnetic resonance
imaging (fMRI) can detect
responses to stimulation
and brain activity
associated with blood flow.
CLINICAL
NEUROPSYCHOLOGY

Pierre Broca and Carl Wernicke

• The roots of clinical neuropsychology, in the 19th
century.
• Recognized that functions such as the recognition of
speech were localized in the left hemisphere of the
brain.

1970 - Neuropsychology was viewed as a new field

characterized by rapid growth (Parsons)
1995 - Neuropsychologists have developed many
procedures for identifying the relationship between
brain problems and behavioral problems (Butters, Delis,
& Lucas)
CLINICAL
NEUROPSYCHOLOGY
• Neuropsychological assessment has been used to
evaluate specific problems in memory.
• MEMORY
• Short term memory occurs when one recollects or
produces material immediately after it has been
presented.
• Long term memory may be stored for a long time (more
than a few days), and the capacity for long-term memory is
quite large.
• Clinical techniques to measure memory dysfunction:
• Wechsler Memory Scale–Revised (WMS-R)
• Memory Assessment Scales (MAS)
• Randt Memory Test (RMT)
• Luria Nebraska battery
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DEVELOPMENTAL NEUROPSYCHOLOGY
• Testing is typically done as part of a complex evaluation.
• Neuropsychological testing is done to provide a baseline.
• Repeated neuropsychological evaluations can help identify
such changes (Baron & Fennell, 2000).
• Neuropsychological tests for children differ widely.
One category of measures tests general development and
adaptive functioning:
• Child Development Inventory
• Child Behavior Checklist
• Reynolds Depression Scale
• Children’s State-Trait Anxiety Scale.
DEVELOPMENTAL
NEUROPSYCHOLOGY
Another group of measures estimates attention and
executive function.
These tests typically evaluate functioning related to
several different aspects of information processing:
• Trail Making Tests (scatter sequential numbers (e.g.,
1, 2, 3, 4) )
- this test evaluates several cognitive skills, including
attention, sequencing, and thought processing.
• Executive function includes volition:
- forming and executing a goal, planning, and taking
action to complete a task (self-control and self-
monitoring).
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ADULT NEUROPSYCHOLOGY
There are many different approaches to identifying the
consequences of brain injury in adults. The two best-known
approaches involve administration of Halstead-Reitan
Neuropsychological Battery and Luria-Nebraska
Neuropsychological Battery:
• Halstead-Reitan Neuropsychological Battery
• Ward Halstead opened a laboratory to study the impact
of impairments of brain function on a wide range of
human abilities (1935).
• Halstead’s observations were formal (obtained through
modifications of existing psychological tests), while
others involved observations in work and social settings
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Components of the HRNB for Adults:
this test is a learning experiment for current learning skills, mental efficiency,
Halstead Category Test
and abstract concept formation.

the patient must put variously shaped blocks into holes of the same shape.
Tactual Test (time,
memory, localization) the test assesses several abilities, including motor speed and tactual and
kinesthetic psychomotor performance, as well as memory.

thirty pairs of rhythm beats are presented, and the patient is to identify which
Rhythm Test
pairs are the same and which are different.
the task measures auditory perception, concentration, and attention.

Sixty nonsense words are presented on a tape recorder.

Speech-sounds after hearing each word, the patient must choose the word from among four
Perception Test alternatives presented visually.
the test measures auditory–verbal perception, auditory–visual coordination,
and some aspects of language and concentration.
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Components of the HRNB for Adults:
the patient taps the index finger as rapidly as possible, alternating hands on
Finger Oscillation Test consecutive trials.
the patient must put variously shaped blocks into holes of the same shape.

This test requires patients to connect numbers and letters as rapidly as

possible.
Trail-making Test
The test measures speed, visual scanning, and ability to process information in
sequence.

a mechanical device (the hand dynamometer) is used to measure the strength

Strength-of-grip Test
of grip in each hand.

in a variety of sensory modalities, such as touch, hearing, and vision, the patient
receives information on one side of the body and then on the other side.
Sensory–perceptual
Examination the test is used to determine whether stimuli presented on one side of the body are
perceived when presented alone and also to determine whether competition with other
stimulation reduces the perception of the stimulus
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ADULT NEUROPSYCHOLOGY
• Luria-Nebraska Neuropsychological Battery
• Luria was an expert on the functions of the human
brain, using different approach to
neuropsychological assessment (Luria, 1966, 1973).
• Luria introduced the concept of pluripotentiality—
that any one center in the brain can be involved in
several different functional systems (Golden, 2015).
• The battery includes 269 items that can be
administered in approximately 24 hours.
• The items are divided into 11 subsections
ADULT NEUROPSYCHOLOGY
Subsections of Luria-Nebraska Neuropsychological Battery:
examines basic and complex motor skills. Some items ask patients to perform fine
Motor functions tasks with the right and left hand and with the eyes open or closed.
Other items involve mouth, tongue, and speech movements.

evaluates rhythm and pitch skills. patients must reproduce melodic sounds
such as those from the song “home on the range.”
Rhythm
they are also to identify soft and loud sounds and musical patterns.
evaluates a variety of kinesthetic (movement) and tactile (touch) abilities. patients
are blindfolded and asked to identify where they have been touched.
Tactile
then they must identify a variety of shapes and letters written on the back of
the patients’ hands. In addition, patients must identify common objects such
as quarters, keys, paper clips, and so on.

Investigates visual and spatial skills. patients are asked to identify objects
Visual through pictures and through progressively more difficult items. They are
asked to put pieces together or identify objects in overlapping sketches.
ADULT NEUROPSYCHOLOGY
Subsections of Luria-Nebraska Neuropsychological Battery:
tests ability to understand the spoken language. Items range from simple
Receptive Speech
phonemes to comprehension of complex sentences.

estimates ability to express speech orally. the word sounds range from “see” to
“Massachusetts” to “episcopal.”
Expressive Speech
Writing identifies basic writing skills, including simple spelling, copying letters and words,
and writing names.

Similar to writing section. It tests whether patients can identify individual letters and
Reading
read symbols, words, sentences, and stories.

Arithmetic Skills tests a variety of simple numeric and algebraic abilities.

assesses verbal and nonverbal memory skills. Items range from simple recall to
Memory
complex memorization tasks.

Intellectual Processes evaluates intellectual level using items similar to those on traditional
intelligence tests.
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CALIFORNIA VERBAL LEARNING TEST (CVLT)

• The test determines how errors are made in learning tasks.
• To identify different strategies, processes, and errors that are
associated with specific deficits.
• The CVLT assesses various variables, including levels of recall
and recognition, semantic and serial strategies, serial position
effects, learning rates across trials, consistency of item recall
across trials, degree of vulnerability to proactive and retroactive
interference, retention of information over short and long
delays, and learning errors in recall and recognition.
• The CVLT also includes other features derived from
experimental cognitive psychology. One can administer it either
in a paper-and-pencil form or with a microcomputer.
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AUTOMATED NEUROPSYCHOLOGICAL TESTING

• New method to provide quick computerized interpretation of
neuropsychological tests.
• The Automated Neuropsychological Metrics (ANAM) was
developed by the U.S. Department of Defense in order to
evaluate changes in human performance when people were
exposed to difficult environmental circumstances.
• ANAM can efficiently screen people with cognitive changes and
that it may be a valuable tool for monitoring cognitive changes
as diseases progress (Kane et al., 2007).
• This includes a variety of different tasks, including code
substitution, code substitution recognition, matching two
samples, mathematics, running memory, and logical reasoning.
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STRESS AND ANXIETY

Stress is a response to situations that involve demands,
constraints, or opportunities (Sarason & Sarason, 1999).
• The study of psychological stress has gained an increasingly
central position within the psychological and biomedical
sciences (Dalton, Hammen, Brennan, & Najman, 2016).
• Psychological stress has three components:
Frustration occurs when the attainment of a goal is blocked.
Conflict is a type of stress that occurs when we must make a
choice between two or more important goals.
Pressure to speed up activities.
Anxiety is an exposure to stressful situations can cause an
observable reaction. An emotional state marked by worry,
apprehension, and tension.
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THE STATE-TRAIT ANXIETY INVENTORY

State anxiety is an emotional reaction that varies from one
situation to another.
Trait anxiety is a personality characteristic.
• Charles D. Spielberger was led to develop the state trait
anxiety theory, which in turn led to the development of the State-
Trait Anxiety Inventory (STAI).
• The STAI provides two separate scores: one for state anxiety (A-
State) and another for trait anxiety (A-Trait).
A-Trait scale consists of 20 items. On a 4-point scale,
subjects indicate how they generally feel about each item.
A similar set of items is used to evaluate the A-State.
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MEASURES OF COPING
Several measures have been developed to assess the ways in
which people cope with stress (Audulv, et. al., 2016).
WAYS OF COPING SCALE is a 68-item checklist (Lazarus, 1995;
Lazarus & Folkman, 1984).
• The scale includes seven subscales for problem solving,
growth, wishful thinking, advice seeking, minimizing threat,
seeking support, and self-blame.
• Problem-focused strategies - involve cognitive and behavioral
attempts to change the course of the stress; these are active
methods of coping.
• Emotion-focused strategies - do not attempt to alter the
stressor but instead focus on ways of dealing with the
emotional responses to stress (Cohen & Lazarus, 1994).
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ECOLOGICAL MOMENTARY ASSESSMENT

• It is a new technical developments that allows to
obtain information on an ongoing or on a
continuing basis (Kaplan & Stone, 2013).
One can obtain information repeatedly and average
the results to get an overall impression of stress.
• One of the advantages is that the information is
collected in the subject’s natural environment.
• This method usually involves a substantial number of
repeated observations and shows variability within the
subject over time (Deaton & Stone, 2016).
NEUROPSYCHOLOGICAL ASSESSMENT

DEPRESSION
• Major depressive disorders (MDDs) are the leading cause of
disability among women worldwide (Kessler, 2003).
• Depression among women is also associated with a variety of
different health-care conditions.
• Maternal depression can have important impacts on young
children.
 Studies suggest that children of depressed mothers have
greater difficulty with school performance, peer relation
ships, and the development of social skills (Kersten-Alvarez et
al., 2012).
• Primary care physicians needed to consider whether it was
necessary to screen for depression among pregnant women and
women who have recently given birth.
NEUROPSYCHOLOGICAL ASSESSMENT
DEPRESSION
• The review began with the
evaluation of measures of
depression that can be
applied in primary care
settings.
 Patient Health
Questionnaire (PHQ) -
used to evaluate and
monitor depressive
symptoms.
 Edinburgh Postnatal
Depression Scale (EPDS)
- most appropriate
screening tool for prenatal
and postnatal depression
(Bina & Harrington, 2016).