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신경심리검사 자료

Neuropsychological Evaluation

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작성자 관리자 작성일13-05-13 09:04 조회10,177회 댓글0건


Neuropsychological Evaluation 

Updated: Apr 2, 2013


Neuropsychological evaluation (NPE) is a testing method through which a neuropsychologist can acquire data about a subject’s cognitive, motor, behavioral, linguistic, and executive functioning. In the hands of a trained neuropsychologist, these data can provide information leading to the diagnosis of a cognitive deficit or to the confirmation of a diagnosis, as well as to the localization of organic abnormalities in the central nervous system (CNS). The data can also guide effective treatment methods for the rehabilitation of impaired patients.
NPE provides insight into the psychological functioning of an individual, a capacity for which modern imaging techniques[1, 2] have only limited ability. However, these tests must be interpreted by a trained, experienced neuropsychologist in order to be of any benefit to the patient. These tests are often coupled with information from clinical reports, physical examination, and increasingly, premorbid and postmorbid self and relative reports. Alone, each neuropsychological test has strengths and weaknesses in its validity, reliability, sensitivity, and specificity. However, through eclectic testing and new in situ testing, the utility of NPE is increasing dramatically.[3, 4]

Major Domains of Neuropsychological Functioning

NPE is useful for measuring many function categories, including the following:
  • Intellectual functioning
  • Academic achievement
  • Language processing
  • Visuospatial processing
  • Attention/concentration
  • Verbal learning and memory
  • Visual learning and memory
  • Executive functions
  • Speed of processing
  • Sensory-perceptual functions
  • Motor speed and strength
  • Motivation/symptom validity
  • Personality assessment

Examples of Commonly Used Neuropsychological Tests

Table 1. Examples of Commonly Used Neuropsychological Tests[5, 6, 7, 8] (Open Table in a new window)
Domain Neuropsychological Test
Intellectual functioningWechsler Scales

Wechsler Adult Intelligence Scale-Revised (WAIS-R)

Wechsler Adult Intelligence Scale-III (WAIS-III)

Wechsler Intelligence Scale for Children-IV (WISC-IV)

Stanford-Binet Intelligence Scale-IV

Academic achievementWechsler Individual Achievement Test (WIAT)

Woodcock-Johnson Achievement Test

Language processingBoston Naming Test

Multilingual Aphasia Examination

Boston Diagnostic Aphasia Examination

Token Test

Visuospatial processingRey-Osterrieth Complex Figure – Copy condition

WAIS Block Design Subtest

Judgment of Line Orientation

Hooper Visual Organization Test

Attention/ concentrationDigit Span Forward and Reversed

Trail Making Tests

Cancellation Tasks (Letter and symbol)

Paced Auditory Serial Addition Test (PASAT)

Vanderbilt Assessment Scale

Behavior Assessment System for Children (BASC)

Serial Sevens

Verbal learning and memoryWechsler Memory Scale (WMS)

Logical Memory I and II - Contextualized prose

Verbal Paired-Associates

WMS-III Verbal Memory Index

Rey Auditory Verbal Learning Test - Rote list learning (unrelated words)

California Verbal Learning Test - Rote list learning (related words)

Verbal Selective Reminding Test - Selective reminding (unrelated words)

Hopkins Verbal Learning Test

Visual learning and memoryWMS

Visual Reproduction I and II

WMS-III Visual Memory Index

Rey-Osterrieth Complex Figure - Immediate and delayed recall

Nonverbal Selective Reminding Test

Continuous Recognition Memory Test

Visuo-Motor Integration Test - Block design

Executive functionsWisconsin Card Sorting Test

Category Test

Stroop Test

Trail Making Test-B

WAIS Subtests of Similarities and Block Design

Porteus Maze Test

Multiple Errands Test (MET)

Serial Sevens

Mini-Mental Status Exam

Speed of processingSimple and Choice Reaction Time

Symbol Digit Modalities Test - Written and oral

Sensory-perceptual functionsHalstead-Reitan Neuropsychological Battery (HRNB) Tactual Performance Test and Sensory Perceptual Examination
Motor speed and strengthIndex Finger Tapping

Grooved Pegboard Task

Hand Grip Strength

Thurstone Uni- and Bimanual Coordination Test

MotivationRey 15 Item Test

Dot Counting

Forced-Choice Symptom Validity Testing

Personality assessmentMinnesota Multiphasic Personality Inventory (MMPI)

Millon Clinical Multiaxial Inventory

Beck Depression Inventory (BDI)

Rorschach Test

Myers-Briggs Type Indicator (MBTI)

Thematic Apperception Test for Children or Adults

Referrals for Neuropsychological Evaluation

NPE is used to quantitatively measure the cognitive and behavioral capabilities of a patient. The data from neuropsychological tests can then be compared with normative data based on a number of different demographic criteria, including (but not limited to) age, race, gender, and socioeconomic status. NPE can include testing of intelligence, attention, memory, and personality, as well as of problem solving, language, perceptual, motor, academic, and learning abilities.

Whom to refer for NPE

Neuropsychological testing provides diagnostic clarification and grading of clinical severity for patients with obvious or supposed cognitive deficits. Often these include patients with a history of any of the following problems:
NPE is of limited value if a patient is severely compromised, as in advanced dementia or early in recovery from serious brain injury (eg, TBI, stroke, anoxia, infection), although brief serial assessment with measures such as the Galveston Orientation and Amnesia Test, high-velocity lead therapy (HVLT), digit span, and motor speed and dexterity is very useful in tracking recovery. NPE's value is also limited if a patient has other serious medical complications or psychiatric disorders.

Information Obtained From Neuropsychological Reports

Neuropsychological tests are a series of measures that identify cognitive impairment and functioning in individuals. They provide quantifiable data about the following aspects of cognition:
  • Reasoning and problem-solving ability
  • Ability to understand and express language
  • Working memory and attention
  • Short-term and long-term memory
  • Processing speed
  • Visual-spatial organization
  • Visual-motor coordination
  • Planning, synthesizing, and organizing abilities

Established Applications of Neuropsychological Evaluation

Applications of NPE include the following:
  • Provide a differential diagnosis of organic and functional pathologies
  • Assess for dementia versus pseudodementia[11, 12, 13, 14]
  • Determine the presence of epilepsy versus somatoform disorder (that is, nonepileptic seizures or pseudoseizures)
  • Determine the presence of traumatic brain injury (TBI) sequelae[16] versus malingering or unconscious highlighting
  • Distinguish between cognitive deficiency caused by indifference (as is occasionally seen in depression patients) and that caused by other diseases and disorders
  • Guide rehabilitation programs and monitor patient progress
  • Guide the therapist in referring to specialists
An NPE also provides data to guide decisions about the patient's condition, such as the following:
  • Competency to manage legal and financial affairs
  • Capacity to participate in medical and legal decision making
  • Ability to live independently or with supervision
  • Ability to return to work and school affairs
  • Candidacy for transplantation[17]
In addition, data from an NPE can be used to guide the following assessments and procedures:
  • Evaluation of the cognitive effects of various medical disorders and associated interventions
  • Assessment of tests for diabetes mellitus, chronic obstructive pulmonary disease (COPD), hypertension, human immunodeficiency virus (HIV) infection, coronary artery bypass graft (CABG), and clinical drug trials
  • Assessment of CNS lesions and/or seizure disorders before and after surgical interventions, including corpus callosotomy, focal resection (eg, topectomy, lobectomy), and multiple subpial transection
  • Monitoring of the effects of pharmacologic interventions
  • Documentation of the cognitive effects of exposure to neurotoxins
  • Documentation of adverse effects of whole brain irradiation in children
  • Comparison with guidelines for electroconvulsive therapy (ECT) influenced by standardized evaluation of memory
  • Standard protocols for assessment of specific disorders, such as dementia of the Alzheimer type (DAT), multiple sclerosis (MS), TBI, and stroke[11, 12, 13, 14, 15, 16, 17, 18]
Developmental disorders (eg, specific learning disabilities) require detailed assessment of cognition, academic achievement, and psychosocial adjustment for proper identification and as a guide to their management. Academic placement in special education and resource classrooms may be needed.

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