Valuable Neuropsychological Tools and Techniques with Older People Snezana Mitrovic-Tosovic CCP -Auckland 2011

Tests we are going to talk about today DKEFS COLOR TRAILS TEST COLOR – FORM SORTING TEST BADS PROSPECTIVE MEMORY TEST

DKEFS – Delis Kaplan Executive Functioning Scale Compendium of 9 separate tests normed for age7-89, with the same M and SD as WAIS and WMS Trail Making *** Verbal Fluency*** Color naming*** 20 Questions** Tower** Proverbs* Word Context* Sorting Visual Fluency

Trail Making Developed to assess flexibility in thinking 5 conditions The primary executive task – condition 4 4 conditions designed to control abilities that are part of condition 4: visual scanning, motor speed, number sequencing, letter sequencing

Experience in using Trail Making Test Test re-test reliability (the highest for condition 5 – motor speed (0.77) while for switching is the lowest (0.38) Unexpected profile (better performance on condition 4 as opposed to conditions 2 and 3. Factors influencing TMT performance : mental slowing, knowledge of the TMT, the order and gender (Tohoku,2011)

Neuroanatomical and neuropsychological correlates of TMT (B) performance Functional MRI studies confirmed involvement of frontal regions of left hemisphere – however showed activities in other areas e.g. medial temporal lobe. Working memory, speed and attention predict performance on TMT

Color Trails Test CTT analogue to TMT Language free as much as possible Psychometric properties similar to those found in TMT Perceptual tracking Divided attention

Verbal Fluency Three testing conditions: letter fluency, category fluency and switching Ability to generate lexical/category items while at the same time observing several rules, executive processes involved: initiation, efficient organization of verbal retrieval and recall, and self-monitoring. A phonemic fluency is mediated by verbal factor located in the left hemisphere and an executive component that reflects integrity of frontal lobes (Craford&Henry,2004) Semantic fluency while also sensitive to frontal damage is largely associated with deficits in temporal structures.

Verbal Fluency cont. Greater age related decline on category fluency than letter fluency Test-retest reliability for switching condition (0.51 and 0.39) Psychomotor slowing alone cannot account for phonemic fluency deficits associated with frontal dysfunction Information processing speed

Color – Word Interference Test Executive function measured by this test is the examinee’s ability to inhibit an over learned verbal response in order to generate conflicting response. Executive processes involved: verbal inhibition ability, self-monitoring, error recognition and ability to amend error, changing cognitive set Consists of 4 conditions: naming colors, reading, inhibition and switching

Color-Word interference Test Frequent atypical performance (better performance on inhibition/switching than inhibition) Possible explanation: practice effect, in inhibition more naming is required. (Lippa&Davis, 2004)

20 Questions Executive functions tapped by this test are: the ability to identify various categories and sub/categories represented by 30 objects, ability to formulate abstract yes/no question to eliminate the maximum number of objects, the ability to incorporate the examiner’s feedback in order to formulate more efficient question

20 Questions Basic skills needed for performance of this task: visual attention and perception, object recognition, and object naming Qualitative analysis: spatial vs. verbal strategy, redundant questions, perseverative questions, stimulus-bound tendencies, severe attention dysfunction, severe anterograde memory problem, failure to learn from experience,

Tower test Executive functions assessed by Tower test include: spatial planning, rule learning, inhibition of impulsive and perseverative responding, the ability to establish and maintain the instructional set, problem solving and learning from experience. Row score reflects participants ability to reach the goal with a fewer movements.

Tests I use less frequently Proverbs Word Context Sorting Visual fluency

The Weigl Color-Form Sorting test Screen for executive dysfunction and global cognitive function Reflects ability to identify groups according to a common feature and then to change a cognitive set and categorize objects according to a different feature. Scores from 1-4; 2/4 had good sensitivity and specificity to detect casernes (Hobson,Meara,Taylor;2007)

BADS Behavioral Assessment of Dysexecutive Syndrome Aims to predict everyday problems arising from dysexecutive syndrome. DES refers to varied group of deficits resulting from different etiologies, locations and variable extent of abnormalities including: impulsivity, planning, problem solving, perseveration, distractibility. Norms for age group up to 87

BADS subtests 6 subtests: Rule shift cards* Action Pprogram Test*** Key Search Test** Temporal Judgment Test* ZOO Map*** Six Elements Test

BADS subtests Action Program Test – practical problem solving – requires five steps to solution. All five steps involve skills that are in everyone’s repertoire ZOO Map – two versions of test – reflects ability to plan, organize action following certain rules.

The Cambridge Prospective Memory Test Prospective remembering involves working memory to formulate, initiate and modify plans of action and retrospective memory e.g. to recall what it is to be done in particular time or in response to particular external event. Prospective memory failures can occur for a variety of reasons: attentional difficulties, memory problems and executive deficits

CAMPROMPT 6 prospective memory tasks to be carried in 25 minutes 3 tasks cued by time and 3 tasks are event cued. Distractor tasks of various paper and pencil puzzles both verbal and nonverbal Norms from 16 to 66+