What Is Neuropsychological (Neurocognitive) Testing? Eric Strachan, Ph.D. Psychologist, Madison Clinic Assistant Professor, UW Psychiatry Last Updated: 9/29

The Plan Appreciate the complexities of cognition Understand the domains of typical neuropsychological testing Apply the domains to HIV-associated Neurocognitive Disorders

A Classic… Aoccdrnig to a rsecreearch at Cmabrigde Uinervtisy, it deosn't mttaer in waht oredr the ltteers in a wrod are, the olny iprmoetnt tihng is taht the frist and lsat ltteer be at the rghit pclae. The rset can be a total mses and you can sitll raed it wouthit a porbelm. Tihs is bcuseae the huamn mnid deos not raed ervey lteter by istlef, but the wrod as a wlohe. Tihs is an uarbn mtyh, by the way, although the premise is true.

My Point Thinking (“cognition”) is a complex, multifaceted phenomenon Perception Transformation Decoding Integration Experience

The Domains of Cognition Processing speed Attention/Working memory Learning Memory Visual spatial ability Language Executive Functioning Motor Functioning Emotional Behavior

Processing Speed

Attention/Working Memory

Imagining Impairment in Processing Speed and Working Memory Remember this 10-digit string… 3 0 3 4 2 0 2 6 4 0

Imagining Impairment in Processing Speed and Working Memory Got it?

Imagining Impairment in Processing Speed and Working Memory Now, remember these instructions… Go out of the building and take a left. Go 3 blocks until you see the sign for N. Ogren. Turn left. The address is 416 N. Ogren.

Imagining Impairment in Processing Speed and Working Memory Who can tell me the number AND the instructions?

Imagining Impairment in Processing Speed and Working Memory 3 0 3 4 2 0 2 6 4 0 Go out of the building and take a left. Go 3 blocks until you see the sign for N. Ogren. Turn left. The address is 416 N. Ogren.

Memory I’m going to read you a list of words… I’m going to read you a short story… Immediate recall and delayed recall Correlated but not perfectly The information can “get in there” even if initial recall is difficult

Language F A S Tell me the names of all the kinds of… Picture naming

Executive Function Control and management of other cognitive functions Necessary for Planning/Decision making Error control/Troubleshooting Novel situations (not part of routine) Dangerous or difficult situations Response override (“I want that cake, but…”)

Executive Function Red Blue Green Yellow Orange

Executive Function

HAND Definition Impairment in at least 2 cognitive domains 1 or 2 standard deviations depending Interference with day-to-day functioning At least 1 month No competing explanations

General Overview of Interventions Limited treatment trials in HIV-associated cognitive impairments but several general approaches should work given the deficits Verbal, Written, Visual (the 4 V’s?) Check for understanding Simplify, if possible