1 Neuropsychological Assessment in Stroke Presentation to the Southwest SLP Network Dr. Anne McLachlan, C.Psych. April 27, 2010

2 Outline What is a Neuropsychological Assessment? Purpose of Neuropsychological. Ax. When to Refer for Neuropsychological Ax.? Screening vs. Comprehensive Ax. Whats in a Neuropsychological Ax.? Case Study

3 What is a Neuropsychological Assessment? Uses a brain-behaviour framework Psychosocial issues Underlying cognitive process: Sensorimotor functioning Attention Executive functions Verbal information processing Visual-perceptual processing Processing Speed Memory

4 Purpose of Neuropsych. Ax. 1. Measure cognitive functioning in order to identify neuroanatomical structures and functions that have been affected 2. Use known pathology of neurological disorder as a framework to identify which cognitive, affective and behavioural syndromes have been affected

5 When to Refer for Neuropsychological Ax.? Obtain a broader picture of the persons cognitive, behavioural and emotional strengths and weaknesses Clarify if clients current deficits are due to CVA, premorbid factors, or other psychological issues Address issues related to return to driving, school or work

6 Screening vs. Comprehensive Assessment Screening 0-3 months post-CVA, person is still changing Identify strengths and deficits to aide in treatment planning 1-2 hours of testing and quicker turn- around for report

7 Screening vs. Comprehensive Assessment Comprehensive Assessment Best done 3-12 months post-CVA 6-8 hours of testing Usually core battery of tests with additional tests to address specific concerns

8 Whats in a Neuropsychological Assessment

9 Background Information Medical records Education & work history Prior emotional history Corroborating information from family

10 Current Emotional Functioning Identify and diagnose symptoms of depression, anxiety, bipolar disorder, psychosis Identify personality factors & coping style and diagnose personality disorders Based on clinical interview and personality testing

11 Classification System DescriptorT-scorePercentile High Average >55>75 th Average th -74 th Mild th -15 th Mild- Moderate nd -6 th Moderate Moderate- Severe Severe 0-19<0.1

12 Sensorimotor Functioning Identify any underlying deficits in sensory input or motor output that may affect other more complex cognitive tasks Neglect (inattention to one side)– lesions in area of thalamus, white matter, basal ganglia and dorsolateral frontal lobe, white matter of parietal lobe visual field deficits – lesions of optic tract or V1 of occipital lobe Apraxia – lesions in frontal, parietal or temporal lobe

13 Estimated Premorbid Level of Intellectual Functioning Is current level of intellectual functioning consistent with estimated premorbid level or is there evidence of decline? Based on single-word reading test, performance on hold tests and work/education history For individuals with CVAs, tend to see focal deficits rather than global decline

14 Verbal Abilities Some neuropsychologists will do Aphasia assessments if no SLP available and there are possible comprehension or speech production difficulties Verbal abilities that are assessed are typically verbal reasoning, fund of general information & generating word meanings Assesses general left-hemisphere functioning

15 Nonverbal Abilities Assess visual-constructional abilities, nonverbal reasoning, visual sequencing General right-hemisphere functioning

16 Processing Speed How quickly individuals can process visual information Usually affected by any brain damage

17 Executive Functions Planning Problem-solving Inhibition Initiation/generation Self-monitoring Cognitive flexibility

18 Executive Functions Primarily in the prefrontal cortex but also influenced by connections in other areas Association cortex of parietal, occipital & temporal lobes Limbic cortex Subcortical structures such as amygdala, basal ganglia, thalamus and cerebellum

19 Attention/Working Memory Attention span, divided attention (efficiency) & sustain attention Dorsolateral prefrontal cortex Basal ganglia Frontal and parietal lobe lesions

20 Learning & Memory Verbal and visual semantic memory Learning new information Immediate and delayed recall of information Recognition of information

21 Learning & Memory 3 main areas of brain N.B. for memory formation, consolidation & retrieval 1. Medial temporal lobe areas (i.e. hippocampus) 2. Diencephalic nuclei such as thalamic nulcei & mammmillary bodies 3. White matter tracts connecting these areas with each other and other cortical areas

22 Case Study