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

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

3. 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

4. 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

5. 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)

6. 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

8. 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

11. 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.

12. 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

13. 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

14. 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)

17. 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

18. 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,

19. 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.

20. Tests I use less frequently
Proverbs
Word Context
Sorting
Visual fluency

21. 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)

23. 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

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

25. 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.

28. 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

29. 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+