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Neuropsychological Assessment in Stroke

Presentation to the Southwest SLP Network

Dr. Anne McLachlan, C.Psych.April 27, 2010

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Outline What is a Neuropsychological

Assessment? Purpose of Neuropsychological. Ax. When to Refer for

Neuropsychological Ax.? Screening vs. Comprehensive Ax. What’s in a Neuropsychological Ax.? Case Study

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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

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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

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When to Refer for Neuropsychological Ax.? Obtain a broader picture of the

person’s cognitive, behavioural and emotional strengths and weaknesses

Clarify if client’s current deficits are due to CVA, premorbid factors, or other psychological issues

Address issues related to return to driving, school or work

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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

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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

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What’s in a Neuropsychological Assessment

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Background Information

Medical records Education & work history Prior emotional history Corroborating information from

family

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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

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Classification System

Descriptor T-score PercentileHigh Average >55 >75th

Average 40-54 16th-74th

Mild 35-39 7th-15th

Mild- Moderate 30-34 2nd-6th

Moderate 25-29 0.6- 2Moderate- Severe

20-24 0.2-0.5

Severe 0-19 <0.1

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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

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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 CVA’s, tend to see focal deficits rather than global decline

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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

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Nonverbal Abilities

Assess visual-constructional abilities, nonverbal reasoning, visual sequencing

General right-hemisphere functioning

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Processing Speed

How quickly individuals can process visual information

Usually affected by any brain damage

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Executive Functions

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

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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

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Attention/Working Memory

Attention span, divided attention (efficiency) & sustain attention

Dorsolateral prefrontal cortex Basal ganglia Frontal and parietal lobe lesions

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Learning & Memory

Verbal and visual semantic memory

Learning new information Immediate and delayed recall of

information Recognition of information

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Learning & Memory

3 main areas of brain N.B. for memory formation, consolidation & retrieval1. Medial temporal lobe areas (i.e.

hippocampus)2. Diencephalic nuclei such as thalamic

nulcei & mammmillary bodies3. White matter tracts connecting these

areas with each other and other cortical areas

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Case Study