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Neuropsychological Assessment in Stroke

Neuropsychological Assessment in Stroke. Presentation to the Southwest SLP Network Dr. Anne McLachlan, C.Psych. April 27, 2010. Outline. What is a Neuropsychological Assessment? Purpose of Neuropsychological. Ax. When to Refer for Neuropsychological Ax.? Screening vs. Comprehensive Ax.

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Neuropsychological Assessment in Stroke

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  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. • What’s 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. • Measure cognitive functioning in order to identify neuroanatomical structures and functions that have been affected • 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 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

  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. What’s 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

  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 CVA’s, 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 • Medial temporal lobe areas (i.e. hippocampus) • Diencephalic nuclei such as thalamic nulcei & mammmillary bodies • White matter tracts connecting these areas with each other and other cortical areas

  22. Case Study

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