Affect Mood and Psychological Functioning

Standardized measures of mood, personality, and psychopathology can be used to assess the contribution

Table III

Learning and Memory

Function

Test

Description

Working memory"

Tests ofMental Control

WAIS-III Letter-Number Sequencing

WAIS-III Arithmetic

The examinee is asked to recite familiar sequences such as the alphabet, days of the week, months of the year, and numbers from 1 to 20 as quickly as possible. The examinee then must recite all sequences, except the alphabet, in reverse order. Serial subtractions involve subtracting a particular number until a predetermined point is reached.

The patient hears a series of alternating numbers and letters and is required to reconfigure them so that all of the numbers are recited first, in ascending order, and then letters in alphabetical order.

Involves mental calculation of aurally presented arithmetic problems of increasing difficulty.

Retrograde memory

Boston Retrograde Memory Test

Transient Events Test (TET)

Involves showing a series of black and white photos of famous persons from the 1920s to the 1980s. If the patient cannot spontaneously generate the correct name, the examiner can give a semantic cue (i.e., ''he was a singer in the 1920s''), and then a phonemic cue (i.e., first name). This test assumes that the patient has been exposed to the information in the first place.

This is a measure of memory for popular news events from the 1950s through the 1990s. Items were selected by way of the New York Times index according to the criteria that they were mentioned at least 250 times during a particular year and less than five times over the subsequent two years. Hence, all items were of transient notoriety thereby minimizing confounding effects of overexposure. Free recall and recognition are tested.

Anterograde memory

Wechsler Memory Scale (WMS-III)

Rey Auditory Verbal Learning Test

Bushke Selective Reminding Test

Three Words Three Shapes Memory Test

Warrington Recognition Memory Test

This is a composite battery of tests assessing orientation, attention, learning, and memory for verbal and visual information across immediate and delayed intervals. It yields a series of index scores.

This measure of verbal encoding, learning, and retention involves drilling the examinee on a series of 15 unrelated words over five successive trials. Learning is followed by an interference trial, immediate recall, and 30-minute delayed recall and recognition. Various comparisons yield information regarding sensitivity to proactive and retroactive interference and rate of forgetting.

This is a special type of list-learning test that is most helpful in cases where encoding is intact, but where there is a question of impairment at the level of consolidation or storage. A list of 12 words is read and the patient must repeat as many words as possible. However, different from the previous list-learning tasks, the examiner then reads only the words that the patient did not recall. This continues across six trials and each time, the patient must try to recite as many words as possible, but only hears the words not recalled on the preceding trial. There are immediate and delayed recall trials followed by visual multiple choice recognition paradigms.

The patient is instructed to copy three words and three shapes after which incidental recall is tested. The patient is drilled on the words and shapes until criterion is reached and recall is tested after intervals of 5, 15, and 30 minutes. Recognition is tested using distracter shapes and words.

Involves the visual presentation of single words and faces at the rate of one every three seconds. The patient is instructed to read each word silently and make and report a judgment regarding his association (pleasant or unpleasant) to it. Immediately afterward, the patient is shown a pair of words, each containing a target word and a distracter, with the instruction to identify the one presented previously. Memory for faces is tested in the same way.

a See also Digit Span forward and PASAT tests in Table II.

Table IV

Language Function

Test name

Description

Boston Diagnostic Aphasia Examination (BDAE)

Boston Naming Test

Nelson Denny Reading Test

Wide Range Achievement Test-III (WRAT-3) Woodcock-Johnson Tests of Achievement Revised

This comprises measures that assess all aspects of expressive and receptive language function, including naming, comprehension, repetition, reading, writing, praxis, and prosody.

One component of the BDAE, this measure of confrontation naming is often administered independently. It consists of a series of 60 black and white line drawings of objects. Naming difficulty increases as the objects progress from high-frequency to low-frequency words. Stimulus cues are provided in the event of perceptual difficulty. Phonemic cues are used to distinguish between retrieval difficulties and lack of knowledge of a particular object name.

This test contains two multiple choice measures that assess vocabulary and reading comprehension. Reading speed is also computed. Reading comprehension can be scored on the basis of both a standard and an extended length of time.

This standardized battery of acquired scholastic skills includes measures of spelling, written arithmetic, and single-word reading.

Selected subjects such as dictation, writing fluency, writing sample, proofing, word attack, and reading comprehension provide measures of reading encoding, comprehension, and written language abilities. This is another useful measure in the assessment of language-based learning disabilities.

Table V

Visuospatial Functioning

Test name

Description

Benton Facial Recognition Test

Benton Line Orientation Test

Visual Object Space Perception Battery

Visual Cancellation

Hooper Visual Organization Test

Complex Figure Drawing

This task is composed of two parts. The first involves matching a target face with one of six faces. The target stimulus is always identical to the correct answer. The second part of the task involves choosing the three photographs, out of the array of six, that contain the same face as the target photograph. Increasing use of camera angle and shadow contribute to the progressive difficulty of the task.

This task involves judging the spatial orientation of sets of line segments by comparing them to a grid composed of 11 radii. It is sensitive to visuoperceptual deficits associated with posterior right hemisphere lesions.

This battery contains eight individual tests that each probe a specific component of object or space perception. Individual subtests are untimed and can be given in isolation or within the context of the full battery. Normative data are based on healthy control subjects as well as patients with right and left-hemisphere lesions.

The objective of this task is to circle each instance of a target letter or symbol from among a field of similar stimuli. There are a total of 60 targets evenly distributed among the four quadrants of the 8-1/2 x 11 inch page. Errors of omission involve failing to respond to the target stimulus. Errors of comission involve responding to stimuli other than the target stimulus.

This task involves examining line drawings of objects that have been broken into fragments and rotated. The objective is to mentally reorganize each set of fragments and subsequently identify the corresponding coherent whole.

This task involves copying a complex line drawing, usually the Rey-Osterreith complex figure or Taylor complex figure. Ability to reproduce the gestalt as well as the internal details of the design facilitate the detection of various perceptual deficits. Significant distortion of or failure to copy one side of the figure can indicate the presence of hemispatial neglect.

Table VI

Motor Functioning

Test name Description

Finger oscillation test

Hand dynamometer

Grooved pegboard

Reitan-Klove Sensory-Perceptual Examination

Finger tapping speed is measured by having the patient tap a key as quickly as possible over a period often seconds, using the index finger. Each hand is tested a number of times and trial totals are averaged. Poor performance consists of slow tapping speed. Unilateral motor weakness can be assessed by comparing tapping speeds of each hand. Bilateral weakness is assessed through comparison with age-matched norms.

Grip strength is measured in each hand by having the patient squeeze a pressure-calibrated instrument. Unilateral motor weakness can be assessed by comparing performance with each hand. Bilateral weakness is assessed through comparison with age-matched norms.

Measures of fine motor speed and dexterity, entailing placement of pegs in a pegboard, are obtained with each hand separately. Poor performance consists of difficulty grasping and manipulating the pegs, resulting in slowed performance.

Collection of measures of tactile, auditory, and visual perception using unilateral and double simultaneous stimulation. Finger tip number writing, visual fields, and tactile finger recognition are tested.

of psychiatric illness to the patient's presentation and diagnosis (Table VII). However, it is important to understand that many neurological illnesses can cause disorders of affect and mood. In addition, certain neurological illnesses can produce symptoms that overlap with particular psychiatric disorders. Therefore, neuropsychologists must have a thorough understanding of the psychiatric profiles associated with various neurobehavioral syndromes and proceed with caution when evaluating psychiatric symptoms in the presence of neurological or medical illness.

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