What Is Neuropsychological (Neurocognitive)...
Transcript of What Is Neuropsychological (Neurocognitive)...
NORTHWEST AIDS EDUCATION AND TRAINING CENTER
What Is Neuropsychological (Neurocognitive) Testing? Eric Strachan, Ph.D. Psychologist, Madison Clinic Assistant Professor, UW Psychiatry
Last Updated: 9/29
The Plan
• Appreciate the complexities of cognition
• Understand the domains of typical neuropsychological testing
• Apply the domains to HIV-associated Neurocognitive Disorders
A Classic…
• Aoccdrnig to a rsecreearch at Cmabrigde Uinervtisy, it deosn't mttaer in waht oredr the ltteers in a wrod are, the olny iprmoetnt tihng is taht the frist and lsat ltteer be at the rghit pclae. The rset can be a total mses and you can sitll raed it wouthit a porbelm. Tihs is bcuseae the huamn mnid deos not raed ervey lteter by istlef, but the wrod as a wlohe.
• Tihs is an uarbn mtyh, by the way, although the premise is true.
My Point
• Thinking (“cognition”) is a complex, multifaceted phenomenon
• Perception • Transformation • Decoding • Integration • Experience
The Domains of Cognition
• Visual spatial ability
• Language
• Executive Functioning
• Motor Functioning
• Emotional Behavior
• Processing speed
• Attention/Working memory
• Learning
• Memory
Processing Speed
Attention/Working Memory
Imagining Impairment in Processing Speed and Working Memory
• Remember this 10-digit string…
3 0 3 4 2 0 2 6 4 0
Imagining Impairment in Processing Speed and Working Memory
• Got it?
Imagining Impairment in Processing Speed and Working Memory
• Now, remember these instructions… – Go out of the building and take a left. – Go 3 blocks until you see the sign for N. Ogren. – Turn left. – The address is 416 N. Ogren.
Imagining Impairment in Processing Speed and Working Memory
• Who can tell me the number AND the instructions?
Imagining Impairment in Processing Speed and Working Memory
3 0 3 4 2 0 2 6 4 0
- Go out of the building and take a left. - Go 3 blocks until you see the sign for N. Ogren. - Turn left. - The address is 416 N. Ogren.
Memory
• I’m going to read you a list of words…
• I’m going to read you a short story…
• Immediate recall and delayed recall - Correlated but not perfectly - The information can “get in there” even if initial recall is difficult
Language
• F A S
• Tell me the names of all the kinds of…
• Picture naming
Executive Function
• Control and management of other cognitive functions • Necessary for
- Planning/Decision making - Error control/Troubleshooting - Novel situations (not part of routine) - Dangerous or difficult situations - Response override (“I want that cake, but…”)
Executive Function
Red Blue Green Yellow
Blue Red Orange Green
Green Orange Yellow Blue
Yellow Red Blue Orange
Executive Function
HAND Definition
• Impairment in at least 2 cognitive domains - 1 or 2 standard deviations depending
• Interference with day-to-day functioning
• At least 1 month
• No competing explanations
General Overview of Interventions
Limited treatment trials in HIV-associated cognitive impairments but several general approaches should work given the deficits
• Verbal, Written, Visual (the 4 V’s?)
• Check for understanding
• Simplify, if possible