5.4 Clinical Neuropsychology and Intellectual Assessment of Adults
243
Area of Function
Comment
V
isuospatial
-C
onstructional
Judgment of Line Orientation
Ability to judge angles of lines on a page presented in a match-to-sample format
Facial Recognition
Assesses matching and discrimination of unfamiliar faces
Clock Drawing
Useful screening technique is sensitive to organization and planning as well as construc-
tional ability
Rey-Osterrieth Complex Figure test
Ability to draw and later recall a complex geometric configuration; sensitive visual
memory as well as executive deficits in development of strategies and planning
M
otor
Finger Tapping
Standard measure of simple motor speed; particularly useful for documenting lateralized
motor impairment
Grooved Pegboard
Ability to rapidly place notched pegs in slotted holes; measures fine finger dexterity as
well as eye–hand coordination
Grip Strength
Standard measure of lateralizing differences in strength
E
xecutive
F
unctions
Wisconsin Card Sorting Test
Measure of problem-solving efficiency is particularly sensitive to executive deficits of
perseveration and impaired ability to flexibly generate alternative strategies in response
to feedback
Category Test
This measure of problem-solving ability also examines ability to benefit from feedback
while flexibly generating alternative response strategies; regarded as one of the most
sensitive measures of general brain dysfunction in the Halstead-Reitan Battery
Trail-Making Test
Requires rapid and efficient integration of attention, visual scanning, and cognitive
sequencing
Delis-Kaplan Executive Function System
(D-KEFS)
Battery of measures that are sensitive to executive functions
P
sychological
F
actors
Beck Depression Inventory
Brief (5 to 10 minutes) self-report measure that is sensitive to symptoms of depression;
best for screening depression in adults up to late middle age, who can be expected to
frankly report symptoms; available in standard (21 four-choice items) or short (13-item)
form
Geriatric Depression Scale
30-item self-report screen for symptoms of depression; the yes-no format is less cogni-
tively demanding than other scales
Minnesota Multiphasic Personality
Inventory 2
This psychometrically developed self-report instrument remains highly useful for
documenting quantitative levels of self-reported symptoms that can be objectively
compared with known populations; drawbacks include administration time (567
true–false questions, requires about 1 to 1.5 hours or more) for frail individuals, and
the emphasis on pathological features for persons who are generally psychologically
healthy; advantages include well-developed validity scales and availability of many
symptom-specific subscales that have been identified over the years
(From Sadock BJ, Sadock VA, Ruiz P.
Kaplan & Sadock’s Comprehensive Textbook of Psychiatry
. 9
th
ed. Philadelphia: Lippincott Williams & Wilkins; 2009,
with permission.)
Table 5.4-2
Selected Tests of Neuropsychological Functioning (
continued
)
developed normative standards. The scope and variety of sub-
tests on which the summary IQ values are based also provide
useful benchmarks against which to compare performance on
other tests of specific abilities. The latest revision of this instru-
ment, the Wechsler Adult Intelligence Scale III (WAIS-III),
offers the additional advantage of greatly extended age norms
(ages 16 to 89) that are directly related to normative perfor-
mances on the Wechsler Memory Scale III (WMS-III). The
Wechsler Intelligence Scales utilize a broad set of complex
verbal and visuospatial tasks that have traditionally been sum-
marized as a verbal IQ, a performance IQ, and full-scale IQ. In
the context of a neuropsychological examination, the patient’s
performance across the procedures provides useful information
regarding long-standing abilities as well as current functioning.
Most neuropsychologists recognize that the summary IQ values
provide only a ballpark range for characterizing an individual’s
general level of functioning. Therefore, it is usually more appro-
priate and meaningful to characterize an individual’s intellectual
functioning in terms of the range of functioning (e.g., border-
line, low average, average, high average, or superior) that is
represented by the IQ value rather than the specific value itself.
Careful examination of the individual’s performance across
the various verbal and performance subtests can provide infor-
mation regarding the patient’s pattern of strengths and weak-
nesses as well as the degree to which these performance
characteristics are consistent with the history and performance
on other aspects of the neuropsychological examination. Tests
of long-standing knowledge, such as for vocabulary or general
information, provide a basis for estimating an individual’s long-
standing (or premorbid) level of intellectual abilities, which in
turn can help to gauge the degree to which an individual may
have deteriorated.
The verbal IQ and performance IQ (VIQ and PIQ) have
historically been reported to be associated with left and right
