Kaplan + Sadock's Synopsis of Psychiatry, 11e

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5.4 Clinical Neuropsychology and Intellectual Assessment of Adults

Table 5.4-2 Selected Tests of Neuropsychological Functioning ( continued )

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 Ability to draw and later recall a complex geometric configuration; sensitive visual memory as well as executive deficits in development of strategies and planning Standard measure of simple motor speed; particularly useful for documenting lateralized motor impairment Ability to rapidly place notched pegs in slotted holes; measures fine finger dexterity as well as eye–hand coordination 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 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 Requires rapid and efficient integration of attention, visual scanning, and cognitive sequencing 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 30-item self-report screen for symptoms of depression; the yes-no format is less cogni- tively demanding than other scales 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 Standard measure of lateralizing differences in strength Battery of measures that are sensitive to executive functions

Rey-Osterrieth Complex Figure test

M otor Finger Tapping

Grooved Pegboard

Grip Strength

E xecutive F unctions Wisconsin Card Sorting Test

Category Test

Trail-Making Test

Delis-Kaplan Executive Function System (D-KEFS)

P sychological F actors Beck Depression Inventory

Geriatric Depression Scale

Minnesota Multiphasic Personality Inventory 2

(From Sadock BJ, Sadock VA, Ruiz P. Kaplan & Sadock’s Comprehensive Textbook of Psychiatry . 9 th ed. Philadelphia: Lippincott Williams & Wilkins; 2009, with permission.)

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

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-