Cogn Assessment

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shelbymailho
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Cogn Assessment
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2011-12-12 22:22:10
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Cognitive Assessment Final
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  1. 2 Fundamental Levels of Cognitive Assessment
    • o Cognition: process, organize, and
    • communicate information (includes executive cognition, SOAP ID
    • o Emotion: feeling and motivational
    • aspects of behavior
  2. What is SOAPID
    • Sequencing
    • Organizing
    • Abstracting
    • Planning
    • Inhibiting
    • Directing
  3. Name the 4 Brain Lobes
    • Frontal
    • Parietal
    • Occipital
    • Temporal
  4. Left Hemisphere is
    language
  5. Right Hemisphere is
    spatial, organization
  6. Thalamus
    • relay station, information goes through (except
    • olfactory)
  7. Hippocampus
    memory consolidation
  8. Amygdala
    associated with emotion (e.g. fear response)
  9. 4 Rationales for Cognitive Assessment
    • Diagnosis
    • Screening
    • Treatment Planning
    • Evaluation
  10. Diagnosis
    • Dementia (which one?)
    • Learning Disability
    • Psychiatric Condition (depression, anxiety)
    • Other Neurological Conditions
  11. Screening
    • To identify persons in need of further diagnostic evaluation
    • Mini-Mental Status Exam
    • RBANS: memory, language, verbal fluency
  12. Treatment Planning
    • Memory difficulties
    • Learning accommodations
    • Medication suggestions (more or less)
  13. Evaluation
    • Repeat Assessments
    • -Evaluate improvement due to therapy·
    • -Improvement from head injury or brain surgery
    • -Improvement of delirium
  14. What is Intelligence?
    Concepts of intelligence are attempts to clarify and organize this complex set of phenomena
  15. Alfred Binet
    • “good sense” faculty of adapting one’s self to circumstances
    • mainly studied children
  16. David Wechsler
    capacity to act purposefully, to think rationally, and to deal effectively with environment
  17. Howard Gardner
    • set of skills of problem solving
    • -Study normal and subnormal
    • -Paper and pencil formats rule out other types of intelligence
  18. Sternlerg and Salter
    goal-directed adaptive behavior; analytic, creative, and practical
  19. Low IQ associated with:
    High IQ associated with:
    • Low- likely to be divorced, incarcerated
    • High- more education, higher status jobs
  20. Concept of "g"
    • General intelligence factor
    • Charles Spearman- factor analysis of various tests à all positively correlated
    • must be measuring unique dimension of mental ability
  21. 2 Components of CHC Theory
    • Fluid Intelligence
    • Crystallized Intelligence
  22. Fluid Intelligence
    reason, form concepts, and solve problems with unfamiliar information
  23. Crystallized Intelligence
    acquired knowledge (i.e. vocabulary)
  24. Test Sensitivity
    how likely is it that the test will pick up something (e.g. mental retardation)
  25. Test Specificity
    testing for normality (is patient “normal”? Will it detect the absence of condition?)
  26. False Positive vs. False Negative
    • False-Positive- saying something’s wrong when it’s not
    • False-Negative- saying something isn’t wrong when it is
  27. Process Approach
    • a way of looking at someone’s performance qualitatively
    • Looking at how people arrive at answers
    • Are they elaborative? Do they get frustrated? Do they get Block Designs correctly even if it’s after the allotted time?
  28. 4 Domains of Assessment
    • Global Composite Level (FSIQ vs. GAI)
    • Specific Composite (VCI, PRI, WMI, PSI)
    • Subtest
    • Item
  29. GAI
    • takes out effects of processing speed and working memory
    • If any of the indices have a 23+ point difference- it’s a significant discrepancy
  30. What is the mean and standard deviation of: standard scores, scaled scores?
    • Standard Score: m = 100, SD = 15
    • Scaled Score: m = 10, SD = 3
  31. Which part of the brain is VCI, PRI, WMI, and PSI associated with?
    • VCI- left hemisphere (language dominant)
    • PRI- right hemisphere (spatial tasks)
    • WMI- Prefrontal Cortex
    • PSI- Subcortical
  32. Aphasia
    language disorder
  33. Agnosia
    • misperception of stimuli (but neurologically intact)
    • Loss of ability to recognize objects, persons, sounds, shapes, or smells while the specific sense is not defective
    • Prosopagnosia: cannot recognize familiar faces
    • Anosognosia: denial of any deficits (lack of insight)
  34. Apraxia
    failure to carry out purposeful movements
  35. Delirium
    clouding of consciousness, sudden onset, confusion, clears up if treated
  36. 2 Main Purposes of Evaluation
    • Premorbid- impairment; have they declined cognitively?
    • Deficiency- how will they function in the real world?
  37. Ecological Validity
    • inferring about the real world
    • how will the person function?
  38. Cortical vs. Subcortical
    • Cortical- higher order processing
    • Subcortical- processing speed
  39. Perseverating
    repeat same word, idea, get stuck
  40. Stimulus Bound Behaviors
    drawn by the stimulus, have trouble disengaging
  41. Utilizing Behaviors
    utilize stimulus
  42. 2 Categories of Seizures
    • Generalized
    • Partial
  43. Stereotypies
    repetitive behaviors (start picking clothes, patting head)
  44. Semiology
    clinical manifestations of a seizure
  45. Preseizure
    • Aura
    • anxiety, sense of fear
  46. Ictus/Ictal
    seizure
  47. Status Epilepsy
    continuous seizure
  48. To Determine Severity of Brain Injury
    • Time of lost consciousness
    • Posttraumatic Amnesia
  49. Abnormality
    • Statistical Deviation
    • Mental Health Deviation
    • Social Norm Deviation
    • Distress to self/others
    • Seek Treatment
    • Impaired Functioning
    • DSM Listings
  50. 4 Pillars of Assessment
    • Norm-referenced tests
    • Interviews
    • Observations
    • Informal assessment procedures
  51. Criterion Validity
    • Correlation between the test and a variable, how can the test predict the future
    • Predictive: omeasures can predict future instances of ____
    • Concurrent: assessing two things at the same time
    • Retrospective or Postdictive Validity: worst kind, how does IQ predict previous occurences?
  52. Content Validity
    • capture content of construct you’re trying to measure
    • Subjective: ask a professional
    • Objective: statistical measures
  53. Divergent Validity
    • Correlate with something that wouldn't correlate
    • -Depression Scale vs. Happiness Scale
    • Should show an inverse relationship
  54. Covergent Validity
    correlate your new test with old test to see if they have a high correlation
  55. Reliability
    • Consistency
    • Reliability precedes Validity
  56. Cognitive Functioning: Intellectual and Academic
    • Intellectual:
    • -Orientation
    • -Attention
    • -Language
    • -Memory
    • -Spatial
    • -Executive
    • -Motor Sensory
  57. Autism
    • Impaired social reciprocity, communication disorders, and cognitive deficits
    • Cognitive: poor verbal comprehension; intact spatial cognition and rote memory
    • Symptoms:
    • -Delayed speech
    • -Echolalia
    • -Idiosyncratic speech
    • -Vocabulary and comprehension disorders
    • -Grammatical immaturity
    • -Rate, tone, and pitch abnormalities
    • -Gaze avoidance and stereotypic behaviors
    • Comorbidity:
    • -ADHD
    • -MR
    • -Epilepsy
    • -Aggressive and impulsive disorders
  58. Asperger's
    • Significant and chronic impairment of social interaction and/or repetitive patterns of behavior
    • Language impairment is NOT present
    • Speech is often flat, dull, monotonous
    • Poor social reciprocity
  59. ADHD
    • Currently 3 subtypes
    • Involves disturbances in attention span, self-regulation, activity level, and impulse control
    • Previous monikers: minimal brain damage; hyperkinetic syndrome, ADD
    • Inhibition is key: an inability to delay a response long enough to evaluate various alternative behaviors – not responsive to feedback
  60. Oppositional Defiant Disorder
    • No law breaking
    • Negativistic behavior
  61. Conduct Disorder
    • Theft, truancy, fire-setting
    • Unlawful
    • Disregard for rules
  62. Fragile X Syndrome
    • X chromosome is compressed or broken
    • Most common in males, and more profound effect since males have only one X chromosome
    • Mild to severe retardation
    • Very poor spatial cognition
    • Hypersensitivity to sensory stimuli; echolalia, rapid speech
  63. Klinefelter Syndrome
    • Extra X chromosome is present – more common of the genetic disorders
    • Infertility, male breast development, underdeveloped masculine build, social-cognitive difficulties
  64. Neurofibromatosis
    • ‘Von Reckinghausen’s’ disease
    • Spots of skin pigmentation (café au lait spots)
    • Benign tumors on/under skin (neurofibromas)
    • Tumors in the iris (Lisch nodules)
    • Focal brain lesions
    • Freckles in unexposed body areas
    • High rates of learning disabilities, behavior problems; visual-spatial disorders
  65. Tuberous Sclerosis
    • CNS involvement, including heart, lungs, bones, kidneys
    • Distinct facial lesions: adenoma
    • sebaceum
    • Amelanotic naevus – present on fact, trunk or limbs
    • CNS lesions result from abnormal proliferation of brain cells and glia during development
    • Tubers occur in the convolution of brain tissue
    • Cognitive deficits, epilepsy, hemiplegia
  66. Fetal Alcohol Syndrome
    • Show delayed development, overactivity, motor clumsiness, attention deficits, learning disorders, MR, and seizure disorders
    • Shorter than expected eye opening, flattening of the mid-face, short nose, indistinct ridges between the nose and mouth, tiny upper lip
  67. Dyslexia
    difficulty learning to read despite IQ
  68. Nonverbal Learning Disabilities
    • Manifest:·
    • Motor coordination
    • Social awkwardness
    • Visual-spatial Function Impaired
  69. Occipital Lobe Function
    Visual cortex, visual processing
  70. Parietal Lobe Function
    integrates sensory information from different modalities, particularly determining spatial sense and navigation
  71. Frontal Lobe Function
    higher order processing
  72. Temporal Lobe Function
    • involved in auditory perception
    • processes semantics in speech and vision
    • contains hippocampus and plays key role in long-term memory formation
  73. Francis Galton
    • coined psychometric intelligence
    • did not succeed in constructing true IQ test
    • simple reaction time, strength of squeeze, keenness of sight-sensory and motor abilities
  74. WWI Tests: Army Alpha
    • Tests of practical judgement
    • -directions/commands
    • -arithmetical problem
    • -synonym-antonym
    • -information (general fund of knowledge)
  75. WWI Tests: Army Beta
    • Non-verbal test
    • -Maze
    • -Cube analysis
    • -Pictorial Completion
  76. Flynn Effect
    3 IQ point increase per decade
  77. Psychometrics
    • Field of study concerned with the theory and techinique of psychological measurement (measure of cognition, abilities, attitudes, personality traits)
    • Primary Concern: construction and validation of measurement instruments
  78. Measurement
    • The assignment of numerals to objects or events according to rules
    • In the physical sciences: numerical estimate and expression of the magnitude of one quantity relative to another
  79. 5 Advantages of Standardized Measures
    • Objectivity
    • Quanitification (measuring abstract concepts with numerals)
    • Communication
    • Economy
    • Scientific Generalization
  80. Nominal
    • Labeling, dichotomous, categorical
    • Cannot interpret the numbers to reveal anything quanititative
  81. Nominal: Mutually Esclusive vs. Exhaustive
    • Mutually Exclusive: each subject/observation is assigned to one and only one category
    • Exhaustive: all observations are classified into specific categories
  82. Ordinal
    • Ranking numbers
    • Reveals direction
  83. Interval
    • Magnitude and Direction
    • No absolute zero
  84. Ratio
    Direction, Magnitude, Equal Distances, and an Absolute Zero
  85. Classical Theory
    • X = t + e
    • Score = true score + error
    • True Score: true score estimated through observed score
    • Error Score: the observed score deviates from the true score due to influence of error (random sources that can move scores up/down relative to true score)
  86. Variance
    How scores vary from the average/mean score for the sample (larger variance means the scores are more spread out)
  87. 3 General Ways of Examining Reliability
    • Test-Retest
    • Parallel Forms (Alternate Forms)
    • Internal Consistency
  88. Test-Retest
    Same test given on two different occassions: should be highly correlated if it's consistent
  89. Parallel Forms
    Two different measures of the same construct
  90. Internal Consistency
    Multiple items on a single test should converge on the same conclusions about true scores
  91. How Can Reliability Be Improved?
    • Standardization
    • Aggregation- using many tests to measure one construct
  92. Validity
    Are you measuring what you say you're measuring?
  93. Construct Validity
    • Whether a given measure actually assesses whether the underlying conceptual or construct
    • Convergent Validity
    • Divergent Validity
  94. Incremental Validity
    • Question of wheter a particular measure provides explanatory power over and above another measure in predicting relevant criterion
    • -Does motivation predict academic performance over and above that which is predicted by IQ?
  95. Symptom Validity Test (SVT)
    assess if the person is faking bad
  96. Mental Status Examination
    An orderly assessment of the important cognitive and emotional functions that are commonly and characteristically disturbed in patients with organic brain disease
  97. Gait: Ataxic, Antalgic, Functional
    • Ataxic: unsteady, wide-based (cerebellum problems)
    • Atalgic: painful, limping
    • Functional: psychiatric
  98. Dyscalculia
    Difficulty in calculation
  99. Acalculia
    Inability to calculate
  100. Dysgraphia
    difficulty writing
  101. Agraphia
    Inability to write
  102. Psychological Assessment
    Employs psychometric instruments to examine the effects of brain function on behavior
  103. Brocas Area
    Verbal expression, articulation
  104. Wernickes Area
    Comprehension, fluency
  105. Contralateral Neglect
    • Damage to right parietal lobe
    • Inattention to left/right
    • Can be visual, auditory, tactile
  106. Adam's Triad
    • "weird"- cognitive problems
    • "walking"- balance/gait problems
    • "water"- wet themselves
  107. Hold Measures
    verbal tests, less vulnerable to brain damage

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