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1 The Practice of

Q: How has screening evolved in the context of neuropsychological assessment?

- Evolved from crudely conceived separation of 'brain damaged' patients to a refined tool for identifying at-risk individuals - Used to identify persons most likely at risk for a specified condition or in need of further diagnostic study

42 important questions on 1 The Practice of

What are some tips to prepare for examinations effectively?

- Start studying early to avoid last-minute stress
- Create a study schedule to organize your time
- Practice past exam papers for familiarization with the format
- Use active study techniques like summarizing, self-testing, and teaching others
- Ensure to take breaks for better focus and retention of information
- Stay well-rested and eat healthily to support brain function

What are the six different purposes that may prompt a neuropsychological examination?

- Diagnosis
- Patient care
- Treatment-1: identifying treatment needs, individualizing treatment programs, and keeping abreast of patients’ changing treatment requirements
- Treatment-2: evaluating treatment efficacy
- Research, both theoretical and applied
- Forensic questions

What role does neuropsychological assessment play in patient care?

- Addresses questions about management and planning
- Helps individualize treatment programs
- Keeps track of patients' changing treatment needs
- Requires the examiner to integrate assessment strategies for different purposes
- Aids in gaining necessary patient information efficiently

Why is neuropsychological assessment still important for diagnosis despite advances in neurodiagnostic techniques?

- Sensitive for distinguishing between psychiatric and neurological symptoms
- Identifies possible neurological disorders in nonpsychiatric patients
- Helps distinguish between different neurological conditions
- Provides behavioral data for localizing lesions
- Essential for revealing behavioral strengths and deficits post-lesion imaging

What role can neuropsychological assessment play in the early detection and prediction of various disorders and outcomes?

- Aid in prodromal or early detection and prediction of dementing disorders or outcome
- Detect cognitive impairments during the prodrome and conversion to Alzheimer's disease
- Identify cognitive deficits in carriers of the Huntington's disease gene

How can neuropsychological assessment assist in pharmacologic research related to mood disorders?

- Help predict responders and best psychopharmacological treatments in mood disorders

Why are neuropsychological evaluations critical for patients with intractable epilepsy?

- Identify candidates for surgery
- Implement postsurgical programs

How has screening evolved in the context of neuropsychological assessment?

- Evolved from crudely conceived separation of "brain damaged" patients to a refined tool for identifying at-risk individuals
- Used to identify persons most likely at risk for a specified condition or in need of further diagnostic study

What information is typically provided through descriptive evaluations in the care and treatment of brain injured patients?

- Detailed cognitive status, behavioral alterations, personality characteristics
- Patient's adjustment to disabilities and how the neurological condition has affected behavior

What abilities were required in the new post of the 55-year-old management expert?

- Analyze and integrate large amounts of information
- Show creative thinking
- Demonstrate good judgment
- Rebuild employees' morale

What were some examples of lapses in judgment shown by the 55-year-old management expert during the neuropsychological examination?

- Suggested putting out a fire in a movie theater by oneself if it's not dangerous
- Overlooked the central problem in a picture where people were sitting in the rain
- Worked quickly with errors in Figural Fluency Test
- Assigned the same number to two different symbols in Symbol Digit Modalities Test
- Allowed errors in arithmetic calculations

How did the word finding difficulties of the 55-year-old management expert manifest during the neuropsychological examination?

- Needed phonetic cueing to retrieve six words on the Boston Naming Test
- Failed to recall two words even with cueing
- Compared a dog and a lion in a confusing manner during discourse
- Showed difficulty in expressing similarities

What did the patient assure in the interview regarding his readiness to return to work?

- Patient claimed he was ready to return to a job he relished
- Mentioned work being his life, with no extracurricular interests
- Denied fatigue or temperament changes
- Insisted he was fully capable of resuming managerial duties

Why were performance defects considered serious impediments at the occupational level for the patient?

- Defects were subtle but significant at occupational level
- Lack of appreciation of deficits noted
- Patient's life, dignity, self-worth closely tied to work
- Expected difficulty in understanding and accepting condition constructively
- High potential for serious depression

How was the patient's emotional situation evaluated following examination findings?

- Patient and wife seen together for examination findings report
- Emotional evaluation done considering wife's reports and support capacity
- Patient couldn't deny fatigue witnessed by his wife
- Wife noticed morning efficiency compared to later-day irritability and lapses
- She welcomed learning about fatigue causing late-day changes

What practical plans did the patient make to return to work following his stroke?

- Returned to work for half-days only
- Had an "assistant" to review actions and decisions
- Realized the need for help after self-monitoring failures
- Received encouraging information about preserved abilities
- Was not pointed out judgmental errors
- Was spared from discouraging information to avoid overwhelming

How did the patient ensure he adhered to the agreed four-hour work day?

- Instead of going to work in the morning, he started after a morning walk or golf game and a midday rest
- By arriving at the office post 1 PM, it made it less likely for him to exceed the half-day work limit
- This helped prevent the patient from stretching his work hours beyond the agreed limit

What was the patient's work schedule ten months after the stroke?

- On the job for about 60 hours per week
- Reported to be doing excellent work
- Experienced a mild naming problem and minor confusions
- Acknowledged feelings of depression in the evening
- Noted a sleep disturbance for which medication was started by the neurologist

What questions can the neuropsychological examination answer regarding patients?

- Capacity for self-care
- Reliability in following a therapeutic regimen
- Ability to handle traffic emergencies
- Appreciation of money and financial situation
- How patients react to deficits and compensate for them
- Feasibility of retraining (profitability)

How can neuropsychological measurements be beneficial in neurological diseases and neuropsychiatric conditions?

- Well-suited for monitoring disease progression
- Play a key role in monitoring cognitive and neurobehavioral status
- Provide indications of neurological condition changes over time
- Helpful in identifying dementia early through repeated testing
- Evaluation of performance inconsistencies post-surgical procedures or retraining

Describe the initial presentation and symptoms of the 27-year-old logger after undergoing surgical removal of a right frontotemporal subdural hematoma.

- Alert and oriented, poorly groomed
- Complained of voices from teeth, receiving radio waves
- Emotionally flat, sparse speech
- 20-30 sec response latencies
- Denied depression, sleep/eating disturbances
- Pointed out hallucination of Ichabod Crane’s headless horseman
- Troubled by delusional ideation

What were the neuropsychological test scores of the patient six and a half months after the injury?

- Below previous scores
- Above average on well-learned verbal material
- Low average to borderline defective on several tests (oral arithmetic, visuomotor tracking, visual reasoning)
- Verbal learning curve considerably below average
- Immediate verbal span and retention within average range
- Defective immediate recall of designs

How did the patient's condition and test scores change after being put on trifluoperazine?

- Still poorly groomed, alert, oriented
- Reaction times within normal limits
- Gain in test scores to high average to superior ranges
- Faster response times enabled full credit on timed items
- Improved performance on puzzle constructions
- Average to high average levels on verbal memory tests
- Superior rating on visual memory test
- Skilled performance on visuomotor tracking tasks

Why is repeated testing important in assessing brain-impaired patients?

- Provide documentation of cognitive repercussions of psychiatric disturbance
- Show effects of psychotropic medication on cognitive functioning
- Prevent gaining distorted impression of cognitive status
- Allow comparison over time to identify changes
- Demonstrate value of testing at different time points
- Help patients understand themselves and set realistic goals
- Reveal changes in self-awareness and emotional functioning
- Assess capacity for empathy and detect alterations in neural pathways
- Identify feelings of strangeness, confusion, and self-distrust

Why may brain-impaired patients experience self-doubt and confusion about their own experiences and behaviors?

- Diminished capacity for empathy due to neurological impairment
- Heightened confusion from misperceptions and altered neural activity
- Problem of shared self-distrust regarding memory and perceptions
- Feelings of strangeness and confusion about familiar habits and sensations
- Tendencies to make errors due to disruptions in neural pathways
- Concept of self-doubt referred to as perplexity
- Emotionally crippling despite being distinguishable from neurotic self-doubts

What can careful reporting and explanation of psychological findings do for patients experiencing perplexity?

- Allay the patient's anxieties
- Dispel confusion
- Provide information about their psychological status
- Help patients understand disruptive experiences of perplexity

What were the behavioral changes observed in the 24-year-old bank teller after sustaining a concussion?

- Inability to perform acceptably at work
- Loss of interest in outdoor sports
- Social withdrawal
- Moodiness and dependency

How did the neuropsychological examination of the 24-year-old bank teller reveal her impairment?

- Impairment of auditory span, concentration, and mental tracking
- Pervasive sense of unsureness reported by the patient
- Hesitancy and doubt about her actions
- Destruction of previous spontaneity due to feelings of doubt

What misunderstanding did the 24-year-old bank teller have regarding her cognitive impairment after the concussion?

- Interpreted inner uneasiness as symptomatic of "mental illness"
- Fears confirmed by psychiatric opinion
- Led to disastrous changes in her personal life
- Clear explanation of limitations and implications brought relief and set the stage for counseling

What does the concerned family of a patient need to know about the patient's condition?

- Understand the patient's new mental changes and their psychosocial repercussions
- Recognize subtle defects in motivation, planning, organizing, and self-monitoring
- Be aware of potential challenges like irritability, self-centeredness, impulsivity, or apathy
- Acknowledge emotional burdens on family members, conflicts, and strains on family ties
- Adapt to the patient's changing capacities and behaviors

What is involved in treatment planning and remediation for cognitive impairments and behavioral disorders in neuropsychology?

- Neuropsychologists focus more on treatment and research
- Access to effective behavioral treatments based on neuropsychological knowledge
- Rehabilitation programs utilize neuropsychological techniques
- Development of treatment programs for soldiers with brain injuries from wars and terrorist acts
- Assessment demands for determining appropriate treatments based on neuropsychological knowledge

Why is sensitive, broad-gauged, and accurate neuropsychological assessment necessary in the rehabilitation setting?

- Determines the most appropriate treatment for candidates with brain dysfunction
- Identifies problem areas and evaluates strengths for rehabilitation
- Requires repeated assessments to adapt programs to changing needs
- Enables treatment specialists to maintain common goals and understanding
- Helps therapists understand patients' problems to improve their performances

What deficits were present in the 30-year-old lawyer following surgical intervention for a ruptured right anterior communicating artery aneurysm?

- Difficulty in retrieving stored information when needed
- Very poor prospective memory
- Diminished emotional capacity
- Impaired social judgment and planning ability
- Poor self-monitoring
- Impaired empathy, self-awareness, spontaneity, drive, and initiative-taking

What skills and abilities did the 30-year-old lawyer retain despite the deficits associated with frontal lobe damage?

- Retained verbal and academic skills and knowledge
- Good visuospatial and abstract reasoning abilities
- Appropriate social behaviors
- Normal motor function

What type of rehabilitation program was the 30-year-old lawyer placed in by his wife after failed attempts to enter the practice of law?

- The program was directed by a therapist with experience with aphasic patients
- Emphasized training to enhance attentional functions and compensate for memory deficits
- Included memory diary and notebook training
- Drilled in necessary memory and notetaking habits

What was the main oversight in the rehabilitation program for the 30-year-old lawyer with frontal lobe damage?

- The program did not address the issue that he did not remember to remember what he needed to when necessary
- Despite learning memory aids, he did not think to utilize them at the right times

What significant event occurred one week after the conclusion of the eight-week rehabilitation program for the 30-year-old lawyer?

- While learning a new job route, he lost his memory book
- He never found the missing memory book
- Despite the evident need, he did not create another one for himself

What were the characteristics, deficits, and capacities of the 42-year-old civil engineer who underwent a training program after a rear-end collision?

- Severe attentional and memory deficits due to a car accident
- Strong emotional and motivational capacities
- Good social and practical judgment
- Abilities for planning, initiation, and self-monitoring
- Excellent verbal and visuospatial knowledge and skills
- Good reasoning ability
- No motor deficits
- Benefited from attentional training and enhanced memory compensation efforts

What questions arise in relation to the worth of rehabilitation and retraining services according to Kashner, Prigatano, Pliskin, and Wilson et al.?

- Does the provided service deliver what is promised?
- Does the behavioral change have psychological or social value?
- Is the change maintained long enough to justify the costs?
- How can neuropsychological assessment help answer these questions?

How can neuropsychological evaluation showcase responses to surgical interventions and brain stimulation?

- It can demonstrate neurobehavioral responses to surgeries like temporal lobectomy, coronary artery bypass, and open-heart surgery.
- It can also show responses to brain stimulation treatments for conditions like Parkinson's disease or left visuospatial awareness improvement.

What role does neuropsychological assessment play in testing drug efficacy and side effects?

- It provides data for drug testing programs for various conditions like cancer, HIV, seizure control, attention deficit disorders, multiple sclerosis, hypertension, and psychiatric disorders.

How has neuropsychological research contributed to understanding brain activity, behavioral alterations, and cognitive function?

- It studies brain activity organization and behavior translation.
- Helps investigate brain disorders, behavioral disabilities, and normal behavior.
- Provides valuable tools for studying small behavioral alterations and cognitive functions related to brain pathology.

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Lezak Chapter 1

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