Fundamental Considerations in Neuropsychological Assessment Brent Van Dorsten PhD Colorado Defense Lawyers Association, Steamboat Springs CO July 24, 2023 I. Introduction to Neuropsychological Testing (5 minutes) A. General Purposes B. Goals/Objectives C. Result Uses II. Injuries to the Head, Diagnosis, Prognosis (10 minutes) A. Archives of Physical Medicine and Rehabilitation 1993, 2023 a. Concussion – grading b. Traumatic Brain Injury i. Mild, mild complicated, Moderate, Severe c. Closed Head Injury d. Post-Concussive Syndrome B. Prognosis for Recovery a. Mild vs. Moderate injury prognosis C. Factors Influencing Recovery a. TBI Severity – Multiple in close proximity, severity, b. Multiple injuries to the head (severity, proximity, recovery) c. Age d. Neurological Disorder - MS, SLE/Lupus, CVA/MI with hypoxia/anoxia, TIA, seizure disorder, ADD/ADHD, chronic fatigue syndrome, fibromyalgia, hypothyroidism, liver disease, epilepsy, Alzheimer’s/dementia, Parkinson’s disease, aneurysm, HIV infection/AIDS, meningitis/encephalitis, tumor e. Low levels of education – Level, grades/GPA, MR/DD/LD, learning disabilities. f. Motivation/Secondary gain (litigation, disability incentives/seeking disability, worker’s compensation, overt or covert incentives for persistent impairments g. Mood, high levels of somatization or emotional distress III. Common Components to Evaluation (5 minutes) A. Record Review and Clinical Interview a. Prior injuries to head b. Education, grades, achievement i. Special education, remedial education c. Medical history i. Acute medical evaluation/EMT/ambulance ER findings, MRI/CT, GCS scores ii. Neurological disease, sleep disorders/OSA iii. Pain issues, substance abuse d. Mood/Cognitive history i. Mood disorders, diagnosis/treatment, ADD/ADHD e. Prior Neuropsych/SLP/cognitive testing results IV. Neuropsychological Testing (8 minutes) A. Administration in Person, Computer, Length a. Fixed vs. Flexible Battery/Hypothesis Testing b. Most Common Areas Assessed c. Multiple tests used in each area – verbal, non-verbal i. Memory (visual, verbal, working, non-verbal) * 1. Immediate, Delayed ii. Concentration/Sustained Attention iii. Processing Speed* iv. Language v. Visuo-Spatial vi. Executive Function* vii. Psychomotor speed B. Performance and Symptom Validity Testing (8 minutes) a. Purpose/Intent b. Frequency of invalid responding c. Standard of Practice – number, number for “invalid” determination d. Interpretation, report writing V. Interpretation of Neuropsychological Testing Results (8 minutes) A. “Normal Range” for Age, Education norms i. High score variability is the NORM not the EXCEPTION ii. Education and variability iii. Pattern recognition (memory/concentration/attention) B. Validity Determination – Opinion versus Valid Opinion C. Factors Shown to Adversely Affect Neuropsychological Test Scores i. Injury to Brain ii. Mood – depression*, anxiety*, PTSD*, bipolar disorder, psychiatric conditions iii. Medications*, medication side effects* – Opioid, sleep, neuroleptic meds iv. Substance use*, abuse, withdrawal – Marijuana*, alcohol*, others v. Orthopedic injuries*, severity*, chronicity, site vi. Neurological conditions, vision*, hearing*, dizziness*,use of dominant hand* vii. Sleep disorders, fatigue*, non-restorative sleep*, Obstructive Sleep Apnea* viii. Motivation*, adherence vs resistance (timed tasks, memory tasks) D. In order to determine injury/TBI as the explanation for impaired results, neuropsychologist must reasonably “rule out” the contribution of each of these factors as a potential contributor VI. Summary (5 minutes) A. Standard questions to Neuropsychology B. Constructing the Test Battery to Answer the Question at Hand C. Validity Determination D. Scoring/Interpretation for Patterns in Comparison to Clinical Complaints E. Determining prognosis for recovery/need for retesting F. Clearly stating what neuropsychological WILL tell us and what it WON’T tell us