Neuropsychological testing

Stage 1 (mild) Able to perform all but the more demanding aspects of work or ADL but widi unequivocal evidence (signs or symptoms diat may include performance on neuropsychological testing) of functional intel lectual or motor impairment. Can walk without assistance 

Stage 2 (moderate) Able to perform basic activities of self-care but can not work or maintain die more demanding aspects of daily life. Ambulatory, but may require a single prop 

Stage 3 (severe) Major intellectual incapacity (cannot follow news or personal events, cannot sustain complex conversa tion, considerable slowing of all ouqiuts) or motor disabihty (cannot walk unassisted, requiring walker or personal support, usually widi slowing and clumsiness of arms as well) 

Stage 4 (end stage) Nearly vegetative. Intellectual and social com prehension and ouq ut are at a rudimentary level. Nearly or absolutely mute. Paraparetic or paraplegic with urinary and fecal incontinence 

000 copies/mL at baseline had 8.5 times higher chance of developing dementia as compared with those with less than 

Health (NIMH) Workgroup WMS-R Visual Span Paced Auditory Serial Addition Test California Veibal Leammg Test Hamilton Depression Scale Speilberger State-Trait Arxiety Scale San Diego HIV Neurobehavioral Research Center (HNRC) Paced Auditory Serial Addition Test 

Multicenter AIDS Cohort Conb oUed Oral Word Association Test 

Study (MACS) Rey Auditory Verbal Learnhig Test Trail Makhig Test Symbol Digit Modahties Test Gr ooved Pegboard Test CES Depression Scale 

More focused neuropsychological batteries have been developed for this purpose, such as those listed in Table 41.2. The HTV Denienda Scale is also a useful tool and only takes five minutes to administer and score (Power et al., 1995). It is important to remember that interpretation of neuropsychological tests also requires attention to patient demographics such as language skills, presence of comorbid conditions, substance abuse, and concomitant use of psychotropic medications. 

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Accurate diagnosis of patients with inhalant use disorders may require a variety of methods, including psychiatric history and mental status examination, physical examination and laboratory testing, neuropsychological testing, and neurophysiological testing. 

Heaton, R.K., and Pendleton, M.G. Use of neuropsychological tests to predict adult patients everyday functioning. J Consult Clin Psvchol 49(6) 807-821, 1981. 

Donovan, D.M. Kivlahan, D.R. and Walker, D.R. Clinical limitations of neuropsychological testing in predicting treatment outcome among alcoholics. Alcoholism Clin Fxp Res 8 470-475, 1984. Fauman, M.A., and Fauman, B.J. Chronic phencyclidine (PCP) abuse A psychiatric perspective. J. Psvchedel ic Drugs 12 307-315,... 

Other diagnostic tests to consider for differential diagnosis erythrocyte sedimentation rate, urinalysis, toxicology, chest x-ray, heavy metal screen, HIV testing, cerebrospinal fluid (CSF) examination, electroencephalography, and neuropsychological tests such as the Folstein Mini Mental Status Exam. 

Review any available diagnostic data from the medical and psychiatric history including interviews from family, neuropsychological testing, and other labs. 

Harvey PG, Hamlin MW, Kumar R, et al. 1988. Relationships between blood lead, behavior, psychometric and neuropsychological test performance in young children. Br J Dev Psychol 6 145-156. 

Hogstedt C, Hane M, Agrell A, et al. 1983. Neuropsychological test results and symptoms among workers with well-defined long-term exposure to lead. Br J Ind Med 40 99-105. 

Lindgren KN, Masten VL, Ford DP, et al. 1996. Relation of cumulative exposure to inorganic lead and neuropsychological test performance. Occup Environ Med 53(7) 472-477. 

For a diagnosis, clinicians rely on histories, on physical, neurological and psychiatric examinations, on neuropsychological tests [1,14], and on laboratory studies [15,16]. 

Increased ventricular size, decreased brain size, and brain asymmetry have been reported. Lower hippocampal volume may correspond to impairment in neuropsychological testing and poorer response to first-generation antipsychotics (PGAs). 

Test (WCST Heaton, Chelune, Talley, Kay, Curtiss, 1993), Category Test and Trail Making Tests (Reitan Wolfson, 1985), Stroop Test (Stroop, 1935), and other tests developed by R. M. Ruff that bear his name. There are many newer ones that may be appropriate to use as well, depending upon the suspected problem you want to assess. Some of these neuropsychological tests can be self-administered, either on a computer or by paper and pencil. However, many of these tests must be administered and results interpreted by a highly trained therapist, usually a clinical psychologist. 

Reitan, R. M., Wolfson, D. (1985). The Halstead-Reitan neuropsychological test battery Theory and clinical interpretation. Tucson, AZ Neuropsychology Press. 

Herbal drugs can have general or specific effects on cognition. To understand the results of neuropsychological testing in drug studies, it will be useful to briefly discuss the breakdown of cognitive functions. 

Spreen 0, Strauss E. (1998). A Compendium of Neuropsychological Tests Administration, Norms, and Commentary. New York Oxford University Press. 

Manly JJ, Jacobs DM, Sano M, Bell K, Merchant CA, Small SA, Stern Y. (1999). Effect of literacy on neuropsychological test performance in nondemented, education-matched elders. J Int Neuropsychol Soc. 5(3) 191-202. 

Pervasive Developmental Disorders. Children with autism or one of the other pervasive developmental disorders can be impulsive and inattentive much like those with ADHD. However, the severe social disability and language problems of children with an autistic disorder usually far exceed that of ADHD. These differences are usually sufficient to clarify the diagnosis. When one is unsure, neuropsychological testing can help clarify matters. 

Subtle, often subclinical, neurological effects have been demonstrated in workers with relatively low blood lead levels, below 40-60 J,g/100ml blood. Performance of lead workers on various neuropsychological tests was mildly reduced, relative to a control group, at mean levels of 49 j,g/100ml blood and, in a prospective follow-up study, at levels between 30 and 45 pg/lOOml blood.In some of these studies, the lead-exposed workers reported significantly more complaints of nonspecific subjective symptoms, such as anxiety, depressed mood, poor concentration, and forgetfulness. However, a recent evaluation of 21 studies found inadequate evidence of decreased neu-robehavioral test performance in adults with cumulative low-level exposure to lead. In con-... 

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