Neuropsychological testing - Oxford Scholarship Jump to ContentJump to Main Navigation
Cognitive NeurologyA clinical textbook$

Stefano Cappa, Jubin Abutalebi, Jean-Francois Demonet, Paul Fletcher, and Peter Garrard

Print publication date: 2008

Print ISBN-13: 9780198569275

Published to Oxford Scholarship Online: March 2012

DOI: 10.1093/acprof:oso/9780198569275.001.0001

Show Summary Details
Page of

PRINTED FROM OXFORD SCHOLARSHIP ONLINE (www.oxfordscholarship.com). (c) Copyright Oxford University Press, 2015. All Rights Reserved. Under the terms of the licence agreement, an individual user may print out a PDF of a single chapter of a monograph in OSO for personal use (for details see http://www.oxfordscholarship.com/page/privacy-policy). Subscriber: null; date: 28 August 2016

Neuropsychological testing

Neuropsychological testing

Chapter:
(p.7) Chapter 2 Neuropsychological testing
Source:
Cognitive Neurology
Author(s):

Jérémie Parienté

Jean-François Démonet

Publisher:
Oxford University Press
DOI:10.1093/acprof:oso/9780198569275.003.0002

Abstract and Keywords

Cognitive assessment requires from the examiner a good theoretical and practical knowledge of the tests used. Because of the broad range of the cognitive functions and the necessity of assessing a subject's performance over several trials for each function, assessing the cognitive status of patients is time-consuming. Therefore, the way in which patients will be assessed has to be guided by strategic decisions involving a trade-off between the minimal list of tests deemed necessary and the risk of patient fatigue over a too prolonged session of testing. This chapter first describes briefly the methodology of the neuropsychological evaluation and how it has to be adapted to situations and questions. It then gives, in table format, a summary of the main neuropsychological and behavioural tests used in clinical and research assessment. This format has been chosen to be readily available to the clinician.

Keywords:   neuropsychological assessment, cognitive assessment, non-test assessment, theoretical neurosciences, real-life behavior, behavioural tests

2.1 Introduction

Single cognitive domain tests, global cognitive ‘batteries’, or non-test assessment, such as questionnaires or inventories for the patient, his/her relatives, or the clinician, can be used in various situations and practices ranging from clinical medicine to theoretical neurosciences, or education and social sciences. As the field of neuropsychological assessment tends to grow, an aim in testing patients should be to reflect real-life behaviour and its disturbances.

Cognitive assessment requires from the examiner a good theoretical and practical knowledge of the tests used. Because of the broad range of the cognitive functions and the necessity of assessing subject's performance over several trials for each function, assessing the cognitive status of patients is time-consuming. Therefore, the way in which patients will be assessed has to be guided by strategic decisions involving a trade-off between the minimal list of tests deemed necessary and the risk of patient fatigue over a too prolonged session of testing (typically the duration of a session should not exceed 90 minutes including short breaks). This strategy for testing depends on the aim of the evaluation: determination of the patient's cognitive status as it contributes to diagnosis; ‘baseline’ evaluation before initiating a treatment; evaluation of an improvement or a deterioration of cognitive functions at follow up; forensic or research purposes.

Among the various purposes of neuropsychological assessment, clinical diagnosis remains the main reason for using cognitive and behavioural tests. This evaluation has to be adapted to its aims and the different tools chosen will vary with clinical circumstances that are as diverse as: late, progressive, or acute recent onset of a cognitive deficit; single cognitive domain impairment or behavioural disturbances; in- or outpatient clinic; etc. Facing these different situations the clinician will have to choose the appropriate tools to answer the question that motivates the neuropsychological examination.

Cognitive tests share different properties: sensibility and specificity to a specific diagnosis; either inter- or intrarater, intersession reproducibility. These data as well as norms (generally stratified for diverse parameters such as age, gender, level of education of control subjects) have to be available in publications after the tests have been validated. Therefore, quantitative scores obtained in a patient are the main outcome of the vast majority of cognitive tests and behavioural scales; these scores have to be compared to the validated norms. However, qualitative aspects of the patient's performance during a test are invaluable sources of information for the clinician. Indeed, in many cases important variations in performance can be observed even in the context of a single test, depending on the nature of the task or the type of stimuli proposed to the patient. From such qualitative observations and the identification of specific error profiles, the notions of association and dissociation between cognitive functions or processes were derived. These concepts have been historically the bases of the development of knowledge in neuropsychology and have proved to be crucial for further advances. The co-occurrences or associations (p.8) of symptoms lead clinicians to identify syndromes that relate to either anatomical or functional brain impairment. For example, the association of agraphia, acalculia, finger anomia, and right/left confusion defines Gerstmann's syndrome, which is anatomically based as it results from lesions of an inferior region of the left parietal lobe, which harbours the cortical territories necessary to these functions. An example of a functional syndrome is the co-occurrence of dysexecutive and memory disorders secondary to Parkinson's disease, which indirectly induces dysfunction of functional pathways involving striato-frontal loops. Dissociations between preserved and impaired cognitive abilities have been used to delineate distinct processes within a given domain (Shallice 1988). For example, dissociations between categories (e.g. animate versus inanimate objects, or verbs versus nouns) can be found in naming performance suggesting that different underlying processes come into play during such a simple task. These observations were used to build up functional models of cognitive abilities, especially in the language domain (Coltheart et al. 1991). Naming can also be used for analysing the type of errors. For example, the preponderance of semantic relative to phonological errors (or vice versa) in post-stroke aphasic patients is an important feature that allows clinicians to determine the level of language disorganization according to cognitive models and possibly the site of the lesion.

In this chapter we will first describe briefly the methodology of the neuropsychological evaluation and how it has to be adapted to situations and questions. We will then give, in table format, a summary of the main neuropsychological and behavioural tests used in clinical and research assessment. This format has been chosen to be readily available to the clinician. For further details about tests listed (or not) in this chapter, the reader should refer to dedicated books (Boller and Grafman 2000; Lezak et al. 2004).

2.2 Methodology

As mentioned above the choice of the tests will depend on the situation in which the patient will be evaluated. Time given, expertise of the examiner regarding neuropsychology in general and the tests in particular, but also the type and severity of the cognitive deficit, behavioural problems, and, of course, the aim of the assessment will guide the examiner to select the appropriate tests to customize the evaluation to the patient's needs—either a ready-to-use battery of tests yielding a global cognitive assessment or different single cognitive domain tests to focus on the cognitive profile specific to the patient. The latter approach will enable the examiner to reveal syndrome or dissociations between altered and preserved processes, categories, or domains.

Of the vast array of neuropsychological tests, no single one could fulfil the requirements of every possible clinical situation and purpose. In practical terms, the clinician should be acquainted with a selection of validated global batteries and domain-specific tests that would bring out a first clinical appreciation. It will then be necessary to resort to more specific cognitive tests depending on the impairments found initially.

2.2.1 Methodology varies with the objectives

2.2.1.1 Clinical evaluation

During this type of assessment with a clinical purpose, the examiner will have to remain flexible and adapt to the ongoing collection of observations. While a battery of tests may be helpful in the first step of the evaluation, it is often necessary to interpret ‘on-line’ the results of the subtests to adapt the testing strategy and focus on the identified deficits.

  • (p.9) Screening. Brief and accurate tests are required. They need to be sensitive but less specific in order to be able to diagnose all the potential patients. Patients with scores below the cut-off at this first evaluation will then be assessed by more specific tests. For example, a Mini Mental State Examination (Folstein et al. 1975) could be a first step in the evaluation of a patient with a memory complaint. If it is found that none of the three words has been recalled, a Grober and Buschke test (Grober et al. 1988) will help the clinician to better understand the memory disturbance and its sensitivity to semantic cuing.

  • Follow-up. In this type of assessment it is necessary to repeat the same tests over a certain period of time. In this situation there is less utility in using highly validated tests, each patient being his/her own control. It is nevertheless important to be aware of the test-retest effects that could be avoided by using parallel versions.

  • Forensic evaluation. The aim of this evaluation is to infer the effective disturbances in real life situations (personal and professional) resulting from neuropsychological disorders. Therefore a trend to assess the patient with more ‘ecological tests’ has emerged (Alderman et al. 2003). However this approach remains complementary to more classical and well-established tests.

2.2.1.2 Evaluation of a rehabilitation procedure

This sort of evaluation has two aims. First, as during clinical evaluation, an appreciation of the patient's cognitive status across time is needed (improvement or deterioration). Second, the specifics of the effects of rehabilitation should be evaluated. Furthermore, it is important to establish whether rehabilitation effects have generalized to non-trained items within the rehabilitated domain or to non-rehabilitated cognitive domains. The results of this evaluation may ultimately lead to modifications of the rehabilitation programme. During this type of assessment the examiner will face three pitfalls.

  • Test-retest effect. This may lead to a false-positive result for the rehabilitation programme. However, some tests are sophisticated enough to avoid this effect, e.g. by using parallel lists of items tested.

  • Spontaneous variability and the natural history of the cognitive performance. For example, it will sometimes be difficult to evaluate the beneficial effect of speech therapy administered to an aphasic patient after a stroke as recovery is part of the natural history. To avoid this confounding factor in the rehabilitation programme assessment it is therefore necessary to evaluate the patient several times at baseline before any treatment. These baseline evaluations will then be averaged and compared to the subsequent evaluations.

  • Test specificity to the rehabilitated cognitive processes programme. Here it is important to choose, on the one hand, tests specific to the cognitive functions that are at stake in the rehabilitation programme and, on the other hand, tests independent of the former (e.g. constructive apraxia tests in an aphasic patient being rehabilitated with a phonological paradigm).

2.2.1.3 In research

In this case, tests will be chosen or even elaborated in order to match the aim of the study, i.e. describing a cognitive process, evaluating the natural history of the cognitive deficit, establishing a specific rehabilitation procedure, or assessing the influence of a specific pharmacological compound. Neuropsychological but also behavioural or quality of life tests will be chosen or elaborated to investigate specific dissociations within or between processes. A qualitative approach to the results obtained will be of particular importance, and focusing on the type of errors will (p.10) enable the researcher to decipher the cognitive disturbance underlying the performance deficit. These research approaches will sometimes require the formation of groups of patients rigorously selected on specific inclusion criteria. Patients fulfilling the criteria will subsequently be systematically assessed with a set of tests predefined on the basis of the study hypothesis.

2.3 Test classification

Since clinicians need to measure the cognitive performance of patients, a very large body of tests has accumulated over the past century ranging from tests administered by the examiner to the patient (California Verbal Learning Test; Delis et al. 1983, 1987, 2000) to self-questionnaires for the carer (Neuropsychiatric Inventory; Cummings et al. 1994).

The ideal test would be reproducible, valid in practice, and readily comprehensible and the ‘best battery’ would encompass a set of modules of tests assessing specifically different cognitive domains that one can use or combine to meet the patient/research protocol's specific needs.

Tests can be classified in different ways as the following example shows.

  • Cognitive (Stroop test; Stroop 1935), behavioural (Lebert et al. 1998), and quality of life (Naglie et al. 2006) tests and questionnaires.

  • Global (Mini Mental State Examination; Folstein et al. 1975), multidomain tests sensitive to different cognitive processes (categorical fluency involving both executive functions, working memory, and semantic memory) or domain-specific tests (Grober and Buschke memory test; Grober et al. 1988).

  • A psychometric approach in which the performance of a subject is compared to a validated norm (IQ measurement with WAIS; Wechsler 1997a) versus concept-driven cognitive evaluation (dissociated performance for producing proper names compared to common names).

In the following tables we provide the reader with some example with batteries, tests, and questionnaires frequently used in the neuropsychological assessment. Tables 2.1 and 2.2 list some ability and neuropsychological assessment batteries, respectively. Table 2.3 and 2.4 list some dementia batteries. Tables 2.52.11 give examples of frequently used single-domain tests (memory, attention, perception, language, construction, reasoning, executive function).

Table 2.1 Batteries testing ability

Battery (reference)

Description

Comments

WAIS-R, Wechsler Adult Intelligence Scale—Revised (Wechsler 1981)

Global cognitive functioning: verbal tests (information, comprehension, arithmetic, similarities, digit span, vocabulary) & non-verbal tests of performance (digit symbol, picture completion, block design, picture arrangement, object assembly)

Complete and representative standardization; verbal intelligence and performance intelligence scores

WAIS-III, Wechsler Adult Intelligence Scale III (Wechsler 1997a)

Global cognitive functioning: same as WAIS-R, plus letter/number sequencing, symbol search, matrix reasoning

Same as for WAIS-R

(p.11)

Table 2.2 Neuropsychological assessment batteris

Battery (reference)

Description

Comments

NAB, Neuropsychological Assessment Batteries (Stern and White 2003)

Attention, spatial, language, memory, executive ‘modules’ in 36 tests

Norms for ages from 18 to 97 (tested on 1400 subjects); norms given for each of the 36 tests; evaluation time up to 4 hours

Table 2.3 Dementia assessment batteries: general

Battery (reference)

Description

Comments

MMSE, Mini Mental State Examination (Folstein et al. 1975)

Brief screening instrument for dementia evaluating 5 domains: concentration or working memory; language; praxis; orientation memory; attention span

Strongly influenced by age & education; rapid to administer (10 minutes); total score, 30

ACE, Addenbrooke's Cognitive Examination (Mathuranath et al. 2000)

Global cognitive functioning: orientation; attention/mental tacking, episodic & semantic memory; verbal fluency; visuospatial ability

15–20 minutes, score from 0 to 100; MMSE score can be calculated from the global score. Cut-off score, 88/100

DRS or MDRS, Dementia Rating Scale or Mattis Dementia Rating Scale (Mattis 1988)

Designed for Alzheimer patients: attention; initiation and perseveration; construction; conceptual, memory

Healthy volunteers, 20 minutes, Alzheimer patient, up to 45 minutes. Maximum score, 144; cut-off, 125 for Alzheimer's disease

CERAD, Consortium to Establish a Registery for Alzheimer Disease (Morris et al. 1989)

Designed for Alzheimer patients: verbal fluency: animals; 15 pictures of the Boston Naming Tests; Mini Mental State; word list memory test; constructional praxis; word list recall; word list recognition

Rigorous standardization procedure; brief evaluation. Used as a diagnosis and to follow patient's course

SIB, Severe Impairment Battery (Saxton and Swihart 1989)

Designed to provide documentation of residual cognitive function at the lowest levels (one step question, use of gestural cues): social interaction; orientation; visuospatial ability; constructional ability; language; memory; attention; orienting to name; praxis

20 minute evaluation; standardization on Alzheimer patients with MMSE lower than 14. Sensitive to disease progression

ADAS-Cog, Alzheimer Disease Assessment Scale, Cognitive subscale (Rosen et al. 1984)

Scale used in research for Alzheimer disease drug approval. Language abilities, memory, praxis, orientation

30–35 minutes to administer. Maximum-minimum scores, 0–70 (higher scores indicating higher impairment)

(p.12)

Table 2.4 Dementia assessment batteries: neuropsychiatric and behavioural assessments

Battery (reference)

Description

Comments

NPI, Neuropsychiatric Inventory (Cummings et al. 1994)

Designed to assess behavioural disturbance in dementia patients by asking the caregiver about: delusion; hallucination; dysphoria; agitation/aggression; apathy; irritability/lability; disinhibition; aberrant motor behaviour

Frequency and severity are assessed on 4- and 3-point scales, respectively

Clinical Dementia Rating (http//www.adrc.wustl.edu/cdrScale.html)

Rates dementia on a 5-point scale where 0 = no dementia. This rating is based on memory, orientation, judgement, & problem solving; community and home activities; and hobbies and determined via a semi-structured questionnaire of the patient & his/her carer separately

CDR 0.5 is qualified ‘questionable impairment’, CDR1 ‘mild impairment’, CDR2 ‘impairment dementia’, & CDR3 ‘severe impairment’

Table 2.5 Tests of attention

Test (reference)

Description

Comments

Reaction time

A set of various tests ranging from simple reaction time (target detection) to more complex tasks (including complex visual target detection)

Test processing speed; speed is recorded

Digit span

The subject is asked to repeat a list of digits forward and backward

Tests short-term memory storage . capacity Individual scores (number of digits repeated in each task) give more information than the combined one as done in the WAIS-R

Sentence repetition

Repeating from easy and short to complicated and long sentences

Ecological test more related than the previous one to everyday functioning

Alpha span (Craik 1990)

Repeating a list of words in alphabetical order

Performance in this test is correlated with digit forward, backward and category fluency

N-back task

This task asks the subject to report when a stimulus item presented serially is the same as an item ‘n’ steps back from the items at hand

Mainly used in research

Stroop test (Jensen and Rohwer 1966)

3 phases: (1) read words of colours printed in black; (2) name the colour of coloured patches; (3) name the colour of the ink of words designating colours (where the meaning of the words & colour of ink are different)

Based upon the fact that it takes longer to find the name of the colour of an ink than to read the word written with this ink. Errors made and time to read/name the list of words/colours are recorded

Trail making test A and B

The subject is asked in part A to connect consecutively circled numbers. In part B, the subject has to perform the same task but alternating numbers and letters in an increasing and alphabetical order

Tests visuomotor tracking, divided attention, & mental flexibility. Subject is required to perform the task as fast as he/she can as time is recorded as well as errors

(p.13)

Table 2.6 Tests of visual inattention

Test (reference)

Description

Comments

Line bisection test (Schenkenberg et al. 1980)

The subject is shown a set of 20 horizontal lines of different size on an A4 format page & is asked to ‘cut each line in half by placing a pencil mark through each line as close to its centre as possible’. Test is performed alternately with both hands & with the page at 0° & at 180°

Test for unilateral inattention. A percent deviation score is then calculated & is positive for marks placed right & negative for marks placed left of the centre

Cancellation tasks (Gauthier et al. 1989)

The patient is asked to cross out all the designated targets (bells, letters, balloons, etc.)

Test for visual inattention. Performance (omissions & errors) & speed are recorded

Drawing and copying test for inattention (Strub and Black 2000)

Patient is asked to draw (e.g. a clock, a daisy in a pot, a house in perspective) & to copy (e.g. a diamond, a cross, a cube, a pipe, a triangle within a triangle)

Test for visual unilateral inattention

Table 2.7 Tests of visual perception

Test (reference)

Description

Comments

Counting dots

The subject is asked to count dots widely scattered over a piece of paper

Visual scanning

Farnswoth's dichotomous test for colour blindness (D15)

Coloured caps of different brightness but slight differences of hue have to be rearranged in a consistent colour continuum starting with a cap fixed on a horizontal tray

Color perception. This test does not require colour naming & helps to distinguish colour agnosia from colour anomia

Judgement of line orientation (Benton et al. 1994)

Patient is asked to match a line segment shown to one of 11 radii forming a semi-circle. The task is repeated 30 times

Visual recognition. Estimates angular relationship of line segments to models

Test of facial recognition (Benton et al. 1994)

Patient is shown a face and asked to match it to the same face, either with identical or different light conditions or rotation

Face recognition. Ability to recognize faces with no memory involvement

Visual form discrimination (Benton et al. 1994)

Patient is asked in this multiple choice test to recognize a target among stimuli with very little variation from the target

Visual form recognition. Because of its multiple choice format, this test can be converted to a memory test

Gestalt completion tests (McCarty & Warrington 1990)

Incomplete pictures are presented & patient has to recognize and name the picture

Perceptual closure capacity. Test can be done on faces or object with varying difficulties

Visual object and space (Warrington & James 1991)

Shape detection screening, incomplete letters, silhouettes, object decision, progressive silhouettes, dot counting, number location, cube analysis

9-test battery exploring object & space perception; each test can be administered on its own. Normative data & cutting scores are provided for each subtest's perception battery

Overlapping figures tests (Gainotti et al. 1989)

Overlapping figures are presented to the patient & he/she is asked to name as many as possible

(p.14)

Table 2.8 Test of memory

Test (reference)

Description

Comments

Auditory verbal learning test (Rey 1964; Schmidt 1996)

The examiner reads list A (15 words) & patient is asked to recall them. Same procedure is done 5 times. Then 15 words of a second (interference) list (B) are read & the patient is asked to recall them. Finally, the patient is asked to recall as many words as possible from previously learned list A. A recognition trial of list A words can also be given

Tests verbal memory and does not control for encoding; The score for each trial is the number of words correctly recalled; it is also of interest to note words repeated during the recall, words from the other list, or errors (intrusions)

California verbal learning test & California verbal learning test—2nd edition (Delis et al. 1983, 1987; 2000)

Lists of 16 words (list A) belonging to 4 different categories (spices, vegetables, etc.) are read in a random order as in the auditory verbal learning test. Then list B is read after 5 trials. Patient after a ‘short delay’ has to recall as many words as possible and is then semantically cued (‘free’ and ‘cued’ recalls). The same procedure is done after a ‘long delay’ (20 minutes). Then a recognition task is administered mixing words from lists A & B and words not presented

Designed to assess the use of spontaneous semantic association as strategy for learning words. This is not a specific memory test but evaluates the interaction between memory & conceptual ability

Grober et Buschke test (Grober et al. 1988)

Patient is shown 4x4 written words belonging to 16 different semantic categories. He/she is asked to read aloud the word related to the category given by the examiner and immediately recall the words. 3 free recalls each followed by a semantically cued recall

This test is designed to assess the influence of semantic cuing in word retrieval. It is more specific to memory than the previous test & does not require patient to organize semantically the items to be remembered

Story recall (Wechsler 1997b)

A story is read aloud to the patient. After a delay, the patient is asked to recall as many details from the story as possible

Resembles everyday demand on memory

Complex figure test (Rey 1941; Corwin & Bylsma 1993)

A complex figure (Rey-Osterrieth) is copied by patient. After a delay, patient is asked to recall the complex figure

Test is designed to assess visual memory

Benton visual retention test (Sivan 1992)

3 figures are presented to the patient & he/she has to draw them, once hidden

This test is sensitive to unilateral spatial neglect & reflects of span of recall

(p.15)

Table 2.9 Tests of language

Test (reference)

Description

Comments

Western aphasia battery (Kertesz 1988) Kaplan

4 oral subtests: spontaneous speech; auditory comprehension; repetition; naming

Battery adapted from the Boston diagnostic aphasia examination (Goodglass & 1983, 2000)

Token test (Boller and Vignolo 1966)

Shapes (circle and squares) of different sizes (big or little) & colours (5 different) are placed in front of patient. He/she is asked to perform 62 different tasks from simple (‘touch the green circle’) to complex (‘when I touch the green circle, you take the white square’)

Test simple to administer and score that is sensitive to aphasia. Good performance relies mainly on auditory comprehension. It has been adapted in a short version (De Renzi & Faglioni 1978)

Boston naming test (Goodglass & Kaplan 2001)

Patient is shown 60 black & white ink pictures from common to less common & is asked to name them. When patient not able to name drawing, examiner gives him/her semantic then phonetic cues

Naming test simple to administer both in aphasic patients with left brain damage & in patients with a neurodegenerative disorder such as Alzheimer's disease

Control oral word association test (Benton & Hamsher 1994)

Patient is asked to give in 1 minute as many words as possible starting with a designated letter (e.g. F, then A and S) excluding proper nouns, numbers, & same words with different suffix

For each of the letters norms are provided except for the letters X and Z. Scores at this test are usually compared to the scores obtained in a similar test in which a patient is asked to give words belonging to a designated category

(p.16)

Table 2.10 Tests of construction

Test (reference)

Description

Comments

Complex figure test (Rey 1941; Corwin & Bylsma 1993)

A complex figure (Rey-Osterrieth) is copied by patient. After a delay, patient is asked to recall the complex figure

Test is designed to assess perceptual organization & visual memory. Each time a portion of the drawing is completed, the examiner gives patient a different-coloured pen in order to keep a record of the sequence used

Clock drawing (Battersby et al. 1956)

Examiner asks patient to draw a clock showing the number and 2 hands, set to 11:10

This test is very sensitive but not specific as it requires from the patient visuospatial abilities, numerical knowledge, working memory, executive function

Block design (Wechsler 1955, 1981, 1997a)

Subject is given red & white blocks & is asked to use them to replicate printed designs

This test is included in WAIS-III

Table 2.11 Tests of reasoning and executive functions

Similarities (Wechsler 1955, 1981, 1997a)

The subject is asked to explain what a pair of words have in common

This test has 2 levels of difficulty

Proverbs

Patient is asked to translate meaning of proverbs into concrete statements

Material used in this test must be familiar to patient

Raven's progressive matrices (Raven 1996)

Patient is asked to match visual patterns & analogy problems pictured in non-representational designs

This test does not require language & has been adapted to both young subjects & older patients (Raven's Coloured Progressive Matrices; Raven 1995)

Wisconsin card sorting test (Berg 1948; Milner 1964)

Subject is given cards on which are printed 1–4 identical symbols (triangle, circle, star, or cross) of different colours (red, blue, green, yellow). One color and type of symbol is printed on each given card. The task is to place the card according to a principle that the patient must deduce from the examiner's response. The rule changes during the test; therefore, patient must change the way he/she places the cards (the rule can be ‘colour’, ‘number’, ‘form’)

For example, patient has card with 4 blue circles. He/she can choose 3 different strategies to classify the card: circle; blue; or number (4.) According to the examiner's answer (‘right’ or ‘wrong’), patient will have to keep the good strategy or continue to deduce the appropriate one

Tower of London (Shallice 1982)

The patient must look ahead to determine the order of moves necessary to arrange 3 coloured rings from their initial position on 2 of 3 sticks to a new set of predetermined positions on 1 or more of the sticks

Frontal assessment battery (Dubois et al. 2000)

Conceptualization (similarities), letter fluency, Luria motor sequence (fist-edge, palm), sensitivity to interference, inhibitory control, & environmental autonomy

Test takes no more than 10 minutesto administer

(p.17) References

Bibliography references:

Alderman, N., Burgess, P.W., et al. (2003). Ecological validity of a simplified version of the multiple errands shopping test. J. Int. Neuropsychol. Soc. 9 (1), 31–44.

Battersby, W.S., Bender, M.B., et al. (1956). Unilateral spatial agnosia (inattention) in patients with cerebral lesions. Brain 79 (1), 68–93.

Benton, A.L. and Hamsher, K. (1994). Multilingual aphasia examination. AJA, Iowa City.

Benton, A.L., Sivan, A.B., et al. (1994). Contribution to neuropsychological assessment. A clinical manual. Oxford University Press, New York.

Berg, E.A. (1948). A simple objective technique for measuring flexibility in thinking. J. Gen. Psychol. 39, 15–22.

Boller, F. and Vignolo, L.A. (1966). Latent sensory aphasia in hemisphere-damaged patients: an experimental study with the token test. Brain 89 (4), 815–30.

Boller, F. and Grafman, J. (2000). Handbook of neuropsychology. Elsevier, Amsterdam.

Coltheart, V., Avons, S.E., et al. (1991). The role of assembled phonology in reading comprehension. Mem. Cognit. 19 (4), 387–400.

Corwin, J. and Bylsma, F.W. (1993). Translations of the excerpts from André Rey's ‘Psychological examination of traumatic encephalopathy’ and PA. Osterrieth's ‘The complex figure copy test’. Clin. Neuropsychologist 7, 3–15.

Craik, F.I. (1990). Changes in memory with normal aging: a functional view. Adv. Neurol. 51, 201–5.

Cummings, J.L., Mega, M., et al. (1994). The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia. Neurology 44 (12), 2308–14.

De Renzi, E. and Faglioni, P. (1978). Normative data and screening power of a shortened version of the token test. Cortex 14 (1), 41–9.

Delis, D.C., Kramer, J.H., et al. (1983, 1987). California verbal learning test (CVLT). Adult version. Psychological Corporation, San Antonio, Texas.

Delis, D. C., Kramer, J.H., et al. (2000). California verbal learning test, 2nd edn (CVLT-II). Psychological Corporation, San Antonio, Texas.

Dubois, B., Slachevsky, M.D., Litvan, I., and Pillon, B. (2000). The FAB: a frontal assessment battery at bedside. Neurology 55, 1621–6.

Folstein, M.F., Folstein, S.E., et al. (1975).‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician. J. Psychiatr. Res. 12 (3), 189–98.

Gainotti, G., D'Erme, P., et al. (1989). Composant of visual attention disrupted in unilateral neglect. In Neuropsychology of visual perception (ed. J.W. Brown). IRBN Press, New York.

Gauthier, L., Dehaut, F., et al. (1989). The bells test: a quantitative and qualitative test for visual neglect. Int. J. Clin. Neuropsychol. 11, 49–54.

Goodglass, H. and Kaplan, E. (1983). Boston diagnostic aphasia examination (BDAE). Lea and Febiger, Philadelphia.

Goodglass, H. and Kaplan, E. (2000). Boston diagnostic aphasia examination (BDAE-3). Lea and Febiger, Philadelphia.

(p.18) Goodglass, H. and Kaplan, E. (2001). Boston naming test. Lea and Febiger, Philadelphia.

Grober, E., Buschke, H., et al. (1988). Screening for dementia by memory testing. Neurology 38 (6), 900–3.

Jensen, A.R. and Rohwer, W.D., Jr (1966). The Stroop color–word test: a review. Acta Psychol. (Amst.) 25 (1), 36–93.

Kertesz, A. (1988). Western aphasia battery. Psychological Corporation, San Antonio, Texas.

Lebert, F., Pasquier, F., et al. (1998). Frontotemporal behavioral scale. Alzheimer Dis. Assoc. Disord. 12 (4), 335–9.

Lezak, M.D., Howieson, D.B., et al. (2004). Neuropsychological assessment. Oxford University Press, Oxford.

Mathuranath, PS., Nestor, P.J., et al. (2000). A brief cognitive test battery to differentiate Alzheimer's disease and frontotemporal dementia. Neurology 55 (11), 1613–20.

Mattis, S. (1988). Dementia rating scale.Psychological Assessment Resources, Odessa, Florida.

McCarty, S.M. and Warrington, E.K. (1990). Cognitive neuropsychology: a clinical introduction. Academic Press, San Diego.

Morris, J.C., Heyman, A., et al. (1989). The Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimer's disease. Neurology 39 (9), 1159–65.

Naglie, G., Tomlinson, G., et al. (2006). Utility-based quality of life measures in Alzheimer's disease. Qual. Life Res. 15 (4), 631–43.

Rey, A. (1941). L'examen psychologique dans les cas d'encephalopathie traumatique. Arch. Psychol. (Paris) 28, 286–340.

Rey, A. (1964). L'examen clinique en neuropsychologie . Presses Universitaires de France, Paris.

Rosen, W.G., Mohs, R.C., et al. (1984). A new rating scale for Alzheimer's disease. Am. J. Psychiatry 141 (11), 1356–64.

Saxton, J. and Swihart, A.A. (1989). Neuropsychological assessment of the severely impaired elderly patients. In Clinics in geriatric medicine (ed. F.J. Pirozzolo). Saunders, Philadelphia.

Schenkenberg, T, Bradford, D.C., et al. (1980). Line bisection and unilateral visual neglect in patients with neurologic impairment. Neurology 30 (5), 509–17.

Schmidt, M. (1996). Rey auditory and verbal learning test. A handbook. Western Psychological Services, Los Angeles.

Shallice, T (1982). Specific impairments of planning. Phil. Trans. R. Soc. (Lond.) B 298, 199–209.

Shallice, T (1988). From neuropsychology to mental structure. Cambridge University Press, Cambridge.

Sivan, A.B. (1992). Benton visual retention test. The Psychological Corporation, San Antonio, Texas.

Stern, R.A. and White, T (2003). Neuropsychological assessment battery. Psychological Assessment Resources, Lutz, Florida.

Stroop, J.R. (1935). Studies of interference in serial verbal reaction. J. Exp. Psychol. 18, 643–62.

Strub, R.L. and Black, F.W (2000). The mental status examinationin neurology. Davis, Philadelphia.

Warrington, E.K. and James, M. (1991). A new test of object decision: 2D silhouettes featuring a minimal view. Cortex 27 (3), 370–83.

Wechsler, D. (1955). Manual for the Wechsler adult intelligence scale. The Psychological Corporation, New York.

Wechsler, D. (1981). WAIS-R manual. The Psychological Corporation, New York.

Wechsler, D. (1997a). Wechsler adult intelligence scale-III. The Psychological Corporation, San Antonio, Texas.

Wechsler, D. (1997b). Wechsler memory scale. Third edition manual. The Psychological Corporation, San Antonio, Texas.