NORTHWEST AIDS EDUCATION AND TRAINING CENTER

What Is Neuropsychological (Neurocognitive) Testing? Eric Strachan, Ph.D. Psychologist, Madison Clinic Assistant Professor, UW Psychiatry

Last Updated: 9/29

The Plan

•  Appreciate the complexities of cognition

•  Understand the domains of typical neuropsychological testing

•  Apply the domains to HIV-associated Neurocognitive Disorders

A Classic…

•  Aoccdrnig to a rsecreearch at Cmabrigde Uinervtisy, it deosn't mttaer in waht oredr the ltteers in a wrod are, the olny iprmoetnt tihng is taht the frist and lsat ltteer be at the rghit pclae. The rset can be a total mses and you can sitll raed it wouthit a porbelm. Tihs is bcuseae the huamn mnid deos not raed ervey lteter by istlef, but the wrod as a wlohe.

•  Tihs is an uarbn mtyh, by the way, although the premise is true.

My Point

•  Thinking (“cognition”) is a complex, multifaceted phenomenon

•  Perception •  Transformation •  Decoding •  Integration •  Experience

The Domains of Cognition

•  Visual spatial ability

•  Language

•  Executive Functioning

•  Motor Functioning

•  Emotional Behavior

•  Processing speed

•  Attention/Working memory

•  Learning

•  Memory

Processing Speed

Attention/Working Memory

Imagining Impairment in Processing Speed and Working Memory

•  Remember this 10-digit string…

3 0 3 4 2 0 2 6 4 0

Imagining Impairment in Processing Speed and Working Memory

•  Got it?

Imagining Impairment in Processing Speed and Working Memory

•  Now, remember these instructions… –  Go out of the building and take a left. –  Go 3 blocks until you see the sign for N. Ogren. –  Turn left. –  The address is 416 N. Ogren.

Imagining Impairment in Processing Speed and Working Memory

•  Who can tell me the number AND the instructions?

Imagining Impairment in Processing Speed and Working Memory

3 0 3 4 2 0 2 6 4 0

- Go out of the building and take a left. - Go 3 blocks until you see the sign for N. Ogren. - Turn left. - The address is 416 N. Ogren.

Memory

•  I’m going to read you a list of words…

•  I’m going to read you a short story…

•  Immediate recall and delayed recall - Correlated but not perfectly -  The information can “get in there” even if initial recall is difficult

Language

•  F A S

•  Tell me the names of all the kinds of…

•  Picture naming

Executive Function

•  Control and management of other cognitive functions •  Necessary for

-  Planning/Decision making -  Error control/Troubleshooting - Novel situations (not part of routine) - Dangerous or difficult situations - Response override (“I want that cake, but…”)

Executive Function

Red Blue Green Yellow

Blue Red Orange Green

Green Orange Yellow Blue

Yellow Red Blue Orange

Executive Function

HAND Definition

•  Impairment in at least 2 cognitive domains -  1 or 2 standard deviations depending

•  Interference with day-to-day functioning

•  At least 1 month

•  No competing explanations

General Overview of Interventions

Limited treatment trials in HIV-associated cognitive impairments but several general approaches should work given the deficits

•  Verbal, Written, Visual (the 4 V’s?)

•  Check for understanding

•  Simplify, if possible