Neuropsychological

Testing

Dr. Subhash Meena

Neuropsychological
Testing and Assessment

A neuropsychological evaluation is a test to measure

how well a person's brain is working. The abilities
tested include reading, language usage, attention,
learning, processing speed, reasoning, remembering,
problem-solving, mood and personality and more.
What mental functions are assessed in a neuropsychological exam?

General intellect.

Reading/reading comprehension.

➔ Language usage and understanding of what others say.

➔ Attention/concentration.

➔ Processing speed.

➔ Learning and memory.

➔ Reasoning.

➔ Executive functions, which are higher-level skills you use to

organize and plan, manage your time, problem solve, multi-task,
make judgments and maintain self-control.
● To help with diagnosis
● To determine cognitive strengths and weaknesses
● To help plan a treatment or other intervention

Why has a
neuropsychological
assessment been
requested?
Brain Imaging: Whole Brain

● Magnetic Resonance Imaging (MRI)

● Functional Magnetic Resonance Imaging (fMRI)
● Computer Assisted Tomography (CAT)
● Positron Emission Tomography (PET)
Magnetic resonance imaging is a medical imaging
technique used in radiology to form pictures of
the anatomy and the physiological processes of
the body. MRI scanners use strong magnetic
fields, magnetic field gradients, and radio waves
to generate images of the organs in the body.
Magnetic resonance imaging, or MRI, is a technology for noninvasively creating
pictures of the soft tissues of the human body.

It is named for its use of a large magnet (M) and a radiofrequency pulse of a certain
resonance (R) to generate a signal from the brain in order to produce an image (I).

It can be used to study both brain anatomy and neural function.

A standard clinical MRI scanner typically has a three-dimensional resolution

Advantages of MRI

-No ionizing radiation exposure

-Better spatial resolution
-Horizontal, Frontal or Sagittal planes

Disadvantages
-Cost
-noisier
 Aging of the brain

20s 80s aging 80s with mild

gracefully Alzheimer’s
http://www.oasis-brains.org
Functional magnetic resonance
imaging or functional MRI
measures brain activity by
detecting changes associated
with blood flow. This technique
relies on the fact that cerebral
blood flow and neuronal
activation are coupled. When an
area of the brain is in use, blood
flow to that region also
increases.
 ➔ fMRI
❖ A discovery by Fox and colleagues revealed that, during increases in
functional activity within the human brain, the increase in oxygen produced
by increased blood flow actually exceeds the tissue’s need for oxygen.

❖ Functional MRI creates a series of images that capture blood oxygen levels in
parts of the brain that are responsible for movement, perception, and
cognition.

❖ fMRI is becoming the diagnostic method of choice for learning how a normal,
diseased or injured brain is working, as well as for assessing the potential risks
of surgery or other invasive treatment of the brain.

❖ An fMRI scan can be used for a variety of purposes, from monitoring

Parkinson’s disease to seeing how a certain medication works in brain.
fMRI depends on functional localization
 ➔ Applications of fMRI
● Discovery of basic brain function

● Discovery of brain dysfunction in disease

● Evaluation of treatment efficacy

Functional MRI (fMRI)
● Images brain hemodynamics
● Blood oxygen level dependent (BOLD)
signal
● Advantages over PET:

○ No injections given

○ Structure and Function

○ Shorter imaging time

○ Better spatial resolution

○ 3-D images

● Check out this website for more info

on fMRI methods:
http://www.fmri.org/fmri.htm
 ➔ DRAWBACKS
❖ fMRI machines are expensive.

❖ fMRI can be difficult for subjects to endure. They must lie motionless in a long,
noisy tube, an experience that can be quite claustrophobic.

❖ The confined space also restricts the types of behavioural experiments that
can be performed.
Brain Regions Impaired by Alcoholism
Non alcoholic Alcoholic
➔ CT or CAT scan
➔ CAT scan is a diagnostic imaging
procedure that uses a combination
of X-rays and computer technology
to produce images of the inside of
the body. It shows detailed images
of any part of the body, including
the bones, muscles, fat, organs and
blood vessels. CAT scans are more
detailed than standard X-rays.
 ➔ CAT (Computer Assisted Tomography)
❖ The modern era of brain imaging began in the early 1970s, when Allan Cormack and
Godfrey Hounsfield independently developed an approach now called x-ray
computerized tomography.

❖ Absorption of X-ray radiation varies with tissue density. High-density (bone) tissue
will absorb a lot of radiation whereas low density material (blood) will absorb little
radiation.

❖ Light colors indicate low-density regions, and dark colors indicate high-density
regions.
 ➔ CAT (Computer Assisted Tomography)
● With computerized tomography, a dye is injected into the blood by a physician.

● The die will help increase contrast so that the image produced by the CAT scan will
be clearer.

● A person’s head is then placed into a CAT scanner and X-rays are passed through the
head.

● These X-rays are detected on the opposite side. While the X-rays are being passed
through the head, the CAT scanner is rotated slowly until measures of the brain have
been taken over 180 degrees. From the measurements that have been taken, a
computer then constructs images of the brain.
 ➔ CAT (Computer Assisted Tomography)
Advantages
❖ Less costly
❖ We can see the structures more clearly as compared to MRI.

Disadvantages
❖ Discrimination between two objects closer than 5mm is not possible.
❖ Difficult to see boundary between grey and white matter as cortex is only 4mm thick.
❖ White and grey matter are similar in density, limiting the technique to distinguish
between them.
❖ Small structures are not clear.
CAT Scan

Picture showing a CAT scanning machine, the location of a brain

tumor, and the way the tumor looks on the image produced by the
CAT scanner.
A positron emission tomography (PET) scan is an
imaging test that can help reveal the metabolic or
biochemical function of your tissues and organs.
The PET scan uses a radioactive drug (tracer) to
show both normal and abnormal metabolic
activity.
➔ PET (Positron-Emission Tomography)
❖ It was the first post-CT development in imaging.

❖ A PET camera is a doughnut-shaped array of radiation detectors positioned to encircle

a subject’s head.

❖ A small amount of water, containing radioactive molecules to label it, is injected into
the bloodstream or a gas containing the radioactive molecule is inhaled.

❖ The radioactive molecules pose little danger to the subject because they are unstable
and break down in just few minutes.

❖ A computer reconstructs variations in the density of the flow of particles from

different locations to produce an image of a section of the brain.
 ➔ PET (Positron-Emission Tomography)
Advantages
❖ Structural correlation with function is possible.
❖ It gives the image of active part of the brain during the task.
Disadvantages
❖ It is expensive.
❖ Experimental conditions cannot be repeated many times as tracer is required to be
injected every time.
❖ PET computer algorithms average the data and superimpose them as a standardized
brain. Thus, anatomical precision becomes difficult because of averaging across
individuals.
❖ Poor temporal resolution.
Thank you