Himanshi Sumrani

A0403421073
MACLP-3

ASSIGNMENT 2

NIMHANS BATTERY
Background:

Neuropsychological assessment plays a crucial role in the assessment of cognitive

decline in older age. In India, there is a dearth of culturally appropriate
standardized measure to assess cognitive functions in early dementia. The aim of
the study was to examine clinical validity of NIMHANS Neuropsychological
Battery for Elderly (NNB-E) in identifying early dementia.

Objectives: To examine validity (discriminant and concurrent) of NIMHANS

Neuropsychological Battery for Elderly (NNB-E).

Results: Participants with AD showed significantly poorer performance on every

test including memory and non-memory domains. However, tests of episodic and
semantic memory were particularly sensitive in discriminating between normal and
AD groups. Further scores on various subtests in the NNB-E were positively
associated with scores on HMSE and negatively associated with Clinical Dementia
Rating and Everyday Abilities Scale for India (EASI) scores.

Conclusions:

NNB-E was able to differentiate normal controls from AD patients, and it can
therefore be an ecologically valid tool for Indian older adults.
Keywords: Cognitive assessment, dementia of Alzheimer's type,
neuropsychological test, validity
AIIMS BATTERY
This test battery has been constructed using Luria’s neurological approach for
understanding brain-behavior relationship. This can be administered on adults as
well as on children. The adult battery can identify brain dysfunction in neurologic
patients with success rates of more than 80%. Whenever the patient is diagnosed as
having a brain dysfunction, the battery can identify a right/left/diffuse brain
dysfunction with over 90% success rate.
Scales in AIIMS Battery
1. Motor Scale
2. Tactile Scale
3. Visual Scale
4. Receptive Speech Scale
5. Expressive Speech Scale
6. Reading Scale
7. Writing Scale
8. Arithmetic Scale
9. Memory Scale
10. Intellectual Process Scale
Contains 160 items spread over 10 basic scales 5 point scale for each item A score
of 0 is given for passing the item and score of 4 is given for complete failure
Credits of 1, 2 and 3 are given to intermediate performances
Motor Functions Scale - This scale comprises 35 items (Nos. 1 through 35). There
are 6 items (Nos. 1, 2, 7, 8, 9, and 10) which elicit simple motor movements of
both hands and fingers with spatial organisation. - Two items (Nos. 3, 4) aim at
asking the subject to learn a 3-step sequence (hand position sequence) and to repeat
it. - Another two items (Nos. 5 and 6) are devoted to past-pointing test using both
hands. - The scale includes two items (Nos. 11 and 12) for finding out finger
dexterity of both hands using glass marbles. - Two items (Nos. 13 and 14) are
devoted to finger oscillation test using manual tapper. - Two items (Nos. 15 and
16) are meant for assessing motor movements of both feet. - There are two items
(Nos. 17 and 18) which measure motor impersistence by fixation of gaze in lateral
visual fields. - Four items (Nos. 19, 20, 21, and 22) require complex motor
movement of various kinds of both right/left hands. - Five items (Nos. 23, 24, 25,
26, and 27) are devoted to the assessment of oral movement of various kinds. -
Last eight items (Nos. 28 through 35) are paper-pencil tests which measure
construction dyspraxia.
Tactile Function Scale - The tactile scale consists of nineteen items (Nos. 36
through 54). - The first item (No. 36) is meant for ascertaining tactile perception on
both the palms. - Two items (Nos. 37 and 38) are devoted to find out muscle and
joint sensation of both hands. - Eight items (Nos. 39, 40, 43, 44, 45, 46, 47, and 48)
facilitate sensory perceptual examination on hand, fingers palm and wrist of either
side of the body. - There are two items (Nos. 41 and 42) in which the patient is
expected to identify how hard he is touched on hands. - Two items (Nos. 49 and
50) involve the use of an aesthesiometer to find out acuity of one/two point
sensation on both the hands. - Last 4 items (Nos. 51, 52, 53, and 54) in the scale
evaluate stereognosis perception on both hands using coins, and wooden geometric
shapes.
Visual Function Scale - There are eight items (Nos. 55 through 62) in this scale. -
First four items (Nos. 55 through 58) require identification/counting of objects or
birds on the stimulus card presented. - There is one item (No. 59) which requires
the patient to recognize the direction of shade. - Two items (Nos. 60 and 61) are
devoted to find out visual spatial functions. The last item (No. 62) of scale requires
the subject to do three dimensional analysis of a picture.
Receptive Speech Scale - There are nineteen items (Nos. 63 through 81) in this
scale. - First five items (Nos. 63 through 67) require pointing to and identification
of objects, letters, words, and numbers. - Items Nos. 68, 69, 70, 71 and 72 are
devoted to identification of geometrical figures, primary colours and action in
pictures. - There are two items (Nos. 73 and 74) which require identification of
phonemes. One item (No. 75) requires identification of nonsense words. - Item
Nos. 76, 77, 78, and 79 are included which require understanding simple and
complex commands by exhibiting motor rather than speech responses. - The last
two items (Nos. 80 and 81) are intended to assess the ability to understand the
content of a sentence and of a paragraph. An effort has been made to see that none
of the items in this scale requires reading skills in the patient.
Expressive Speech Scale - This scale consists of 17 items (Nos. 82 through 98). -
The first item (No. 82) expects the patient to name objects by viewing and the
second item (No. 83) to name objects on a card. - The third item (No. 84) requires
the patient to name the body parts shown on a card while the fourth item (No. 85)
requires him to produce narrative description (of a picture). - Four items (Nos. 86
through 89) require articulation of simple speech sounds, familiar and unfamiliar
words of varying length and complexity. - Next two items (No. 90 and 91) are
devoted to find out complex systems of grammatical expression by filling words
which are missing in a sentence/paragraph. - There are two items (Nos. 92 and 93)
which requires automatic reproduction of previously learned material. - Five items
(Nos. 94 through 98) expect the patient to repeat verbally presented words and
sentences.

Reading Scale - This scale consists of ten items (Nos. 99 through 108). - The first
two items (Nos. 99 and 100) expect the patient to identify letters and words. -
There are two items (Nos. 101 and 102) which require identification of words from
out of the matrix of words. - Last six items (Nos. 103 through 108 expect the
patient to read (from card) letters, words, sentences (of varying length and
complexity) and a paragraph.

Writing Scale - This scale has thirteen (Nos. 109 through 121) items. - The first
item (No. 109) requires the patient to count letters in verbally presented words and
another two (Nos. 110 and 111) expect him to identify first/second letters of the
verbally presented words. - Three items (Nos. 112, 113, and 114) expect the patient
to copy letters and words shown on cards. - There are four items (Nos. 115, 116,
117, and 118) which require writing of letters, numbers, words, and a sentence on
dictation. - There are two items (Nos. 119 and 120) which intend to assess
automatic writing skills. - In the last item (No. 121) the patient is expected to write
names of objects visually presented on a card.

Arithmetic Scale - Arithmetic scale consists of thirteen items (Nos. 122 through
134). - The first item (No. 122) expects the patient to write numbers on dictation
while item No. 123 expects the patient to translate and write numbers given on a
card in words. - The next two items (Nos. 124 and 125) expect them to identify the
significance of number placement. - Some items (Nos. 127 through 130) are
devoted to find out the simple arithmetic operations (addition, subtraction,
multiplication, and division). - Item No. 131 evaluates the patient’s complex
computational skills (using more than one type of arithmetic operation). - The last
three items (Nos. 132, 133, and 134) consist of arithmetic problems which assess
the application of the principle of induction and deduction.
Memory Scale - There are twelve items (Nos. 135 through 146) in the memory
scale. - First two items (Nos. 135 and 136) assess remote and recent memory of the
patient. - Two items (Nos. 137 and 138) involve recognition task (of birds and
animals shown on cards). - One item (No. 139) is devoted to immediate verbal
recall of units (each unit comprising of one three-letter word). - There are two
items (Nos. 140 and 141) assess immediate memory for digits- forward and
backward. - Two items (Nos. 142 and 143) assess verbal recall with homogeneous
and heterogeneous interference and one item (No. 144) requires immediate recall
of visually presented designs. - Two items (Nos. 145 and 146) evaluate nonverbal
recall with homogeneous and heterogeneous interference.

Intellectual Processing Scale - Intellectual processes scale comprises fourteen

items (Nos. 147 through 160). - First three items (Nos. 147, 148, and 149) elicit
general information in the patient. - One item (No. 150) is devoted to find out
comprehension for social situations. - Next item (No. 151) expects the patient to
explain popular proverbs. - There are six items (Nos. 152 through 156 and 158)
which assess in the patient the ability to determine opposites, find out similarities
and differences, form analogies and concepts. - One item (No. 157) is devoted for
finding out logical reasoning for numbers. - There is one item (No. 159) which
expects the patient to identify the missing elements in a complex geometric
configuration- a task similar to that of Raven’s Progressive Matrices. - The last
item (No. 160) is devoted to maze learning in the patient.

HALSTEAD REITEN BATTERY

The Halstead-Reitan Neuropsychological Test Battery (HRNB) and allied
procedures is a comprehensive suite of neuropsychological tests used to assess the
condition and functioning of the brain, including etiology, type (diffuse vs.
specific), localization and lateralization of brain injury. The HRNB was first
constructed by Ward C. Halstead,[3] who was chairman of the Psychology
Department at the University of Chicago together with his doctoral student, Ralph
Reitan (who later extended Halstead's Test Battery at the Indiana University
Medical Center). A major aim of administering the HRNB to patients was if
possible to lateralize a lesion to either the left or right cerebral hemisphere by
comparing the functioning on both sides of the body on a variety of tests such as
the Suppression or Sensory Imperception Test, the Finger Agnosia Test, Finger Tip
Writing, the Finger Tapping Test, and the Tactual Performance Test.  One
difficulty with the HRNB was its excessive administration time (up to 3 hours or
more in some brain-injured patients). In particular, administration of the Halstead
Category Test was lengthy, so subsequent attempts were made to construct reliable
and valid short-forms

The Halstead Category Test is a nonverbal test that measures a person's ability to
formulate abstract principlesThe test consists of 208 stimuli that are shown on
slides.Each test item suggests a number ranging from one to four. The patient is
instructed to determine or guess a particular number based on their
conceptualization of the abstract principle represented by the slide.After the patient
decides on a particular response, he or she must depress one of four levers on the
instrument, which are numbered from one to four.depressed the correct number, a
door chime will ring.depresses one of the incorrect numbers, a buzzer will
sound.Based on this feedback, correct or incorrect, the patient must determine the
underlying principle in each of seven different subtests.The scoring for this test
consists of the total number of errors made by the patient.

Test included

Tactual performance test

A form board containing ten cut-out shapes, and ten wooden blocks matching those
shapes are placed in front of a blindfolded individual.

• Individuals to use only their dominant hand to place the blocks in their
appropriate space on the form board.The same procedure is repeated using only the
non-dominant hand, and then using both hands.Finally, the form board and blocks
are removed, followed by the blindfold. From memory, the individual is asked to
draw the form board and the shapes in their proper locations.

• The test usually takes anywhere from 15 to 50 minutes to complete. There is a

time limit of 15 minutes for each trial, or each performance segment.Scoring
involves recording the time to complete each of the three blindfolded trials and the
total time for all trials combined

Seashore Rhythm Test

Thirty pairs of tape-recorded, non-verbal sounds are presented. For each pair,
individuals decide if the two sounds are the same or different, marking "S" or "D"
respectively on their answer sheets. The pairs are grouped into three subtests.

This test is also called the Seashore Rhythm Test, and is based on the Seashore
Tests of Musical Ability. It evaluates auditory attention and concentration, and the
ability to discriminate between non verbal sounds.

The test helps detect brain damage, but not the location of damage. Adequate
hearing and visual abilities are needed to take this test. Scoring is based on number
of correct items, with higher scores indicating less damage or good
recovery.Scores should be interpreted along with information from other tests

Finger-oscillation test

 Individuals place their dominant hand palm down, fingers extended, with the
index finger resting on a lever that is attached to a counting device.
 Individuals are instructed to tap their index finger as quickly as possible for
ten seconds, keeping the hand and arm stationary.
 This trial is repeated five to 10 times, until the examiner has collected counts
for five consecutive trials that are within five taps of each other.Before
starting the test, individuals are given a practice session. They are also given
brief rests between each 10-second trial, and one to two-minute rests after
every third trial. This entire procedure is repeated with the non-dominant
hand. The test takes approximately ten minutes to complete.

Speech sounds perception test

  Sixty tape-recorded nonsense syllables containing the sound "ee" (for
example, "meer" and "weem") are presented.
 After each syllable, individuals underline, from a set of four written
syllables, the spelling that represents the syllable they heard.This test
evaluates auditory attention and concentration and the ability to discriminate
between verbal sounds.
 It provides some information regarding specific areas of brain damage, and
may also indicate attention deficits or hearing loss.
 Scoring and interpretation are similar to that used for the Rhythm Test.

Trail making test

 This test consists of two parts. Part A is a page with 25 numbered circles
randomly arranged. Individuals are instructed to draw lines between the
circles in increasing sequential order until they reach the circle labeled
"End." Part B is a page with circles containing the letters A through L and
13 numbered circles intermixed and randomly arranged.
 Individuals are instructed to connect the circles by drawing lines alternating
between numbers and letters in sequential order, until they reach the circle
labeled "End."
 If individuals make mistakes, the mistakes are quickly brought to their
attention, and continue from the last correct circle. The test takes
approximately five to 10 minutes to complete.

Aphasia screening test

 Aphasia is the loss of ability to understand or use written or spoken

language, due to brain damage or deterioration.
 In this test, individuals are presented with a variety of questions and tasks
that would be easy for someone without impairment.
 Examples of test items include verbally naming pictures, writing the name of
a picture without saying the name aloud, reading printed material of
increasing length, repeating words stated by the examiner, simple arithmetic
 problems, drawing shapes without lifting the pencil, and placing one hand to
an area on the opposite side of the body.

Sensory-perceptual test

This test detects whether individuals are unable to perceive stimulation on one side
of the body when both sides are stimulated simultaneously.

• It has tactile, auditory, and visual components involving the ability to

(a) specify whether touch, sound, or visible movement is occurring on the right,
left, or both sides of the body;

(b) recall numbers assigned to particular fingers (the examiner assigns numbers by
touching each finger and stating the number with the individual's eyes closed);

(c) identify numbers "written" on fingertips while eyes are closed; and

(d) identify the shape of a wooden block placed in one hand by pointing to its
shape on a form board with the opposite hand.

Reliability

The reliability and validity of neuropsychological tests may affected by many

factors Mood states especially anxiety and depression.

Result may be confused by medication effects

LURIA NEBRASKA
The Luria-Nebraska Neuropsychological Battery (LNNB) is a standardized test
that identifies neuropsychological deficiencies by measuring functioning on
fourteen scales. It evaluates learning, experience, and cognitive skills. The test was
created by Charles Golden in 1981 and based on previous work by Alexander
Luria that emphasizes a qualitative instead of quantitative approach. The original,
adult version is for use with ages fifteen and over, while the Luria-Nebraska
Neuropsychological Battery for Children (LNNB-C) can be used with ages eight to
twelve; both tests take two to three hours to administer. The LNNB has 269 items
divided among fourteen scales, which are motor, rhythm, tactile, visual, receptive
speech, expressive speech, writing, reading, arithmetic, memory, intellectual
processes, path gnomonic, left hemisphere, and right hemisphere. The test is
graded on scales that are correlated to regions of the brain to help identify which
region may be damaged. The Luria-Nebraska has been found to be reliable and
valid; it is comparable in this sense to other neuropsychological tests in its ability
to differentiate between brain damage and mental illness. The test is used to
diagnose and determine the nature of cognitive impairment, including the location
of the brain damage, to understand the patient's brain structure and abilities, to
pinpoint causes of behavior, and to help plan treatment.

This battery contains a total of 269 test items that make up 11 clinical scales

 motor functions,
 rhythm and pitch,
 tactile and kinesthetic functions,
 visual functions,
 Receptive
 language,
 reading,
 writing,
 arithmetic,
 expressive language,
 memory, and
 intellectual processes.

In addition to these scales, three additional scales have been developed (based on
the 269 test items) that are sensitive to brain impairment and recovery following
brain injury and are known as the pathognomonic, profile elevation and
impairment scales

Scores for three summary scales can also be calculated: pathognomonic, right
hemisphere, and left hemisphere.A children's version of the battery, called the
Luria Nebraska Neuropsychological Battery for Children (LNNB-C), appropriate
for children aged eight to 12, is also available.
The probability of brain damage is assessed by comparing an individual's score on
each of the battery's 11 clinical scales to a critical level appropriate for that
person's age and education level.

For example, if a person has five to seven scores above the critical level, they most
likely have some sign of neurological impairment. Eight or more scores above the
critical level indicate a clear history of neurological disorder.