Neuropsychological Assessment Battery

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The Neuropsychological Assessment Battery (NAB; Stern & White, 2003) is a comprehensive test battery that assesses five cognitive domains (Attention, Language, Memory, Spatial, and Executive Functions). The purpose of the current descriptive study was to present data on the index and primary test scores from the five main NAB cognitive modules in a sample of patients with moderate-to-severe traumatic brain injury (TBI) admitted to a residential postacute rehabilitation program. Twenty patients were administered all five main NAB modules upon recommendation from the NAB Screening module. The sample performed significantly worse than normal on tests that assess selective and divided attention, psychomotor speed, verbal memory, and cognitive flexibility. The largest proportion of patients performing below an established impairment cutoff (10th percentile) occurred on the Numbers and Letters, List Learning, Story Learning, Daily Living Memory, and Categories Tests. Significant performance decrements were not observed on any indices or tests from the Language or Spatial cognitive domain modules. The pattern of performance on the NAB demonstrated by the current sample is consistent with the neuropsychological profile observed in postacute patients with moderate-to-severe TBI without focal deficits (e.g., aphasia), demonstrating its relative sensitivity in this patient population. A comparison between the current study sample and a related clinical sample from the NAB standardization data is discussed.

This study aimed to explore the effects of age, education and gender on the performance of eight tests in the Korean version of the CERAD neuropsychological assessment battery and to provide normative information on the tests in the Korean elderly. The battery was administered to 618 healthy volunteers aged from 60 to 90. People with serious neurological, medical and psychiatric disorders, including dementia, were excluded. Multiple linear regression analyses were performed to assess the relative contribution of the demographic factors on the score of each cognitive test. Age, education, and gender were found to have significant effects on the performance of many tests in the battery. Based on these results, 4 overlapping age normative tables (60 to 74, 65 to 79, 70 to 84, and 75 to 90 years of age) with 3 educational strata (0 to 3 years, 4 to 6 years, and 7 years and more) for both genders are presented. The normative information will be useful for a clinical interpretation of the CERAD neuropsychological battery in Korean elderly as well as for comparing the performance of the battery across countries.

Neuropsychology is the study of brain-behavior relationships and how those relationships impact critical daily life functions. A neuropsychological evaluation is frequently requested to provide a comprehensive assessment when an individual has experienced a complex medical/neurologic condition that affects cognitive functioning, learning, and/or behavior. A neurological evaluation can be particularly helpful to understand the functional impact of traumatic brain injury (TBI), concussion, seizures/epilepsy, birth complications, and ADHD.

This paper aims to present the process of construction and content validity of the Brazilian Brief Neuropsychological Assessment Battery Neupsilin, developed to briefly examine the neuropsychological profile of both clinical and healthy populations. It evaluates time and spatial orientation, attention, perception, memory, arithmetic abilities, language, praxia and executive functions (problem solving and verbal fluency). The process of construction was based on psychometric procedures: 1) construction of a preliminary version of the instrument, founded on clinical and research experience of the three specialists, as well as on research on the literature and on already available instruments; 2) blind judges' analyses: a) an analysis of the importance of the inclusion of each subtest considering the assessed construct and the instrument's goal, b) an analysis of the adequacy of each item regarding the construct; 3) reformulation of the instrument; 4) semantic analysis of the items and brainstorming; 5) final analysis done by three specialist judges; 6) pilot study and final version, and 7) content validity. Modifications were done in each stage of the development of the Neupsilin. It demonstrated adequate content validity, with advantages and limitations.

In Brazil, there is an important demand for neuropsychological assessment instruments adapted to the social, cultural and linguistic features of its population. Neuropsychological evaluation can be done through a flexible exploration (non-standardized tasks and standardized subtests), and/or through a fixed assessing battery (standardized instruments). For the adjustment of a neuropsychological assessment instrument to the characteristics of the population of a determined country, during the development and/or adaptation process, it is fundamental to consider the interface between postulations brought by neuropsychology (Lezak, Howieson, & Loring, 2004; Strauss, Sherman, & Spreen, 2006), experimental psychology, cognitive psychology (Posner, 1998), psycholinguistics (Gernsbacher, 1994; Harley, 2001) and psychometrics (Pasquali, 2003; Urbina, 2004).

The theoretic-methodological postulations from neuropsychology involve the concept of modularity, that is, it assumes that the cognitive system contains subsystem components, or cognitive processors of relative independence. These subsystems have to be considered in the constructs included in the assessment process. They also encompass the notion of double and simple dissociation (Willmes, 1998). One of the aims of neuropsychological assessment is to find dissociations between functions and their components, that is, preserved and impaired abilities. Along with neuropsychological criteria, psycholinguistic criteria must be considered in the elaboration of items, which compose evaluations with linguistic stimuli of different levels of complexity (words, non-words, sentences, texts). At the word level, aspects to be considered are familiarity, frequency in the language, lexical extension, prototypicality, concreteness, lexicality, regularity, phonologic or semantic relationships, grammatical class, among other psycholinguistic factors. At the sentence level, some variables are essentiality, contextuality, plausibility, syntactic extension, conventionality, directionality and literality. In terms of discourse, aspects generally considered are cohesion, coherence and textual extension (Brookshire, 2003; Reis & Castro-Caldas, 1997; Parente & Salles, 2007; Salles & Parente, 2002, 2007).

Regarding psychometric criteria, instruments can be constructed based on theoretical and empirical procedures suggested in Pasquali's (1999) fluxogram, including the attainment of normative data (in general by age and education), reliability and validity (Capitani, 1997; Geisinger, 1994, 1998; Guillevic & Vautier, 2005; Pasquali, 2003; Urbina, 2004). Thus, it can be observed that, besides the interest in cognitive functioning, the product psychometric quality of fixed battery scores is also being focused by neuropsychological assessment studies. Finally, the focus of experimental neuropsychology contributes to the methodological reasoning of considering criteria for experimental manipulation of variables which potentially interfere with performance in each task. It is necessary to know experimental paradigms, that is, standardized strategies for the study of the distinct cognitive processes (Sevilla, 1997).

Neupsilin was, therefore, developed based on such pillars, and its construction (and not the adaptation of any already existing international instrument) justifies itself for a series of factors. Firstly, the need of an instrument constructed with standardization for the Brazilian population. It is noticeable that in Latin America, traditionally, tests developed in other countries have been translated and used based on international performance norms, obtained for foreign populations (Ostrosky-Sols, Ardila, & Rosselli, 1999). This practice may invalidate results found in the neuropsychological assessment process. Secondly, there is a need for a brief neuropsychological assessment instrument to be used in clinical, hospital and research context. There is a lack of tests, even in the world context, which do not demand an extended time of application (Ostrosky-Sols et al., 1999). Considering the Brazilian literature in the field, we have not found studies with brief instruments whose purpose is to provide a general profile of neuropsychological functions. Some of the assessment instruments used in Brazil, such as the Mini Mental State Examination (Mini-Mental) (Almeida, 1998; Bertolucci, Brucki, Campacci, & Juliano, 1994; Camozzato & Chaves, 2002; Chaves & Izquierdo, 1992; Folstein, Folstein, & McHugh, 1975), the Criteria of Positivity for Cognitive Deficits (Chaves & Izquierdo, 1992); the Frontal Assessment Battery (FAB Battery) (Beato, Nitrini, Formigoni, & Caramelli, 2007), and the Working Memory Battery - BAMT-UFMG (Wood et. al., 2001) focus on the assessment of one or few neuropsychological functions, requiring the clinician/ researcher to adopt a set of combined tasks to build up a neuropsychological profile.

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