LSP Neuropsychological Assessment 3 — Questions and Answers
Question 1: Which measure is considered the gold standard for estimating premorbid intellectual functioning in neuropsychological evaluations?
- Word reading tests such as the WTAR or NART (Correct answer)
- Current performance on fluid reasoning tasks
- Digit Symbol Coding from the WAIS-IV
- Verbal memory composite scores
Correct answer: Word reading tests such as the WTAR or NART
Word reading tests (WTAR, NART) rely on irregular word pronunciation that is relatively resistant to acquired brain damage, providing an estimate of premorbid ability.
Question 2: A patient with a right hemisphere stroke demonstrates left hemispatial neglect. Which bedside task would most sensitively reveal this deficit?
- Line bisection or cancellation task (Correct answer)
- Digit Span Backward
- Boston Naming Test
- Category fluency
Correct answer: Line bisection or cancellation task
Line bisection and cancellation tasks require detecting stimuli across the full visual field, exposing neglect of the contralateral (left) side after right hemisphere lesions.
Question 3: The Test of Memory Malingering (TOMM) uses a forced-choice paradigm. Performance significantly below chance (below 50%) strongly suggests:
- Intentional suppression of correct responses (Correct answer)
- Severe amnestic disorder
- Encoding failure due to hippocampal damage
- Random responding from inattention
Correct answer: Intentional suppression of correct responses
Below-chance performance on forced-choice symptom validity tests indicates the patient must recognize the correct answers to consistently choose the wrong ones, indicating deliberate suppression.
Question 4: In the Boston Process Approach to neuropsychological assessment, the clinician focuses primarily on:
- How a patient solves a problem, not just the final score (Correct answer)
- Comparing raw scores to age-matched norms exclusively
- Maximizing standardization across all administration conditions
- Using fixed batteries without examiner flexibility
Correct answer: How a patient solves a problem, not just the final score
The Boston Process Approach emphasizes qualitative observation of problem-solving strategies and error types to localize and characterize brain dysfunction beyond summary scores.
Question 5: Balint syndrome, associated with bilateral parieto-occipital lesions, is characterized by the triad of simultanagnosia, optic ataxia, and:
- Ocular apraxia (psychic paralysis of gaze) (Correct answer)
- Prosopagnosia
- Hemianopia
- Color agnosia
Correct answer: Ocular apraxia (psychic paralysis of gaze)
Balint syndrome comprises simultanagnosia (inability to perceive multiple objects), optic ataxia (visuomotor misreaching), and ocular apraxia (difficulty voluntarily shifting gaze).
Question 6: A neuropsychologist uses demographically corrected normative data when interpreting test scores. The primary reason for this correction is to:
- Control for the influence of age, education, and sex on cognitive performance (Correct answer)
- Eliminate the effect of test anxiety on scores
- Standardize scores across different test publishers
- Account for cultural differences in test motivation
Correct answer: Control for the influence of age, education, and sex on cognitive performance
Demographic corrections adjust expected performance based on variables such as age, education, and sex that strongly influence normative distributions independent of brain status.
Question 7: Which of the following best characterizes the memory impairment seen in Huntington's disease compared to Alzheimer's disease?
- HD shows retrieval-based forgetting with better recognition; AD shows encoding failure with poor recognition (Correct answer)
- HD and AD both show severe encoding failure and recognition impairment
- HD primarily affects semantic memory; AD primarily affects procedural memory
- HD shows intact recall but impaired recognition; AD shows the reverse
Correct answer: HD shows retrieval-based forgetting with better recognition; AD shows encoding failure with poor recognition
Huntington's disease produces a subcortical retrieval deficit with relatively preserved recognition, whereas Alzheimer's disease produces an encoding failure that impairs both free recall and recognition.
LSP Neuropsychological Assessment 3
Which measure is considered the gold standard for estimating premorbid intellectual functioning in neuropsychological evaluations?