Hierarchy of Testing Functions

A given cognitive function is usually composed of multiple discrete functions. Memory performance is affected not only by the ability to recognize and recall stimuli but also by the ability to perceive those stimuli, process and store them, and finally reproduce them in an observable fashion. Most neuropsychologists approach patient assessment using a general hierarchy of functions involved in cognition.

The primary components of this hierarchy are the perception of stimuli, ability to attend to the stimuli, and the ability to generate some form of response. In consideration of these issues, one of the first cognitive functions to be tested in almost all examination formats is level of consciousness ( ..Chapter..! ). If a patient is comatose there is little need to conduct neuropsychological testing. Testing of sensory systems (usually visual, auditory, tactile, and proprioceptive) is also conducted to ensure adequate stimuli processing. Finally, in order to assess a patient, a competent effector system that enables responding must be present. Therefore, testing of basic motor, vocal, and praxis abilities is conducted. If deficits are noted in any of these basic abilities, the neuropsychologist uses that information in the interpretation of other cognitive tests to increase or decrease confidence in those results. Once these three levels of abilities have been tested, testing of higher cognitive functions (such as intelligence, reasoning, language) can begin.

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