Testing Batteries Versus Individualized Testing

There are two basic approaches to testing methods in neuropsychological assessments: the use of comprehensive testing batteries or the use of individualized testing. Each approach has its strengths and weaknesses, and most neuropsychologists use a combination of these two approaches to capitalize on the strengths and minimize the weaknesses.

THE BATTERY APPROACH

Neuropsychological testing batteries provide a structured approach to the assessment of cognitive function. Although there are many neuropsychological testing batteries, two batteries are most commonly used: the Halstead-Reitan Battery '131 and the Luria-Nebraska Neuropsychological Battery. '191 The Halstead-Reitan Battery is a collection of tests that Halstead found to discriminate normal individuals from patients with organic brain disease. The core of the Halstead-Reitan Battery includes six tests developed by the authors (measuring abstract reasoning, tactile performance, tactile/visual-spatial memory, rhythm perception and memory, speech-sound perception, and primary motor speed) and seven tests developed by other individuals (measuring intelligence, psychomotor speed, sequencing abilities, language function, sensory function, grip strength, and personality functioning). The entire battery requires at least 6 hours for administration, not including scoring and interpretation, so testing often requires multiple visits. The original standardization sample for the development of the Halstead-Reitan Battery norms were inadequate. Recently, new norms have been generated using a larger and perhaps more representative standardization sample. '171 The Halstead-Reitan Battery appears to be adequate in discriminating brain-damaged individuals from neurologically healthy individuals, but is not sensitive to mild cognitive impairment or to precise localization. Despite these limitations, the Halstead-Reitan Battery is the most commonly used neuropsychological assessment battery.

The Luria-Nebraska Neuropsychological Battery y developed out of the extensive investigations of behavioral neurology conducted by the Russian neurologist Luria and the work of Christensen,y who brought Luria's theories and methods of neuropsychological testing to America. The battery uses selected Luria test items that best discriminate brain-damaged patients from neurologically healthy individuals. It consists of 269 individual items that are scored on a zero (no impairment) to 2 (impairment) scale. The test items are simple and complex commands and problems, such as motor commands and arithmetic. The 269 items are composed of 11 clinical/ability scales measuring motor abilities, rhythm sense and reproduction, tactile abilities, visual abilities, receptive speech, expressive speech, writing, reading, arithmetic abilities, memory function, and intelligence. Three additional scales provide information as to the presence of pathognomonic signs, left hemisphere damage, and right hemisphere damage. Administration of the Luria-Nebraska Neuropsychological Battery is approximately 2 to 3 hours (substantially less than the Halstead- Reitan Battery).

Although authors of the Luria-Nebraska Neuropsychological Battery have published numerous articles in support of its reliability and validity, other investigators have not been able to replicate these results. y The inadequate validity and reliability of the Luria-Nebraska Neuropsychological Battery are owing primarily to the lack of any theoretical model used in its development. Whereas the strength of Luria's original work was his ability to generate hypotheses about brain-behavior relationships and methods to tests these hypotheses, the developers of the Luria-Nebraska Neuropsychological Battery were unable to emulate this strength.

INDIVIDUALIZED TESTING APPROACH

The main advantage to the battery approach is that it allows for the collection of massive amounts of information on the status of cognitive functioning in a highly standardized manner. This advantage is contrasted with numerous disadvantages: the time required for a complete assessment is often excessive and fatigues the patient; the batteries

often include assessment measures that are not necessary for a given patient, and, conversely, the batteries do not provide comprehensive assessments of all cognitive functions. By recognizing these limitations, most neuropsychologists use an individualized approach to testing.

An individualized approach allows the neuropsychologist to use pertinent information to guide test selection. For example, if neuropsychological assessment is requested for a patient with diagnosed Alzheimer's disease, the neuropsychologist knows that trying to complete a Halstead-Reitan Battery would not only be unfair to the patient but would also provide little useful information. Instead, the examiner may choose to use a number of shorter tests with lower performance ranges to allow for extremely low scores. Using this approach, the neuropsychologist chooses tests (either from existing batteries or tests designed to assess specific deficits) that assess cognitive functions relevant to a given patient. Thus, examination time is shortened, and the specificity of the testing results is increased. Inevitably, however, the selection of tests introduces a certain bias, and some domains of good or bad function may be missed

Neuropsychologists have a vast array of tests from which to choose when using the individualized approach. Over 700 tests of cognitive functioning are available, assessing such complex functions as intelligence and such basic functions as primary motor speed. Although a detailed description of all of these neuropsychological tests is well beyond the scope of this chapter, the next section provides a brief description of the most commonly used tests and their role in assessing specific cognitive domains. This review is limited to the most commonly used tests in neuropsychological assessments of adults.

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