neuropsychology

Dalam praktek psikiatri

Marlina S. Mahajudin

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konsep
Neurodeficit

Neuroproduktif

Neurobehavior

Neuropsychiatry

neuropsychology
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tujuan
Membantu menegakkan diagnosis
GMO
Membantu deteksi dini gangguan
/fungsi otak
Membantu mencari lesi gangguan
organik

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Penting tahu konsep tes dan

penilaiannya.
Jangan terpaku pada skoring :
- tahu ada kelainan/gangguan fungsi
- cek dan recek dengan anamnese
dan gejala klinis
- recek dengan tes lain
- pengaruh budaya dan pendidikan tak
dapat diabaikan
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Monitoring Cognitive
Functions
Nine Cognitive Domains

Memory
Language
Visuospatial
Praxis
Attention&Concentration
Calculation
Judgment/Insight
Reasoning
Abstract thought

Careful
Monitoring !

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ORIENTATION

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orientation
Awareness interview (S.W.Anderson )
Structured interview :
1. Person
2. Place
3. Time
4. Items dealing with appreciation of deficit
- motor function
- thinking
- memory

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Right-left orientation test(RLOT)

Benton, Hamsher et al 1983

20 item test right and left side :

1. Body parts
2. subjects own body or examiner

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Body orientation test

(Semmes,1963)
1.
2.
3.
4.
5.

Instruksi:
Tunjukkan/pegang bagian tubuh
Nama bagian tubuh yang disentuh
pemeriksa
Sentuh bagian tubuh saya yang saya
sebut
Meniru pemeriksa apa yang disentuh
Sentuh bagian tubuh sesuai urutan
digambar ini(gambar orang)
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Topographical localization(Lezak)
Instruksi gambarkan denah rumah anda
(suami) bandingkan dengan gambar
istri
Bisa diganti gambar :
* arah mata angin
* lokasi kota di map Indonesia
tak perlu skoring
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ATTENTION
CONCENTRATION
TRACKING

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vigilance
Examine the ability to sustain and
focus attention itself.
Raise the hand or tap, if a number
and or a letter is perceived.
60 items or more read, display at a
rate of one per half-second.
Complex : tap after b only after d.
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Short-term storage capacity

Digit span
- forward span : digits, verbal
- reversed span : with distractibility
Sentences repetition
- kalimat berita berganti kalimat
tanya
- makin lama makin panjang.
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Mental tracking
Brain injury disturbances in keeping one
or more lines of thought going ( in cocktail
party conversation)
Some perceptual tracking or scanning
from the stimuli
Tracking task can be complicated by
requiring to track > 2 stimuli, associated
ideas simultaneus, alternatively or
sequently divided / shifting attention
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Mental tracking
Digit backward
Reversing serial order : WORLD
Stroop test (Dodrills Format):
- kertas kumpulan 176 kata berwarna
11 kesamping, 16 kebawah
- part I baca secepatnya, part II warna
Symbol digit modalities test (SDMT)
Trail making test.
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perception

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perception
Visual perception ;
- visual inattention
* hemineglect ( clock, line bisection)
* marking task (bisa visual scanning)
* reading
* writing, copying and drawing
- visual scanning : bahaya accident
prone
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Visual recognition
- angulation :
* kemampuan mengenali besar/kecil
sudut, biasanya lesi hemisfere kanan
* Judgement of line orientation
-Recognition of pictured objects
-Face recognition
* bukan famous faces(tes memori)
* mencari wajah yang sama demgam
posisi dan pencahayaan berbeda
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VISUAL INTERFERENCE
The hidden figures test (Talland 1965)
The overlapping figures test
* Poppelreuter-type overlapping
figure
Picture search
Visual masking problems
Visual tracking test
* Line tracing task ( Talland, 1965)
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Auditory perception
AUDITORY DISCRIMINATION
konsep : kemampuan penderita
untuk dapat membedakan
suara
- konsonsonan & vokal dari
dua pasang kata yang
hampir sama
desis - tepis
APHASIA
bisa pakai tes neurologi
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VERBAL FUNCTIONS
and
LANGUAGE SKILLS
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VERBAL FUNCTIONS AND

LANGUAGE SKILLS
1.
2.
3.
4.
5.
6.

APHASIA
Spontaneus speech
Repetition
Speech comprehension
Naming
Reading
Writing
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Aphasia screening test

(Halsted & Wepman,59)

1. copy a square bentuk lain tanpa angkat

pinsil anda
2. apa nama bentukan itu
3. coba eja
4. ikuti saya : saya mau kepasar tuliskan
lesi hemisfere kiri bisa copy tidak tulis
lesi hemisfere kanan bisa copy bisa tulis
The token test(Boller & Vignolo, 1966)
Indonesia tes Tadir
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CONCEPT FORMATION
and
REASONING

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Concept formation and reasoning

Concept formation
- focus on quality or process of thinking
more than the content of the respons
- their scores stand for qualitive judgement
of the extent to which the response was
* abstact/concrete
* complex/simple
* apt/irrelevant

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CONCEPT FORMATION TEST IN

VERBAL FORMATS
1. proverbs
2.word usage test
- comparison & similarities
- Stanford-Binnet subtest (Terman &
Merril, 1973)
VISUAL FORMATS
1. Category test (HCT)Reitan&Wolfson.1993
2.Ravens Progressive Matrices(RPM)
3. Identification of Common Objects (Laine
and Butters,1982)
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REASONING
VERBAL REASONING
- Comprehension (Wechsler,1981)
open ended questions:
* common-sense judgement
* practical reasoning
* meaning of proverbs
hati hati verbal memory span ?
- Stanford Binet subtest
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REASONING ABOUT VISUALLY

PRESENTED MATERIAL
Picture completion (Wechler,1981)
Picture arrangement (Wechler, 1981)
Picture problems

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SYMBOL PATTERNS
SORTING
- SORT & SHIFT
* object sorting test (Wegl,1941)
buat rancangan sheets seperti
naming: untuk pria & wanita
pemeriksa menyuruh
mengelompokkan dg kategori
* Wisconsin card sorting (WCST)
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MATHEMATICAL PROCEDURES
ARITHMETIC REASONING PROBLEMS
- Difficulties in immediate memory,
concentration, or conceptual
manipulation
and tracking skill menurun
- Arithmetic story problems(soal cerita)
sering dipakai brain teasing
- Block counting task (Terman&
Marril,1973)
CALCULATIONS
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EXECUTIVE FUNCTIONS

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Konsep ada 4 komponen

Volition
Planning
Purposive action
Effective performance
Dibuktikan untuk perilaku:
appopriate-socially responsibleeffectively self-serving adult conduct
self-direction & self-regulation
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VOLITION
- Capacity for intentional behavior
* formulate the goal
* motivationinitiate activity
- gangguan :apthetic/unappreciative
wandering
- pemeriksaan :OBSWAN
* motivational capacity
* capacity of self awareness
awareness of physical status,
environment&situational,social
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social awareness

PLANNING
- To cary out an intention or achieve
goal constitute planning and
involve a
number of capacities
PROTEUS MAZE TEST(Porteus,1965)
TOWER OF LONDON(Shalice, 1982)

PURPOSIVE ACTION
- intention-plan productive, self-serving
activity (switch,stop,sequences in orderly
integrated and integrated manner
Tinkertoy test(TTT) (Lezak,1982)
konstruksi test membangun dan
melepaskan BENTUKAN/BANGUNAN
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Assessment of self-regulation:
1. produktivity
cari ketidak seimbangan antara
INTENTION-ACTION
OBSWAN : bisa cerita detail
langkah2 plan tapi action
ragu/tidak bisa
2. flexibility and the capacity to shift
disini ada perceptual-cognitiveresponse dimension
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Perceptual deficit : scanning and inability

to change perceptual set easily
Conceptual rigidity : concrete/rigid in
understanding-problemsolving and
stimulus bound(atensi melekat)
Inflexibility in response: perseverative,
stereotyped,nonadaptive behavior and
difficulties in regulating and modulating
motor acts
Tes : uses of objects (bata, pinsil 5 )
gunanya ? Convergen : stereotype
Divergen : banyak
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Assessmen of perseveration:
contoh : Luria tes
1. hyperkinetik-like motor perseveration
susah berhenti (lebih ggn motor)
2. Perseveration elements, sudah instruksi
gambar kedua tapi insert gambar pertama
3. Perseveration of features, mempertahankan
karakteristik gambar tes pertama
3. Perseveration in activities, beri stimulus
berbeda tulis huruf-angka kacau

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MOTOR PERFORMANCE
SERING TIDAK BISA DIBEDAKAN
DENGAN GANGGUAN EXECUTIVE!
Pemeriksaan apraksia
Manual dexterity and strength
- Finger tapping test (FTT) (Spreen
and Straus, 1991)attention?
- Purdue pegboard test (Tiffin1968)

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CONSTRUCTION

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drawing
Copying
- dari tulis nama, meniru bunga
tersukar complex figure test
Free drawing
- human figure(draw a person, tree cs)
-bicycle (ada scoring)
-clock face (ada scoring)
Building and assembling
- block design (weschler two dimensional)
- Stick test (Butters and Barton)
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BUILDING and ASSEMBLING

TWO DIMENSIONAL CONSTRUCTION
- Block design (Wechler,1981)
- Stick test (Benson and Barton,1970)
- Object assembly
gambar/alat yang dikenal diprotoli
THREE DIMENSIONAL
- Block design
mudah tumpuklah blok
sukar mirip candi/rumah dsb
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MEMORY : TEST
PAIRED MEMORY TEST
QUESTIONAIRS

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General review of memory

functions
Harus mencakup:
Span of immediate retention
- very short-term retention with
interference
Learning capacity
- recent memory, newly learned
retained
Efficiency of retrieval
- both recently learned and long-stored
(remote)
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Verbal memory
Verbal automatism
- suruh menyebut urutan alfabet,
hitungan dalam bentuk seri
Letter and digits
- serial digit learning diucapkan
Words
* Rey auditory-verbal learning test
* California verbal learning test
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Sentences recall
Strory recall
tergantung panjang pendeknya
cerita dan lama jeda(brain
teasing) maka yang dinilai
* immediate recall
* delayed recall

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VISUAL MEMORY
VISUAL RECOGNITION
VISUAL RECALL : REPRODUCTION
- Complex figure test : recall
administration
* Rey Complex Figure
* Taylor Complex figure
* Medical College of Georgia
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REMOTE MEMORY
FAMOUS PEOPLE TEST
PRESIDENTS TEST
AUTOBIOGRAPHICAL MEMORY

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MEMORY BATTERIES,PAIRED
AND QUESTIONAIR
BATTERIES
Weschler memory scale
PAIRED
?
QUESTIONAIRES
Memory functional scale
SPSMQ
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Mild cognitive impairment ?

Tantangan untuk psikiatri-psikologi!!
persimpangan Alzheimer(DD/)
Tes pejabat publik
Rey auditory verbal learning test
Buschke cued recall selective reminding
test
Logical memory subtest of Wechler
Memory Scale
New York University paragraph recall test
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