Cognitive Assessment in London | Cognitive Assessments Therapists

What are Cognitive Assessments?

Cognitive Assessment in London - Cognitive assessment (or logical testing) is used to determine an individual’s general thinking and argumentative abilities, also known as intellectual functioning or IQ. Intelligence testing can assess various domains of your child’s logical capacity.

Cognitive ability tests assess abilities involved in thinking (e.g., reasoning, perception, memory, verbal and mathematical ability, and problem solving).

Such tests pose questions designed to estimate applicants' potential to use mental processes to solve work-related problems or to acquire new job knowledge. Traditionally, the general trait measured by cognitive ability tests is called "intelligence" or "general mental ability." However, an intelligence test often includes various item types which measure different and more specific mental factors often referred to as "specific mental abilities." Examples of such items include arithmetic computations, verbal analogies, reading comprehension, number series completion, and spatial relations (i.e., visualizing objects in three-dimensional space).

Some cognitive ability tests sum up the correct answers to all of the items to obtain an overall score that represents a measure of general mental ability. If an individual score is computed for each of the specific types of abilities (e.g., numeric, verbal, reasoning), then the resulting scores represent measures of the specific mental abilities.

Traditional cognitive tests are well-standardised, contain items reliably scored, and can be administered to large groups of people at one time.

Examples of item formats include multiple choice, sentence completion, short answer, or true-false. Many professionally developed cognitive tests are available commercially and may be considered when there is no significant need to develop a test that refers specifically to the particular job or organization.

An assessment at the therapy clinic may test for the following:

• Verbal comprehension: understanding verbal information, thinking in words and explaining thoughts in words.
• Perceptual reasoning: ability to organize and reason with visual information, and to solve visual problems.
• Working memory: ability to regain and manipulate verbal information
• Processing speed: ability to search, process and recognize information accurately.
• Mostly, the average score for IQ and various domains is between 90 and 109. Higher scores represent higher cognitive functioning and lower scores represent lower cognitive functioning. However, when the scores between domains varies greatly, individual domain scores may provide a more correct reflection of an individual’s cognitive ability than the overall IQ score.

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Cognitive Domains

Memory

Complaints about poor memory are the most frequent reason for referral to a cognitive disorder clinic and provide a good starting point for the consultation despite not being very specific. A useful framework for analyzing memory complaints divides memory into several separate domains. Episodic memory (personally experienced events) comprises anterograde (newly encountered information) or retrograde (past events) components and depends on the hippocampal–diencephalic system. A second important system involves memory for word meaning and general knowledge (semantic memory), the key neural substrate being the anterior temporal lobe. Working memory refers to the very limited capacity which allows us to retain information for a few seconds and uses the dorsolateral prefrontal cortex. The term ‘‘short term’’ memory is applied, confusingly, to several different memory problems, but has no convincing anatomical or psychological correlate.

Episodic memory

• Anterograde memory loss is suggested by the following:
• forgetting recent personal and family events (appointments, social occasions)
• losing items around the home
• repetitive questioning
• inability to follow and/or remember plots of movies, television programmers
• deterioration of message taking skills c increasing reliance on lists. Retrograde memory loss is suggested by:
• memory of past events (jobs, past homes, major news items)
• getting lost, with poor topographical sense (route finding).

Memory loss and learning impairment out of proportion to other cognitive disturbance is known as the amnesic syndrome. Generally, both anterograde and retrograde memory loss occur in parallel, such as in Alzheimer’s disease or head injury, but dissociations occur. Relatively pure anterograde amnesia may be seen when there is hippocampal damage, particularly in herpes simplex encephalitis, focal temporal lobe tumors, or infarction. Confabulation—for example, in Korsakoff’s syndrome—might be grandiose or delusional, but more often involves the mis ordering and fusion of real memories which end up being retrieved out of context. A transient amnesic syndrome with pronounced anterograde, and variable retrograde, amnesia is seen in transient global amnesia (TGA), while ‘‘memory lacunas’’, and repeated brief episodes of memory loss suggest transient epileptic amnesia (TEA).

Working memory

Lapses in concentration and attention (losing your train of thought, wandering into a room and forgetting the purpose of the visit), are common and increase with age, depression, and anxiety. Such symptoms are much more evident to patients than to family members and, in isolation, are usually not of great concern. It should be noted, however, that basal ganglia and white matter diseases may present with predominantly working memory deficits.

Semantic memory

Patients with semantic breakdown typically complain of loss of words. Vocabulary diminishes and patients substitute words like ‘‘thing’’. There is a parallel impairment in appreciating the meaning of individual words which first involves infrequent or unusual words. Word finding difficulty is common in both anxiety and aging, but variable and not associated with impaired comprehension. This is in stark contrast to the anomia in semantic dementia which is relentlessly progressive and associated with atrophy of the anterior temporal lobe, usually on the left.

Simply asking both patient and informant to give an overall memory rating (out of 10) is often helpful. It is seldom, if ever, that truly amnestic patients will give themselves scores such as 0 or 1, although their spouse might. The reverse is often true of those who forget primarily because of anxiety or depression.

Language

Listening to the history will reveal many language deficits, particularly where poor fluency, prosody, agrammatism and articulation are involved. Evidence of word finding impairments and paraphasia errors are also usually quickly apparent. Documenting several examples of these errors is often quite helpful to subsequent clinicians. Sometimes, a relatively fluent history may mask quite significant naming and single word comprehension deficits, and it is important to assess this routinely with infrequently encountered words.

Executive and frontal lobe function

Impairments in this domain typically involve errors of planning, judgement, problem solving, impulse control, and abstract reasoning. Although executive function is generally believed to be a (dorsolateral) frontal lobe function, this set of skills is probably more widely distributed in the brain. Head injury is a common cause of impaired executive function, which is also usually seen in Alzheimer’s disease, even in the early stages. It is important not to forget that most of the frontal lobe is subcortical white matter, and the leukodystrophies, demyelination, and vascular pathology all cause executive dysfunction. Basal ganglia disorders also impair these skills, the prime example being progressive supranuclear palsy (PSP).

Visuospatial ability

Information from the visual cortex is directed towards the temporal or parietal cortex via one of two streams. The dorsal (‘‘where’’) stream links visual information with spatial position and orientation in the parietal lobe, whereas the ventral (‘‘what’’) stream links this information to the store of semantic knowledge in the temporal lobes. The frontal eye fields are important in directing attention towards targets in the visual field. Visual neglect may produce a failure to groom one half of the body or eat what is placed on one side of a plate. Visual hallucinations invariably suggest an organic cause and are prominent in dementia with Lewy bodies and acute confessional states. Formed visual hallucinations may also be seen in the absence of cognitive impairment in the Charles Bonnet syndrome and are often associated with poor eyesight.

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What is IQ?

An intelligence quotient (IQ) is a total score derived from several standardised tests designed to assess human intelligence. IQ is a score obtained by dividing a person's mental age score, obtained by administering an intelligence test, by the person's chronological age, both expressed in terms of years and months. The resulting fraction is multiplied by 100 to obtain the IQ score.

IQ test measure

The IQ test consists of several tasks measuring various measures of intelligence including short-term memory, analytical thinking, mathematical ability and spatial recognition. Like all IQ tests it does not attempt to measure the amount of information you have learned but rather your capacity to learn. Once you've provided your answers, we compare your results to people of your age and then we provide a normalized score. Normalized scoring can be difficult to understand for those without a background in statistics. It's best to think of your score as a number which represents your IQ compared to others, not as a measure of intelligence. Normalizing means the average IQ score is 100. How far you fall either side of this number determines roughly how unusual your IQ is. Only 2% of the population have an IQ greater than 128. Half of the population have an IQ score between 85 and 115.

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Reasons for Cognitive Assessment in London

Cognitive assessments are suitable for children and adults. An individual does not need to have high language abilities to receive a cognitive assessment. Individuals who experience any of the following could benefit from a cognitive assessment:

• Difficulties with: language, reading and/or writing, memory, processing and retaining information
• Poor attention and/or concentration
• Struggles with academic life
• Exceeding within areas of academic life

Cognitive assessments bring many benefits, including:

• Providing a learning profile, including strengths and difficulties
• Identifying a learning need
• Being able to compare to a standardized sample
• Helping to identify able and talented
• Guiding personalized learning
• Providing evidence to support a specific application
• Supporting access arrangements
• Being evidence-based
• Being a robust and comprehensive assessment
• Helping to distinguish between special educational needs and English as an additional language.

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Types of Cognitive Assessment in London

The type of assessment used will depend on the patient's age.

Children from 4 to 7 years and 3 months:

WPPSI-IV Wechsler Preschool & Primary Scale of Intelligence Fourth Edition. WPPSI– Wechsler Pre-School & Primary Scale of Intelligence – test covers children from 2 years and 6 months to 7 years and 7 months. The WPPSI was introduced in 1967 and originally designed for children between 4 years and 6.5 years old before later revisions expanded that range. The test is currently in its fourth revision as the WPPSI-IV and consists of 14 subtests that are broken up into three scoring indexes: Verbal, Performance, and Full Scale IQ.

Children from 6 to 16 years 11 months:

WISC-V Wechsler Intelligence Scale for Children Fifth Edition. Cognitive assessments are held in a testing room that is quiet and has minimal distraction for your child.  The word “test” will not be used with the child and will instead be replaced by the words “puzzles and games”, to create a more relaxed environment for your child. This test was introduced as an offshoot of the Wechsler-Bellevue Intelligence Scale and was introduced in 1949. This test is often used to help with educational placement, identifying gifted students, and can also be used in conjunction with the Wechsler Individual Achievement Test to help identify students with learning disabilities or gaps between academic achievement and cognitive abilities. The most recent version of the test is the WISC-V, which was released in 2014.

Adults:

WAIS – Wechsler Adult Intelligence Scale – test covers teenagers from 16 years of age through adulthood. The current version of the test is the WAIS-IV which was launched in 2008.

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Process of Cognitive Testing

1. Initial appointment with patient – context is gathered from the patient, including developmental history, academic ability, medical issues, family relationships, and issues raised by the parents in order to combine a holistic picture of your child’s environment.
2. Testing over one or two session – depending on your child’s ability and willingness to test, the testing will be done over one or two sessions
3. Scoring and interpreting results – each assessment will be scored and interpreted against standardized results
4. Report writing – the behavior of the patient during testing will be recorded, along with the results of the testing, and recommendations
5. Feedback session – the psychologist will discuss the results of the testing in this session and provide recommendation for patients, parents and schools as required