Neuropsych Battery Selector

Neuropsychological Battery Selector

Purpose

Selecting a neuropsychological test battery is a clinical judgment task, not a checklist exercise. A competent programmer without clinical neuropsychology training will get this wrong because:

• Not all "memory tests" test the same construct. The CVLT-II/III assesses list learning with encoding strategies; Logical Memory tests narrative recall; the BVMT-R tests visual-spatial memory. Each is sensitive to different lesion profiles (Lezak et al., 2012, Ch. 11).
• Test selection must match the referral question. A dementia screen requires different instruments than a TBI return-to-work evaluation or a pre-surgical epilepsy workup.
• Normative data are not interchangeable. Age, education, cultural background, and premorbid ability all determine which norms to apply and whether a given score is actually impaired (Mitrushina et al., 2005).
• Redundant tests waste time and fatigue patients. Over-testing degrades performance and inflates apparent impairment, particularly in older adults and those with attentional deficits (Strauss et al., 2006).

When to Use This Skill

Use this skill when you need to:

• Select neuropsychological tests matched to a suspected cognitive deficit profile
• Assemble a battery for a specific referral question (dementia differential, TBI, pre-surgical, forensic)
• Advise on which cognitive domains to assess given a neurological condition
• Evaluate whether a proposed battery has adequate domain coverage or problematic redundancy
• Choose between brief screening vs. comprehensive evaluation

Do NOT use this skill for:

• Interpreting test scores (that requires a different skill)
• Diagnosing neurological conditions from test results alone
• Administering tests (this requires licensed clinical training)

Research Planning Protocol

Before executing the domain-specific steps below, you MUST:

1. State the research question -- What cognitive domain(s) are being assessed and why?
2. Justify the method choice -- Why neuropsychological testing (not neuroimaging, behavioral paradigm)? What alternatives were considered?
3. Declare expected outcomes -- What deficit pattern would support the clinical/research hypothesis?
4. Note assumptions and limitations -- What does this battery assume about the patient? Where could it mislead?
5. Present the plan to the user and WAIT for confirmation before proceeding.

For detailed methodology guidance, see the research-literacy skill.

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⚠️ Verification Notice

This skill was generated by AI from academic literature. All parameters, thresholds, and citations require independent verification before use in research. If you find errors, please open an issue.

Step 1: Clarify the Referral Question

The referral question determines everything. Map it to one of these categories:

(Lezak et al., 2012, Ch. 5; Sweet et al., 2011 -- 78% of neuropsychologists use a flexible battery approach)

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Step 2: Identify Target Cognitive Domains

Based on the referral question and suspected condition, select domains to assess. Every battery MUST cover at least attention/processing speed, memory, and executive function. Add domains based on the clinical picture.

Cognitive Domain Framework

Attention / Processing Speed

• WAIS-IV Processing Speed Index (Coding, Symbol Search): ~15 min (Wechsler, 2008)
• Trail Making Test Part A: ~3 min (Reitan, 1958; deficient if >78 sec, ages 25--54)
• Continuous Performance Test (CPT-3): ~14 min (Conners, 2014)
• WAIS-IV Digit Span (Forward): ~5 min (Wechsler, 2008)

Executive Function

• Wisconsin Card Sorting Test (WCST-64): ~15 min (Heaton et al., 1993)
• Trail Making Test Part B: ~5 min (Reitan, 1958; deficient if >273 sec, ages 25--54)
• Stroop Color-Word Test: ~5 min (Golden, 1978)
• Tower of London/D-KEFS Tower: ~15 min (Shallice, 1982; Delis et al., 2001)
• Verbal Fluency -- FAS: ~5 min (Benton et al., 1994; mean ~36--44 words total for ages 25--54, education 12+ years)
• Verbal Fluency -- Animals: ~2 min (Strauss et al., 2006; mean ~20--24 animals for ages 25--54)

Memory

• WMS-IV (Logical Memory I & II, Verbal Paired Associates I & II): ~30--45 min including delay (Wechsler, 2009)
• CVLT-II/CVLT-3 (California Verbal Learning Test): ~30 min (Delis et al., 2000/2017)
• RAVLT (Rey Auditory Verbal Learning Test): ~15 min (Rey, 1964; Schmidt, 1996)
• BVMT-R (Brief Visuospatial Memory Test--Revised): ~25 min including delay (Benedict, 1997)
• Logical Memory (WMS-IV): immediate and delayed recall; sensitivity 90--95% for MCI when combined with CVLT (Rabin et al., 2009)

Language

• Boston Naming Test (BNT-60): ~15--20 min (Kaplan et al., 1983)
• Token Test (short form): ~10 min (De Renzi & Vignolo, 1962)
• Controlled Oral Word Association (COWA/FAS): ~5 min (listed above under executive; also indexes language)
• Western Aphasia Battery--Revised (WAB-R): ~30--60 min (Kertesz, 2007; use for suspected aphasia)

Visuospatial / Visuoconstructional

• Rey Complex Figure Test -- Copy: ~5--10 min (Osterrieth, 1944; Meyers & Meyers, 1995)
• WAIS-IV Block Design: ~10 min (Wechsler, 2008)
• Judgment of Line Orientation (JLO): ~15 min (Benton et al., 1994)
• Hooper Visual Organization Test (VOT): ~15 min (Hooper, 1983)

Motor Function

• Grooved Pegboard: ~5 min per hand (Klove, 1963; Ruff & Parker, 1993)
• Finger Tapping Test: ~10 min (Halstead, 1947; Reitan & Wolfson, 1993)

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Step 3: Assemble the Battery

Core Battery (~2--3 hours)

Every evaluation should include these unless contraindicated:

Extended Battery (~4--6 hours)

Add these for complex referrals (forensic, dementia differential, pre-surgical):

Assembly Rules

1. One verbal learning test: Choose CVLT-II/III OR RAVLT, not both. They measure overlapping constructs (Strauss et al., 2006--778).
2. One copy figure: RCFT copy OR Block Design for visuoconstruction screening. Use both only if visuospatial function is the primary question.
3. Delay intervals: Schedule verbal memory delay recall (~20--30 min after learning) during non-memory tasks. Same for visual memory delay.
4. Fatigue management: Place demanding tests (WCST, CVLT) early. Place motor tests as breaks. Offer rest periods every 60--90 min (Lezak et al., 2012, Ch. 6).
5. At least one validity measure: Mandatory. Use TOMM Trial 1 (sensitivity 83%, specificity 93% at cutoff <=40; Denning, 2012) as a minimum. For forensic cases, use two or more PVTs from different modalities (Sweet et al., 2011).

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Step 4: Select Appropriate Norms

Normative Data Decision Tree

1. Age: Always match. Most tests provide age-stratified norms.
2. Education: Use education-corrected norms when available (e.g., Heaton et al., 2004 norms for TMT, WCST, verbal fluency).
3. Premorbid IQ: For patients with estimated IQ far from average, IQ-adjusted norms improve accuracy over education alone. MOANS norms found BNT, Token Test, and JLO correlate more strongly with IQ (r = .47--.61) than with education (r = .24--.31) (Steinberg et al., 2005).
4. Cultural/linguistic background: US-normed tests may overestimate impairment in non-English speakers or culturally diverse populations (Lucas et al., 2005; Pena-Casanova et al., 2009). Use population-specific norms when available (e.g., NP-NUMBRS for Spanish speakers).
5. Sex: Match when norms are available. Grooved Pegboard shows significant sex differences: women faster than men (Ruff & Parker, 1993). Finger Tapping: men faster, especially in older groups.