Which neuropsychological tests would you take with you to an island?

Ripe for the island: Which neuropsychological tests would you take with you to an island?

Imagine you are to be taken to a remote island, but you are only allowed to take a limited number of things with you. Despite the lack of space, the island obviously places great emphasis on high-quality health care. Indeed, you are to take with you what you consider to be the most useful neuropsychological tests – and your international colleagues have been invited to do the same. Would you tend to suspect that everyone would select a similar test inventory, or would there be strong regional differences in selection?

Neuropsychological tests have a high relevance worldwide

What is certain is that neuropsychological tests are commonly used around the world. Many neurological diseases and psychiatric disorders lead to cognitive impairments, which can occur in different forms and degrees of severity. This poses a particular challenge to differentiated diagnostics. Therefore, since the beginning of neuropsychology, many different test paradigms have been developed to help objectively assess cognitive impairment.  Even in times of imaging techniques such as MRI or PET, neuropsychological tests still play a major role in diagnostics and are an essential tool in the practice of many neuropsychologists worldwide.

Which neuropsychological tests are most commonly used?

In recent years, several standardized surveys of neuropsychological practice have been conducted worldwide1-6 , asking questions about (neuro)psychological training, current work situation, most commonly studied disorders, and therapeutic methods used. A central question, however, was of course also which neuropsychological tests are most frequently used. The respondents could choose from a list of 60 regionally used tests. From these, rankings were compiled per country/region.

Table 1 summarizes the country-specific rankings of surveys from Latin America¹, France², Spain³, USA⁴, South Africa⁵ and Italy⁶ and ranks them according to which tests or test paradigms are most frequently used in several countries.

The top 3 neuropsychological tests in the world: Trail Making Test, Word List Learning Tests, and Stroop Test

Table 1: Summary ranking of the most frequently used neuropsychological tests/test paradigms.

* For the ranking “Gesamt” we considered 1) in how many countries the test/test paradigm was mentioned in the top 20 and 2) which mean rank was reached across all countries.

1. Trail Making Test: Trail Making Test: The popularity of the Trail Making Test is easy to explain: The test can be administered in a very short time, is easy to understand, and has proven to be a sensitive test for detecting cognitive impairment, especially in a variety of neurological and psychiatric disorders. Indeed, despite the simplicity of the task, various cognitive functions such as information processing speed or cognitive flexibility can be assessed. A first precursor of the Trail Making Test was developed as early as 1938 and subsequently integrated into test batteries of the US Army. Since then, many different variants of the test have been developed, such as the digital Langensteinbach version in the Vienna Test System. (TMT-L).

2. word-list learning tests: word-list learning tests (such as CVLT, RAVLT or the Auditory Word-List Learning Test AWLT in the Vienna Test System) are frequently used, especially for the investigation of memory disorders. Although several variants of the test paradigm exist in different languages, the central idea is to memorize a list of words in several learning sessions in order to be able to recall them at a later time. By dividing the test into several test phases, different memory functions can be recorded: immediate recall, learning ability, and long-term memory performance such as free recall and recall of learning content after shorter and/or longer pauses. In addition, the test paradigm can also be transferred well to nonverbal content such as the recall and reproduction of abstract figures (see Figural Memory Test FGT in the Vienna Test System).

3. Stroop Test: In 1935, J. R. Stroop published an influential article on a mental phenomenon we now know as the Stroop effect – the interference between automatic and controlled mental processing. Reading is a much more automated cognitive activity than naming colors. Therefore, naming the color of a visually presented word is slowed down when the content of the word contradicts the color (e.g., the word “red” is written in the color yellow). Later on, it turned out that this experimental psychological test paradigm is also suitable for the investigation of (neuro-)psychological questions in the applied field, because the tendency to interference differs depending on the cognitive impairment. In particular, individuals with frontal dysfunctions show conspicuities here. Today, the Stroop test paradigm is most easily performed in digital form (see STROOP in the Vienna Test System).

The international neuropsychological test inventory is relatively homogeneous

When comparing these countries, it is immediately noticeable that the same tests or test paradigms appear repeatedly in each country-specific test list. This indicates that the test paradigms themselves work well in different cultures. Moreover, the relatively homogeneous test selection is particularly noteworthy given the diversity of cognitive dimensions and existing test paradigms. Thus, on our imaginary island, you would most likely find a small but proven selection of tests and test paradigms, and thus notice that neuropsychologists worldwide work with a similar toolbox.

References:

¹Arango-Lasprilla, J. C., Stevens, L., Morlett Paredes, A., Ardila, A., & Rivera, D. (2017). Profession of neuropsychology in Latin America. Applied Neuropsychology:Adult, 24(4), 318–330. https://doi.org/10.1080/23279095.2016.1185423

²Lopes, A. B., Leal, G., Malvy, L., Wauquiez, G., Rivera, D., & Arango-Lasprilla, J. C. (2019). Neuropsychology in France. Applied Neuropsychology: Adult. https://doi.org/10.1080/23279095.2019.1633329

³Olabarrieta-Landa, L., Caracuel, A., Pérez-García, M., Panyavin, I., Morlett-Paredes, A., & Arango-Lasprilla, J. C. (2016). The profession of neuropsychology in Spain: Results of a national survey. Clinical Neuropsychologist, 30(8), 1335–1355. https://doi.org/10.1080/13854046.2016.1183049

⁴Rabin, L. A., Paolillo, E., & Barr, W. B. (2016). Stability in test-usage practices of clinical neuropsychologists in the United States and Canada over a 10-year period: A follow-up survey of INS and NAN members. Archives of Clinical Neuropsychology, 31(3), 206–230. https://doi.org/10.1093/arclin/acw007

⁵Truter, S., Mazabow, M., Morlett Paredes, A., Rivera, D., & Arango-Lasprilla, J. C. (2018). Neuropsychology in South Africa. Applied Neuropsychology:Adult, 25(4), 344–355. https://doi.org/10.1080/23279095.2017.1301453

⁶Onida, A., Di Vita, A., Bianchini, F., Rivera, D., Morlett-Paredes, A., Guariglia, C., & Arango-Lasprilla, J. C. (2018). Neuropsychology as a profession in Italy. Applied Neuropsychology:Adult, 0(0), 1–15. https://doi.org/10.1080/23279095.2018.1466782