The Empirical and Clinical Utility of Neurocognitive Tests

  1. The skills that are measured in the Gur Battery include very discrete, elemental functions: attention, recall, memory, etc.
  2. Actually, the individual does not operate in terms of discrete functions, but the actions are generally a synthesis of integrated functions.
  3. The usual level of functioning involves broader superordinate functions, such as problem solving, concept formation, application of previous knowledge, creativity, etc. They arebound together by a specific or general purpose, something that is deficient in the default (regressive) mode in the severely mentally ill.
  4. Thus, these tests do not evaluate the total integrative capacity of the mind (brain).
  5. The literature demonstrates that the tests are subject to a variety of confounds: setting (medical/recreational), motivation, and effort, meaningfulness of the test, and defeatist attitudes. Keith has published a paper showing that the Beck Cognitive Insight Scale (reflectiveness and flexibility) also correlate with the Gur scores. He found the direction is from BCIS to Gur score.
  6. Because of the confounds, the tests do not show the tests do not tell the true or pure ability.
  7. The San Diego scores (the favorite outcome measure) Further, the outcome measures, such as the San Diego test also measure relatively discrete skills.
  8. To get a more valid assessment of the individual’s ability, it would involve increasing motivation and effort. There are a variety of behavioral methods, such as reinforcement, shaping, and feedback, etc.
  9. We have observed that an individual, who has scored two standard deviations below normal on the test, could engage in challenges, such as playing chess or driving a car, when motivated.
  10. If the tests are used to measure the capacity, we would want to administer them when the patient is at his best (motivated, has purpose, and not bound by defeatist attitudes).
  11. It has been found that the tests can help to predict transition to psychosis in high risk individuals. The point here is that the tests demonstrate the patient at his/her worst point.
  12. A new approach would be to develop tests that a) are more complex and b) take into account the individual’s strengths and resources. Perhaps some variant of the Sternberg test would be useful.
  13. The tests have some empirical value in that in longitudinal studies they demonstrate vulnerability at the earliest stages, before traumatic events, and then as a measure of prodromal vulnerability to move into psychosis.
  14. Additional Hypothesis: When the individuals are withdrawn and in their beds, they are in the default mode, which activates hallucinations, as well as regressive behavior.