Hold test
Encyclopedia
Hold tests are neuropsychological tests
which tap abilities which are thought to be largely resistant to cognitive
declines following neurological damage
. As a result these tests are widely used for estimating premorbid intelligence in conditions such as dementia
, traumatic brain injury
, and stroke
.
it is important to be able to accurately estimate premorbid intelligence. Accurate estimation allows the quantification of the impacts of neurological damage or decline, when compared to tests of current intelligence. The magnitude of decline is important for prognosis, rehabilitation planning and financial compensation.
Ofcourse, hold tests of abilities directly affected by neurological damage are likely to underestimate intelligence. For example using reading tests in patients with aphasia
.
Some of the other methods used are:
A review examined whether hold tests, best estimate or regression equation methods were most accurate in predicting overall IQ (full scale IQ) as determined by Wechsler Adult Intelligence Scale
(WAIS-R) in a non-neurologically impaired population. It was found that different methods were more accurate depending on the IQ level of participants e.g. WRAT-3 (hold test) was most accurate for those of below average intelligence, NAART (hold test) was most accurate for those of average intelligence and the best estimate method was most accurate for above average intelligence. This provides support for the idea that no single method is superior in all cases and a combination of approaches is most appropriate in clinical practice
.
Neuropsychological test
Neuropsychological tests are specifically designed tasks used to measure a psychological function known to be linked to a particular brain structure or pathway. Tests are used for research into brain function and in a clinical setting for the diagnosis of deficits. They usually involve the...
which tap abilities which are thought to be largely resistant to cognitive
Cognition
In science, cognition refers to mental processes. These processes include attention, remembering, producing and understanding language, solving problems, and making decisions. Cognition is studied in various disciplines such as psychology, philosophy, linguistics, and computer science...
declines following neurological damage
Brain damage
"Brain damage" or "brain injury" is the destruction or degeneration of brain cells. Brain injuries occur due to a wide range of internal and external factors...
. As a result these tests are widely used for estimating premorbid intelligence in conditions such as dementia
Dementia
Dementia is a serious loss of cognitive ability in a previously unimpaired person, beyond what might be expected from normal aging...
, traumatic brain injury
Traumatic brain injury
Traumatic brain injury , also known as intracranial injury, occurs when an external force traumatically injures the brain. TBI can be classified based on severity, mechanism , or other features...
, and stroke
Stroke
A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...
.
Usage
In neuropsychological assessmentNeuropsychological assessment
Neuropsychological assessment was traditionally carried out to assess the extent of impairment to a particular skill and to attempt to locate an area of the brain which may have been damaged after brain injury or neurological illness...
it is important to be able to accurately estimate premorbid intelligence. Accurate estimation allows the quantification of the impacts of neurological damage or decline, when compared to tests of current intelligence. The magnitude of decline is important for prognosis, rehabilitation planning and financial compensation.
Hold tests used
Hold tests typically measure crystallised intelligence, that is stored knowledge and skills, such as vocabulary and pronunciation.Ofcourse, hold tests of abilities directly affected by neurological damage are likely to underestimate intelligence. For example using reading tests in patients with aphasia
Aphasia
Aphasia is an impairment of language ability. This class of language disorder ranges from having difficulty remembering words to being completely unable to speak, read, or write....
.
- National Adult Reading TestNational Adult Reading TestThe National Adult Reading Test is a widely accepted and commonly used method in clinical settings for estimating premorbid intelligence levels of English-speaking patients with dementia in neuropsychological research and practice. Such tests are called hold tests as these abilities are thought to...
(NART) - Wechsler Test of Adult Reading (WTAR)
- Wide Range Achievement TestWide Range Achievement TestThe Wide Range Achievement Test 4 is an achievement test which measures an individual's ability to read words, comprehend sentences, spell, and compute solutions to math problems. The test currently is in its fourth revision....
(WRAT)
Alternate methods
The use of hold tests is only one of a few possible methods of quantification of premorbid function. In practice a neuropsychologist may use a combination of methods to yield the most accurate estimate of premorbid intelligence.Some of the other methods used are:
- Previous testing: While this method can be highly accurate and useful, it is rare that such information is available and even rarer still that any information beyond basic IQ testing was obtained. In the majority of cases this information is not available and other methods of estimation are required.
- Historical method: This involves a clinical interview and review of records to make a subjective estimation of premorbid Intelligence. An advantage of this method is that a clinical interview and review of records are an essential part of assessment and thus can be assessed from information that is obtained in the normal course of assessment.
- Statistical estimation: Involves the incorporation of demographic information, such as age, race education and occupational attainment into a regression equation that yields a probable intelligence complete with standard error of the estimate. One advantage of this method is the avoidance of the use current performance levels.
- Best estimate: This method determined from test scores, other observations and historical data what is the best performance of an individual. Once the highest level of functioning has been identified this is the standard against which all other performance is measured. In general a single high score should not be relied upon, unless supported from other observations. In most cases the the best performance estimate will be based on a cluster of highest scores and a single. For example a doctor who performs in tests at an average level but who has displayed superior function in prior education and occupational performance is obviously underperforming upon potential in test and past education and occupation would represent the best estimate. The advantage of the best estimate method is that a broad range of abilities are taken into account and neuropsychologists are not bound to any single battery of tests.
A review examined whether hold tests, best estimate or regression equation methods were most accurate in predicting overall IQ (full scale IQ) as determined by Wechsler Adult Intelligence Scale
Wechsler Adult Intelligence Scale
The Wechsler Adult Intelligence Scale intelligence quotient tests are the primary clinical instruments used to measure adult and adolescent intelligence. The original WAIS was published in February 1955 by David Wechsler, as a revision of the Wechsler-Bellevue Intelligence Scale...
(WAIS-R) in a non-neurologically impaired population. It was found that different methods were more accurate depending on the IQ level of participants e.g. WRAT-3 (hold test) was most accurate for those of below average intelligence, NAART (hold test) was most accurate for those of average intelligence and the best estimate method was most accurate for above average intelligence. This provides support for the idea that no single method is superior in all cases and a combination of approaches is most appropriate in clinical practice
Clinical neuropsychology
Clinical neuropsychology is a sub-field of psychology concerned with the cognitive function of individuals with neurological and psychiatric disorders. Neuropsychological assessment examines cognitive function in the broadest sense, including the behavioural, emotional, social and functional status...
.