@brainpilot/skills 0.0.6

package/skills/10_Clinical_Neuropsychology/neuropsych-battery-selector/references/deficit-profiles.md

@@ -0,0 +1,302 @@
+# Deficit Profiles by Neurological Condition
+
+Expected neuropsychological patterns for common referral conditions. These profiles describe **typical presentations**; individual patients may deviate. Use these as hypotheses to test with the battery, not as diagnostic criteria.
+
+---
+
+## Alzheimer's Disease (AD)
+
+### Typical Profile: Memory >> Executive >> Language > Visuospatial
+
+| Domain | Expected Pattern | Key Indicator |
+|---|---|---|
+| **Memory** | Severely impaired: encoding and storage deficit | CVLT/RAVLT: flat learning curve, rapid forgetting, poor recognition discriminability, high intrusion errors (Delis et al., 2000) |
+| **Language** | Anomia (early); semantic paraphasias | BNT: low score with semantic errors; category fluency (animals) < phonemic fluency (FAS) (Henry et al., 2004) |
+| **Executive function** | Relatively preserved early; declines with progression | WCST: may be intact in early AD; TMT-B: slowed but often proportional to TMT-A slowing |
+| **Visuospatial** | Variable; impaired in posterior cortical atrophy variant | RCFT copy: piecemeal approach; JLO: impaired in PCA variant (Crutch et al., 2012) |
+| **Attention/Speed** | Relatively preserved early | WAIS-IV PSI: mild decline; TMT-A: mildly slowed |
+
+### Distinguishing Features
+
+- **Rapid forgetting**: The hallmark. Delayed recall scores are disproportionately lower than immediate recall. Recognition does NOT rescue performance (encoding/storage deficit, not retrieval).
+- **Intrusion errors**: Elevated on CVLT/RAVLT -- patients insert semantically related non-list words (Delis et al., 2000; Graves et al., 2019).
+- **Semantic fluency < phonemic fluency**: Animals count drops before FAS count; this reversal is relatively specific to AD vs. FTD (Henry et al., 2004).
+- **Temporal gradient**: Remote autobiographical memory is better preserved than recent memory in early stages.
+- **Anosognosia**: Patients often underestimate their deficits; informant reports are critical (Weintraub et al., 2012).
+
+### Atypical AD Variants
+
+- **Posterior cortical atrophy (PCA)**: Visuospatial and visuoperceptual deficits dominate. JLO, RCFT copy, and visual object recognition impaired early. Memory relatively preserved initially (Crutch et al., 2012).
+- **Logopenic primary progressive aphasia**: Word-finding difficulty with phonological errors; impaired sentence repetition. BNT: severely impaired; Token Test: impaired for complex commands (Gorno-Tempini et al., 2011).
+- **Frontal/dysexecutive variant**: Executive dysfunction dominates. WCST perseverative errors, poor verbal fluency, behavioral changes (Ossenkoppele et al., 2015).
+
+### Key References
+- Weintraub, S., Wicklund, A. H., & Salmon, D. P. (2012). The neuropsychological profile of Alzheimer disease. *Cold Spring Harbor Perspectives in Medicine*, 2, a006171.
+- Henry, J. D., Crawford, J. R., & Phillips, L. H. (2004). Verbal fluency performance in dementia of the Alzheimer's type: a meta-analysis. *Neuropsychologia*, 42, 1212--1222.
+
+---
+
+## Behavioral Variant Frontotemporal Dementia (bvFTD)
+
+### Typical Profile: Executive/Behavioral >> Language > Memory >> Visuospatial
+
+| Domain | Expected Pattern | Key Indicator |
+|---|---|---|
+| **Executive function** | Severely impaired: perseveration, disinhibition, poor planning | WCST: high perseverative errors, low categories; Stroop interference: very poor; verbal fluency: reduced, rule violations (Rascovsky et al., 2011) |
+| **Behavioral/Social** | Disinhibition, apathy, loss of empathy, stereotyped behavior | Clinical interview, NPI, informant scales (not captured well by standard cognitive tests) |
+| **Memory** | Relatively preserved encoding; retrieval deficit pattern | CVLT/RAVLT: poor free recall BUT recognition intact (retrieval, not storage deficit). This is the key distinction from AD (Hornberger et al., 2010) |
+| **Language** | Variable; may have word-finding difficulty | BNT: mildly reduced; fluency: reduced output with perseverations and rule breaks |
+| **Visuospatial** | Generally preserved | RCFT copy, Block Design, JLO: typically normal range |
+
+### Distinguishing bvFTD from AD
+
+| Feature | bvFTD | AD |
+|---|---|---|
+| Memory pattern | Retrieval deficit (recognition rescues) | Encoding/storage deficit (recognition impaired) |
+| Semantic vs. phonemic fluency | Phonemic often worse than semantic | Semantic often worse than phonemic |
+| Behavioral changes | Early and prominent | Late feature |
+| Visuospatial | Preserved | Variable, may be impaired |
+| Executive tests | Disproportionately impaired | Often proportional to overall severity |
+
+### Caution
+- bvFTD can be difficult to distinguish from AD in early stages. Up to 10--30% of clinically diagnosed bvFTD cases have AD pathology at autopsy (Perry et al., 2017).
+- Standard neuropsychological tests underdetect bvFTD because they do not adequately assess social cognition, reward processing, or naturalistic executive function.
+- Consider adding: Faux Pas Test, Iowa Gambling Task, or TASIT (The Awareness of Social Inference Test) for social cognition assessment (Torralva et al., 2009).
+
+### Key References
+- Rascovsky, K., et al. (2011). Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia. *Brain*, 134, 2456--2477.
+- Hornberger, M., et al. (2010). Convergent grey and white matter evidence of orbitofrontal cortex changes related to disinhibition in behavioural variant frontotemporal dementia. *Brain*, 134, 2502--2512.
+
+---
+
+## Primary Progressive Aphasia (PPA)
+
+### Semantic Variant (svPPA)
+
+- **Core deficit**: Loss of semantic knowledge -- objects, words, facts
+- **Profile**: Severely impaired naming (BNT: very low, with semantic errors like "animal" for "camel") and single-word comprehension. Fluent but empty speech. Surface dyslexia/dysgraphia. Object recognition impaired.
+- **Memory**: Episodic memory relatively preserved (tests not dependent on semantic knowledge)
+- **Anatomy**: Anterior temporal lobe atrophy, typically left-predominant (Gorno-Tempini et al., 2011)
+
+### Nonfluent/Agrammatic Variant (nfvPPA)
+
+- **Core deficit**: Effortful, halting speech with grammatical errors; impaired comprehension of complex syntax
+- **Profile**: BNT: moderately impaired; speech rate and phrase length reduced; Token Test: impaired for complex commands; repetition impaired for sentences but not single words
+- **Anatomy**: Left inferior frontal and insular atrophy (Gorno-Tempini et al., 2011)
+
+### Key Reference
+- Gorno-Tempini, M. L., et al. (2011). Classification of primary progressive aphasia and its variants. *Neurology*, 76, 1006--1014.
+
+---
+
+## Vascular Dementia (VaD) / Vascular Cognitive Impairment
+
+### Typical Profile: Processing Speed + Executive >> Memory > Language > Visuospatial
+
+| Domain | Expected Pattern | Key Indicator |
+|---|---|---|
+| **Processing speed** | Severely impaired -- often the earliest and most prominent deficit | WAIS-IV PSI: disproportionately low; TMT-A: very slow; SDMT: very low (Sachdev et al., 2014) |
+| **Executive function** | Impaired: particularly cognitive flexibility and working memory | TMT-B: disproportionately slow relative to TMT-A (B/A ratio >3); verbal fluency reduced; WCST: perseverative errors (Sachdev et al., 2014) |
+| **Memory** | Impaired but with retrieval pattern | CVLT/RAVLT: poor free recall but recognition significantly better (encoding relatively preserved). Distinguishes from AD (Graham et al., 2004) |
+| **Visuoconstructional** | Impaired if subcortical pathology present | RCFT copy: disorganized; Block Design: slowed |
+| **Language** | Variable, depends on lesion location | BNT may be intact unless strategic infarct in language areas |
+
+### Subtypes
+
+- **Multi-infarct dementia**: Stepwise decline; focal deficits depend on infarct locations. May have aphasia (left MCA), neglect (right MCA), or memory impairment (PCA/thalamic).
+- **Subcortical ischemic vascular dementia (SIVD)**: Gradual onset; white matter disease disrupts fronto-subcortical circuits. Predominant deficits: processing speed, executive function, and working memory (Sachdev et al., 2014).
+- **Strategic single infarct**: Depends on location -- thalamic infarcts can cause severe memory impairment; caudate infarcts cause executive dysfunction; angular gyrus infarcts cause a Gerstmann-like syndrome.
+
+### Caution
+- Mixed AD + VaD pathology is very common, especially in older adults. "Pure" VaD is relatively rare (Schneider et al., 2007).
+- Recent meta-analysis suggests that cognitive impairment from small vessel disease is NOT limited to executive function and processing speed but affects all domains (Uiterwijk et al., 2016).
+
+### Key Reference
+- Sachdev, P. S., et al. (2014). Diagnostic criteria for vascular cognitive disorders: a VASCOG statement. *Alzheimer Disease & Associated Disorders*, 28, 206--218.
+
+---
+
+## Traumatic Brain Injury (TBI)
+
+### Typical Profile: Attention/Speed + Executive + Memory (severity-dependent)
+
+| Severity | Primary Deficits | Expected Duration |
+|---|---|---|
+| **Mild TBI (concussion)** | Attention, processing speed, working memory | Most resolve within 1--3 months (McCrea et al., 2009). Persistent symptoms (>3 months) in ~10--15% |
+| **Moderate TBI** | Attention, processing speed, memory encoding, executive function | Significant improvement in first 6--12 months; residual deficits common (Rabinowitz & Levin, 2014) |
+| **Severe TBI** | All domains; attention and processing speed most affected | Improvement continues for 2+ years; permanent deficits likely (Rabinowitz & Levin, 2014) |
+
+### Characteristic Pattern (Moderate-Severe)
+
+| Domain | Expected Pattern | Key Indicator |
+|---|---|---|
+| **Attention/Speed** | Disproportionately impaired -- often the most prominent and persistent deficit | TMT-A: very slow; WAIS-IV PSI: low; CPT-3: elevated omissions and slowed RT (Rabinowitz & Levin, 2014) |
+| **Executive function** | Impaired: particularly planning, cognitive flexibility, inhibition | TMT-B: very slow; WCST: perseverative errors; Stroop: poor interference control; verbal fluency: reduced (Dikmen et al., 2009) |
+| **Memory** | Impaired acquisition but relatively preserved retention | CVLT/RAVLT: reduced total learning (slow acquisition) but retention rate (delayed/immediate ratio) may be normal. Distinguishes from AD pattern (Vanderploeg et al., 2001) |
+| **Motor** | Often asymmetric depending on lesion laterality | Grooved Pegboard: slowed, especially in the hand contralateral to focal lesion; Finger Tapping: reduced speed |
+
+### Special Considerations
+
+- **Effort testing is critical**: TBI evaluations (especially in forensic/litigation context) have the highest base rate of invalid performance (~30--40% in medicolegal settings; Mittenberg et al., 2002). Must include multiple PVTs.
+- **Acute vs. chronic assessment**: Avoid comprehensive testing in the first 1--2 weeks post-injury; use serial brief assessments to track recovery trajectory.
+- **Diffuse axonal injury (DAI)**: Produces processing speed and attention deficits disproportionate to focal findings on imaging. Speed-dependent tests (Coding, TMT-A, SDMT) are most sensitive.
+- **Premorbid estimation**: Essential -- many TBI patients have lower premorbid functioning (risk factor for injury); without premorbid estimate, deficits may be over-attributed to injury.
+
+### Key References
+- Rabinowitz, A. R., & Levin, H. S. (2014). Cognitive sequelae of traumatic brain injury. *Psychiatric Clinics of North America*, 37, 1--11.
+- Dikmen, S. S., Corrigan, J. D., Levin, H. S., Machamer, J., Stiers, W., & Weisskopf, M. G. (2009). Cognitive outcome following traumatic brain injury. *Journal of Head Trauma Rehabilitation*, 24, 430--438.
+
+---
+
+## Stroke (by Location)
+
+### Left Hemisphere Stroke
+
+| Vascular Territory | Primary Deficits | Key Tests |
+|---|---|---|
+| **Left MCA (anterior/Broca's area)** | Non-fluent aphasia, apraxia of speech, right hemiparesis (face/arm > leg) | WAB-R (low fluency, preserved comprehension); BNT: severely impaired; verbal fluency: severely reduced |
+| **Left MCA (posterior/Wernicke's area)** | Fluent aphasia with poor comprehension, paraphasias | WAB-R (fluent output, impaired comprehension, impaired repetition); Token Test: severely impaired |
+| **Left MCA (global)** | Global aphasia: severely impaired expression and comprehension | WAB-R: all language domains impaired; AQ very low |
+| **Left PCA** | Alexia without agraphia, right visual field cut, verbal memory impairment | Reading tests impaired; writing preserved; CVLT/RAVLT: impaired |
+| **Left ACA** | Bilateral leg weakness, abulia, transcortical motor aphasia | Reduced verbal output; preserved comprehension and repetition |
+
+### Right Hemisphere Stroke
+
+| Vascular Territory | Primary Deficits | Key Tests |
+|---|---|---|
+| **Right MCA (parietal)** | Left hemispatial neglect (present in ~50% of RH stroke; Heilman et al., 2003), constructional apraxia | Line bisection, star cancellation, RCFT copy (left-sided omissions), Block Design: broken configurations |
+| **Right MCA (frontal)** | Left hemiparesis, motor neglect, anosognosia | Functional assessment; neglect battery |
+| **Right PCA** | Left visual field cut, prosopagnosia, visual-spatial memory impairment | BVMT-R: impaired; face recognition tests; RCFT recall: impaired |
+
+### Caution
+- NIHSS underestimates right hemisphere stroke severity: only 2 points for neglect vs. 7 for aphasia (Foerch et al., 2005).
+- Neglect can be present without awareness (anosognosia); up to 80% of right-hemisphere stroke survivors leave acute care undiagnosed for neglect (Gillen et al., 2005).
+
+### Key Reference
+- Heilman, K. M., Watson, R. T., & Valenstein, E. (2003). Neglect and related disorders. In K. M. Heilman & E. Valenstein (Eds.), *Clinical Neuropsychology* (4th ed.). Oxford University Press.
+
+---
+
+## Parkinson's Disease (PD)
+
+### Typical Profile: Executive + Visuospatial + Processing Speed; Memory Retrieval Deficit
+
+| Domain | Expected Pattern | Key Indicator |
+|---|---|---|
+| **Executive function** | Impaired: particularly set-shifting, planning, and working memory | WCST: perseverative errors; TMT B/A ratio elevated; verbal fluency: reduced, especially phonemic (Kudlicka et al., 2011) |
+| **Visuospatial** | Impaired in posterior cortical subtype | JLO: impaired; RCFT copy: disorganized; clock drawing: spatial errors (Kehagia et al., 2013) |
+| **Processing speed** | Bradyphrenia (slowed thinking, paralleling bradykinesia) | WAIS-IV PSI: low; TMT-A: slowed |
+| **Memory** | Retrieval deficit pattern | CVLT/RAVLT: reduced free recall but recognition intact (subcortical pattern). Differs from AD (Higginson et al., 2012) |
+| **Motor** | Asymmetric; correlates with motor severity | Grooved Pegboard: slowed, correlates with UPDRS motor score (Proud et al., 2023); Finger Tapping: reduced |
+
+### Dual Syndrome Hypothesis (Kehagia et al., 2013)
+
+1. **Frontostriatal subtype**: Dopaminergic. Executive dysfunction, working memory, and planning deficits. May improve with dopamine replacement. Lower risk of rapid dementia conversion.
+2. **Posterior cortical subtype**: Cholinergic. Visuospatial deficits, semantic fluency impairment, visual hallucinations. Higher risk of rapid dementia conversion.
+
+### PD-MCI to PD Dementia Conversion
+
+- PD-MCI prevalence at diagnosis: ~25% (Aarsland et al., 2010)
+- PD dementia cumulative incidence: ~75--80% at 15--20 years (Hely et al., 2008)
+- Risk factors for conversion: posterior cortical deficit pattern, visual hallucinations, older age, more severe motor disease
+
+### Key Reference
+- Kehagia, A. A., Barker, R. A., & Robbins, T. W. (2013). Cognitive impairment in Parkinson's disease: the dual syndrome hypothesis. *Neurodegenerative Diseases*, 11, 79--92.
+
+---
+
+## Multiple Sclerosis (MS)
+
+### Typical Profile: Processing Speed >> Memory (retrieval) > Executive; Language Relatively Spared
+
+| Domain | Expected Pattern | Key Indicator |
+|---|---|---|
+| **Processing speed** | Most consistently impaired domain | SDMT: most sensitive single measure (Benedict et al., 2017; Langdon et al., 2012); WAIS-IV PSI: low; PASAT: impaired |
+| **Memory** | Retrieval deficit with intact encoding | CVLT-II: reduced total learning but recognition relatively intact (DeLuca et al., 2004) |
+| **Executive function** | Variable; depends on lesion load | Verbal fluency: may be reduced; WCST: variable; TMT-B: slowed |
+| **Visuospatial** | Generally preserved | Block Design, JLO: typically normal |
+| **Language** | Generally preserved | BNT: typically normal; naming deficits rare |
+| **Motor** | Often impaired, especially dominant hand | Grooved Pegboard: slowed; may be confounded by spasticity and sensory loss |
+
+### Recommended Brief Battery: BICAMS (Langdon et al., 2012)
+
+The Brief International Cognitive Assessment for MS takes ~15 min:
+1. SDMT (processing speed)
+2. CVLT-II (first 5 learning trials only -- verbal memory)
+3. BVMT-R (first 3 learning trials only -- visual memory)
+
+### Prevalence
+- Cognitive impairment affects 40--65% of MS patients across all disease stages and subtypes (Benedict et al., 2006).
+- Can be present from earliest disease stages (clinically isolated syndrome).
+
+### Key Reference
+- Langdon, D. W., et al. (2012). Recommendations for a Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS). *Multiple Sclerosis Journal*, 18, 891--898.
+
+---
+
+## Epilepsy
+
+### Temporal Lobe Epilepsy (TLE)
+
+| Feature | Left TLE | Right TLE |
+|---|---|---|
+| **Verbal memory** | Impaired (CVLT/RAVLT, Logical Memory) | Relatively preserved |
+| **Visual memory** | Relatively preserved | Impaired (BVMT-R, RCFT recall) |
+| **Naming** | Often impaired (BNT) | Usually preserved |
+| **Executive function** | May be secondarily impaired | May be secondarily impaired |
+| **Lateralization** | Material-specific verbal memory deficit | Material-specific visual memory deficit |
+
+- Memory lateralization is critical for pre-surgical evaluation (Jones-Gotman et al., 2010).
+- Wada/IAP test results should be correlated with neuropsychological findings.
+- Seizure frequency, duration, and age at onset all affect severity of deficits (Hermann et al., 2002).
+
+### Frontal Lobe Epilepsy (FLE)
+
+| Domain | Expected Pattern | Key Indicator |
+|---|---|---|
+| **Executive function** | Impaired: set-shifting, planning, response inhibition | WCST: elevated perseverative errors; Stroop: poor interference; TMT-B: slowed |
+| **Attention/Working memory** | Often impaired | Digit Span backward: low; CPT: elevated errors |
+| **Motor** | Fine motor coordination deficits | Grooved Pegboard: slowed; Finger Tapping: reduced |
+| **Memory** | Less impaired than TLE; may have working memory deficits | CVLT/RAVLT: relatively preserved or mild retrieval deficit |
+| **Language** | Can be impaired, particularly if left frontal | Verbal fluency: reduced; BNT: may be mildly impaired |
+
+### Key Reference
+- Hermann, B. P., Seidenberg, M., Schoenfeld, J., & Davies, K. (2002). Neuropsychological characteristics of the syndrome of mesial temporal lobe epilepsy. *Archives of Neurology*, 54, 369--376.
+
+---
+
+## Dementia with Lewy Bodies (DLB)
+
+### Typical Profile: Visuospatial + Executive + Attention (fluctuating) >> Memory
+
+| Domain | Expected Pattern | Key Indicator |
+|---|---|---|
+| **Visuospatial** | Disproportionately impaired -- key distinguishing feature from AD | RCFT copy: severely disorganized; JLO: impaired; clock drawing: severe spatial distortion; Block Design: impaired (Tiraboschi et al., 2006) |
+| **Executive function** | Impaired: particularly fluency and cognitive flexibility | Verbal fluency: reduced; TMT-B: very slow; Stroop: poor |
+| **Attention** | Fluctuating -- marked variability across and within testing sessions | Digit Span: variable; CPT: inconsistent performance; within-session variability on timed tests |
+| **Memory** | Less impaired than AD; retrieval pattern | CVLT/RAVLT: free recall impaired but recognition relatively preserved (Ferman et al., 2006) |
+
+### Distinguishing DLB from AD
+
+- Visuospatial deficits disproportionate to memory deficits (opposite of AD)
+- Fluctuating cognition (may perform differently on the same test an hour apart)
+- Visual hallucinations (complex, well-formed)
+- Parkinsonism (motor features may appear before or after cognitive symptoms)
+- REM sleep behavior disorder
+
+### Key Reference
+- McKeith, I. G., et al. (2017). Diagnosis and management of dementia with Lewy bodies: Fourth consensus report. *Neurology*, 89, 88--100.
+
+---
+
+## Summary: Differential Diagnosis at a Glance
+
+| Feature | AD | bvFTD | VaD | DLB | PD | TBI |
+|---|---|---|---|---|---|---|
+| **Most impaired** | Memory (encoding) | Executive/behavior | Speed/executive | Visuospatial/attention | Executive/visuospatial | Speed/attention |
+| **Least impaired (early)** | Motor, visuospatial | Visuospatial, memory (recognition) | Language (unless strategic infarct) | Memory (recognition) | Language | Language (unless focal) |
+| **Memory pattern** | Encoding/storage deficit | Retrieval deficit | Retrieval deficit | Retrieval deficit | Retrieval deficit | Acquisition deficit |
+| **Recognition memory** | Impaired | Preserved | Relatively preserved | Relatively preserved | Preserved | Variable |
+| **Fluency pattern** | Semantic < phonemic | Both reduced, perseverations | Both reduced, slowed | Both reduced | Phonemic often worse | Both reduced |
+| **Onset** | Gradual | Gradual (behavioral) | Stepwise or gradual | Gradual with fluctuations | Gradual | Acute |
+| **Key non-cognitive feature** | Anosognosia | Personality change | Vascular risk factors | Hallucinations, parkinsonism | Motor symptoms | History of injury |

package/skills/10_Clinical_Neuropsychology/neuropsych-battery-selector/references/test-catalog.md

@@ -0,0 +1,304 @@
+# Test Catalog: Neuropsychological Tests by Cognitive Domain
+
+Comprehensive reference for tests referenced in the SKILL.md. For each test: cognitive domain, administration time, normative data, sensitivity/specificity for key conditions, and primary citation.
+
+---
+
+## Attention and Processing Speed
+
+### Trail Making Test -- Part A (TMT-A)
+
+- **Construct**: Visual scanning, graphomotor speed, sustained attention
+- **Administration time**: ~3 min
+- **Procedure**: Connect 25 circled numbers (1--25) in ascending order as quickly as possible
+- **Scoring**: Time to completion in seconds
+- **Normative benchmarks**: Mean 29 sec (ages 25--54); deficient >78 sec (Tombaugh, 2004)
+- **Norms available**: Heaton et al. (2004) age/education/sex-corrected; Tombaugh (2004) age-stratified; Mayo MOANS
+- **Sensitivity**: Highly sensitive to generalized cognitive slowing; limited specificity for any single domain
+- **Key citation**: Reitan, R. M. (1958). Validity of the Trail Making Test as an indicator of organic brain damage. *Perceptual and Motor Skills*, 8, 271--276.
+
+### WAIS-IV Processing Speed Index (PSI)
+
+- **Subtests**: Coding (~3 min), Symbol Search (~2 min); supplemental: Cancellation (~3 min)
+- **Construct**: Graphomotor speed, visual scanning, incidental learning
+- **Administration time**: ~15 min total for PSI subtests
+- **Normative sample**: 2,200 adults ages 16--90 (US standardization; Wechsler, 2008)
+- **Sensitivity**: PSI is the most sensitive WAIS-IV index to neurological conditions; earliest to decline in aging and most affected in TBI, MS, VaD (Wechsler, 2008, technical manual)
+- **Key citation**: Wechsler, D. (2008). *WAIS-IV: Administration and Scoring Manual*. Pearson.
+
+### Continuous Performance Test (CPT-3)
+
+- **Construct**: Sustained attention, vigilance, impulsivity
+- **Administration time**: ~14 min
+- **Scoring**: Hit rate, omission errors, commission errors, reaction time, d-prime
+- **Normative sample**: 1,400 individuals ages 8+ (Conners, 2014)
+- **Sensitivity**: Sensitive to ADHD (sensitivity ~80%, specificity ~70% for clinical vs. non-clinical; Epstein et al., 2003)
+- **Key citation**: Conners, C. K. (2014). *Conners Continuous Performance Test 3rd Edition*. Multi-Health Systems.
+
+### Digit Span (WAIS-IV)
+
+- **Construct**: Forward = attention span (~7 +/- 2 digits; Miller, 1956); Backward = working memory; Sequencing = executive working memory
+- **Administration time**: ~5--10 min (all three conditions)
+- **Normative sample**: Part of WAIS-IV standardization (n = 2,200; Wechsler, 2008)
+- **Clinical utility**: Forward span <5 suggests significant attention impairment; Reliable Digit Span (RDS) >= 7 is an embedded PVT cutoff (Greiffenstein et al., 1994)
+- **Key citation**: Wechsler, D. (2008). *WAIS-IV: Administration and Scoring Manual*. Pearson.
+
+### Symbol Digit Modalities Test (SDMT)
+
+- **Construct**: Processing speed, sustained attention, visuomotor integration
+- **Administration time**: ~5 min (90-second timed test)
+- **Normative sample**: Smith (1982); updated norms by Kiely et al. (2014) and Pereira et al. (2015)
+- **Sensitivity**: Recommended as single best measure for MS cognitive screening (Langdon et al., 2012; BICAMS battery). Sensitivity ~80% for MS cognitive impairment (Benedict et al., 2017)
+- **Key citation**: Smith, A. (1982). *Symbol Digit Modalities Test: Manual*. Western Psychological Services.
+
+---
+
+## Executive Function
+
+### Wisconsin Card Sorting Test (WCST-64)
+
+- **Construct**: Cognitive flexibility, set-shifting, abstract reasoning, perseveration
+- **Administration time**: 12--20 min
+- **Scoring**: Categories completed, perseverative errors, perseverative responses, failure to maintain set
+- **Normative sample**: Heaton et al. (1993); 899 individuals ages 6.5--89, stratified by age and education
+- **Sensitivity**: Sensitive to frontal lobe lesions, but not specific -- parietal and diffuse lesions also impair performance (Stuss et al., 2000). Perseverative errors are the most clinically useful score.
+- **Key citation**: Heaton, R. K., Chelune, G. J., Talley, J. L., Kay, G. G., & Curtiss, G. (1993). *Wisconsin Card Sorting Test Manual: Revised and Expanded*. PAR.
+
+### Trail Making Test -- Part B (TMT-B)
+
+- **Construct**: Set-shifting, divided attention, cognitive flexibility
+- **Administration time**: ~5 min
+- **Procedure**: Connect alternating numbers and letters (1-A-2-B-3-C...) in sequence
+- **Scoring**: Time to completion in seconds
+- **Normative benchmarks**: Mean 75 sec (ages 25--54); deficient >273 sec (Tombaugh, 2004)
+- **Sensitivity**: TMT B/A ratio >2.5 suggests executive dysfunction beyond simple slowing (Arbuthnott & Frank, 2000)
+- **Key citation**: Reitan, R. M. (1958). Validity of the Trail Making Test as an indicator of organic brain damage. *Perceptual and Motor Skills*, 8, 271--276.
+
+### Stroop Color-Word Test
+
+- **Construct**: Response inhibition, selective attention, cognitive flexibility
+- **Administration time**: ~5 min (three 45-second trials: word reading, color naming, interference)
+- **Scoring**: Number of items completed per trial; interference score
+- **Normative sample**: Golden (1978); updated by Stroop Normative Update (Pearson)
+- **Sensitivity**: Interference trial sensitive to frontal lobe dysfunction, particularly orbitofrontal and anterior cingulate regions (Stuss et al., 2001)
+- **Key citation**: Golden, C. J. (1978). *Stroop Color and Word Test*. Stoelting.
+
+### Tower of London / D-KEFS Tower Test
+
+- **Construct**: Planning, problem-solving, inhibition, rule-following
+- **Administration time**: ~15 min
+- **Scoring**: Total achievement score, rule violations, move accuracy
+- **Normative sample**: D-KEFS standardization: 1,750 individuals ages 8--89 (Delis et al., 2001)
+- **Sensitivity**: Sensitive to frontal lesions, particularly dorsolateral prefrontal cortex (Shallice, 1982)
+- **Key citation**: Shallice, T. (1982). Specific impairments of planning. *Philosophical Transactions of the Royal Society B*, 298, 199--209.
+
+### Verbal Fluency -- Phonemic (FAS/CFL)
+
+- **Construct**: Phonemic word retrieval, executive search strategy, self-monitoring
+- **Administration time**: ~5 min (3 x 60-second trials)
+- **Scoring**: Total words generated across three letters
+- **Normative benchmarks**: Mean ~36--44 total words for ages 25--54, education 12+ years (Tombaugh et al., 1999)
+- **Sensitivity**: Reduced output in frontal lobe lesions, FTD, PD, depression. More affected than semantic fluency in frontal pathology (Henry & Crawford, 2004)
+- **Key citation**: Benton, A. L., Sivan, A. B., Hamsher, K., Varney, N. R., & Spreen, O. (1994). *Contributions to Neuropsychological Assessment* (2nd ed.). Oxford University Press.
+
+### Verbal Fluency -- Semantic (Animals)
+
+- **Construct**: Semantic memory access, category-driven retrieval
+- **Administration time**: ~2 min (1 x 60-second trial)
+- **Scoring**: Total animals named
+- **Normative benchmarks**: Mean ~20--24 animals for ages 25--54 (Strauss et al., 2006)
+- **Sensitivity**: Reduced output in Alzheimer's disease -- semantic fluency often more impaired than phonemic fluency in AD, opposite pattern in FTD (Henry et al., 2004). Animals <15 is a red flag for dementia in older adults (Canning et al., 2004).
+- **Key citation**: Strauss, E., Sherman, E. M. S., & Spreen, O. (2006). *A Compendium of Neuropsychological Tests* (3rd ed.). Oxford University Press.
+
+---
+
+## Memory
+
+### California Verbal Learning Test -- Second/Third Edition (CVLT-II/CVLT-3)
+
+- **Construct**: Verbal list learning, encoding strategies, recall (immediate/delayed/cued), recognition, intrusions
+- **Administration time**: ~30 min (including 20-min delay)
+- **Scoring**: Trials 1--5 total, short/long delay free/cued recall, recognition discriminability, semantic clustering, intrusions
+- **Normative sample**: CVLT-II: 1,087 adults ages 16--89 (Delis et al., 2000). CVLT-3: updated 2017 sample with new indices (Delis et al., 2017)
+- **Sensitivity**: Total learning score: sensitivity 90.2%, specificity 84.2% for distinguishing MCI from normal aging (Rabin et al., 2009). CVLT-3 novel intrusion analysis differentiates AD (encoding deficit, high intrusions) from HD (retrieval deficit) (Graves et al., 2019)
+- **Clinical decision**: If AD is suspected, examine recognition discriminability and intrusion pattern. Intact recognition + poor free recall = retrieval deficit (subcortical). Poor recognition = encoding/storage deficit (hippocampal/AD).
+- **Key citation**: Delis, D. C., Kramer, J. H., Kaplan, E., & Ober, B. A. (2000). *California Verbal Learning Test--Second Edition*. Pearson.
+
+### Rey Auditory Verbal Learning Test (RAVLT)
+
+- **Construct**: Verbal list learning, interference susceptibility, recognition
+- **Administration time**: ~15 min (including delay)
+- **Scoring**: Trials 1--5 total, interference trial, immediate/delayed recall, recognition
+- **Normative sample**: Schmidt (1996); Mitrushina et al. (2005); multiple international normative datasets
+- **Sensitivity**: Comparable to CVLT-II for detecting memory impairment. Advantage: free to use (no copyright fee), shorter administration, multiple alternate forms available
+- **Difference from CVLT**: RAVLT does not provide semantic clustering analysis or cued recall trials, limiting qualitative analysis of encoding strategies
+- **Key citation**: Schmidt, M. (1996). *Rey Auditory Verbal Learning Test: A Handbook*. Western Psychological Services.
+
+### Wechsler Memory Scale -- Fourth Edition (WMS-IV)
+
+- **Subtests**: Logical Memory I/II, Verbal Paired Associates I/II, Visual Reproduction I/II, Designs I/II
+- **Construct**: Auditory memory (narrative, associative), visual memory, immediate vs. delayed recall
+- **Administration time**: Adult battery (ages 16--69): ~75--130 min; Older Adult battery (ages 65--90): ~45--60 min (Wechsler, 2009; Pearson)
+- **Normative sample**: 1,400 adults ages 16--90 (co-normed with WAIS-IV; Wechsler, 2009)
+- **Sensitivity**: Logical Memory recognition + CVLT-II long delay = 87.5% accurate classification of MCI-to-AD conversion over 4 years (Rabin et al., 2009). WMS-IV full battery provides Auditory Memory Index, Visual Memory Index, Immediate Memory Index, Delayed Memory Index.
+- **Key citation**: Wechsler, D. (2009). *WMS-IV: Technical and Interpretive Manual*. Pearson.
+
+### Brief Visuospatial Memory Test -- Revised (BVMT-R)
+
+- **Construct**: Visual-spatial learning and memory
+- **Administration time**: ~25 min (including 25-min delay)
+- **Scoring**: Three learning trials (total recall), delayed recall, recognition discrimination
+- **Normative sample**: 588 adults ages 18--79 (Benedict, 1997)
+- **Sensitivity**: Included in BICAMS battery for MS. Sensitive to right temporal and parietal lesions. Alternate forms available (6 forms), reducing practice effects in serial assessment.
+- **Key citation**: Benedict, R. H. B. (1997). *Brief Visuospatial Memory Test--Revised*. PAR.
+
+---
+
+## Language
+
+### Boston Naming Test (BNT)
+
+- **Construct**: Confrontation naming, word retrieval
+- **Administration time**: 60-item: ~15--20 min; 30-item short form: ~10 min
+- **Scoring**: Total correct (spontaneous + with stimulus cues); qualitative error analysis
+- **Normative sample**: Mitrushina et al. (2005); Mayo MOANS (Steinberg et al., 2005) -- correlation with IQ (r = .61) stronger than with education (r = .31). BNT is strongly influenced by cultural and linguistic background.
+- **Sensitivity**: Sensitive to AD naming impairment (anomia is early feature); naming errors in AD are predominantly semantic (superordinate or semantically related), while in non-fluent aphasia errors are phonemic (Lezak et al., 2012, Ch. 13)
+- **Caution**: Significant cultural bias in item selection. Some items (e.g., "pretzel," "beaver") are culturally specific. Use local norms or adapted versions for non-US populations.
+- **Key citation**: Kaplan, E., Goodglass, H., & Weintraub, S. (1983). *The Boston Naming Test*. Lea & Febiger.
+
+### Token Test (Short Form)
+
+- **Construct**: Auditory comprehension, receptive language
+- **Administration time**: ~10 min (36-item short form; De Renzi & Faglioni, 1978)
+- **Scoring**: Total correct out of 36
+- **Normative sample**: MOANS norms (Steinberg et al., 2005); NEURONORMA (Pena-Casanova et al., 2009) age/education-adjusted
+- **Sensitivity**: Sensitive to subtle receptive language deficits that may be missed by bedside exam. Useful for differentiating aphasia subtypes.
+- **Key citation**: De Renzi, E., & Vignolo, L. A. (1962). The Token Test: A sensitive test to detect receptive disturbances in aphasics. *Brain*, 85, 665--678.
+
+### Western Aphasia Battery -- Revised (WAB-R)
+
+- **Construct**: Comprehensive aphasia assessment (fluency, comprehension, repetition, naming)
+- **Administration time**: Full: ~60 min; Bedside screening: ~15 min
+- **Scoring**: Aphasia Quotient (AQ), Cortical Quotient (CQ), classifies aphasia type
+- **Normative sample**: Kertesz (2007); aphasia classification validated against lesion studies
+- **Sensitivity**: Gold standard for aphasia classification and severity rating. Use when aphasia is suspected from clinical presentation or screening.
+- **Key citation**: Kertesz, A. (2007). *Western Aphasia Battery--Revised*. Pearson.
+
+---
+
+## Visuospatial and Visuoconstructional
+
+### Rey Complex Figure Test (RCFT)
+
+- **Construct**: Copy = visuoconstructional ability, planning; Recall = visual memory
+- **Administration time**: Copy ~5--10 min; Immediate recall ~3 min; Delayed recall (30 min) ~3 min
+- **Scoring**: 36-point scoring system (Osterrieth, 1944; Meyers & Meyers, 1995)
+- **Normative sample**: Meyers & Meyers (1995): 601 adults ages 18--89
+- **Sensitivity**: Copy score sensitive to right parietal lesions and executive planning deficits (piecemeal approach). Recall sensitive to right temporal lesions. Qualitative approach (organizational strategy) adds diagnostic value (Troyer & Wishart, 1997).
+- **Key citation**: Meyers, J. E., & Meyers, K. R. (1995). *Rey Complex Figure Test and Recognition Trial*. PAR.
+
+### WAIS-IV Block Design
+
+- **Construct**: Visuoconstructional ability, spatial analysis, nonverbal problem-solving
+- **Administration time**: ~10 min
+- **Scoring**: Timed accuracy score; bonus points for speed
+- **Normative sample**: Part of WAIS-IV standardization (n = 2,200; Wechsler, 2008)
+- **Sensitivity**: Sensitive to right parietal lesions. "Broken configuration" errors (loss of 2x2 or 3x3 gestalt) suggest constructional apraxia.
+- **Key citation**: Wechsler, D. (2008). *WAIS-IV: Administration and Scoring Manual*. Pearson.
+
+### Judgment of Line Orientation (JLO)
+
+- **Construct**: Visuospatial perception (angular discrimination) -- no motor component
+- **Administration time**: ~15 min (30-item form); ~8 min (15-item short form)
+- **Scoring**: Total correct out of 30
+- **Normative sample**: Benton et al. (1994); MOANS age/IQ-adjusted (Steinberg et al., 2005); sex differences: men outperform women by ~2 points (Benton et al., 1994)
+- **Sensitivity**: Sensitive to right parietal lesions and posterior cortical atrophy. Useful in PD (posterior cortical subtype) and DLB (Cagnin et al., 2015)
+- **Key citation**: Benton, A. L., Sivan, A. B., Hamsher, K., Varney, N. R., & Spreen, O. (1994). *Contributions to Neuropsychological Assessment* (2nd ed.). Oxford University Press.
+
+### Hooper Visual Organization Test (VOT)
+
+- **Construct**: Visual organization, mental integration of fragmented stimuli
+- **Administration time**: ~15 min
+- **Scoring**: Total correct out of 30 (half-credit scoring available)
+- **Normative sample**: Hooper (1983); updated norms in Mitrushina et al. (2005) for ages 20--85
+- **Sensitivity**: Sensitive to right hemisphere lesions and diffuse brain damage. Less culturally biased than BNT because stimuli are visual, but naming component introduces some language demand.
+- **Key citation**: Hooper, H. E. (1983). *Hooper Visual Organization Test Manual*. Western Psychological Services.
+
+---
+
+## Motor Function
+
+### Grooved Pegboard Test
+
+- **Construct**: Fine motor dexterity, eye-hand coordination, motor speed
+- **Administration time**: ~5 min per hand (~10 min total)
+- **Procedure**: Insert 25 keyed pegs into randomly oriented holes; dominant hand first
+- **Scoring**: Time to completion (seconds) per hand; errors (pegs dropped)
+- **Normative sample**: Ruff & Parker (1993): 360 adults ages 16--70, stratified by age/sex/education. Sex differences: women faster than men. NP-NUMBRS for Spanish speakers (Heaton et al., 2021).
+- **Sensitivity**: Sensitive to motor impairment in PD (correlated with motor severity; Proud et al., 2023), MS, TBI. Lateralized slowing suggests contralateral hemisphere pathology.
+- **Discontinue**: After 5 min per hand if not completed (Klove, 1963)
+- **Key citation**: Klove, H. (1963). Clinical neuropsychology. In F. M. Forster (Ed.), *The Medical Clinics of North America*. Saunders.
+
+### Finger Tapping Test
+
+- **Construct**: Motor speed, lateralized motor function
+- **Administration time**: ~10 min (5 x 10-sec trials per hand)
+- **Procedure**: Tap a lever with the index finger as rapidly as possible
+- **Scoring**: Mean taps per 10-second trial for each hand
+- **Normative benchmarks**: Men dominant hand mean ~50 taps; women ~46 taps (Ruff & Parker, 1993). Non-dominant hand typically 5--10% slower. >10% difference between hands suggests lateralized impairment.
+- **Normative sample**: Ruff & Parker (1993): 360 adults ages 16--70. Gender differences: men faster, especially in older groups.
+- **Sensitivity**: Sensitive to contralateral motor cortex lesions, basal ganglia pathology, cerebellar dysfunction
+- **Key citation**: Reitan, R. M., & Wolfson, D. (1993). *The Halstead-Reitan Neuropsychological Test Battery: Theory and Clinical Interpretation* (2nd ed.). Neuropsychology Press.
+
+---
+
+## Premorbid Estimation
+
+### Test of Premorbid Functioning (TOPF)
+
+- **Construct**: Premorbid intellectual functioning (estimated FSIQ range 53--141)
+- **Administration time**: ~10 min
+- **Procedure**: Read aloud 70 phonemically irregular words
+- **Normative sample**: Co-normed with WAIS-IV and WMS-IV (Pearson, 2009)
+- **Accuracy**: Reading tests provide the most reliable premorbid estimates; addition of demographics provides modest improvement. Underestimates IQ in high-functioning individuals (Bright & van der Linde, 2020).
+- **Key citation**: Pearson (2009). *Advanced Clinical Solutions for WAIS-IV and WMS-IV*. Pearson.
+
+### Wechsler Test of Adult Reading (WTAR)
+
+- **Construct**: Premorbid intellectual functioning
+- **Administration time**: ~10 min
+- **Procedure**: Read aloud 50 irregular words
+- **Normative sample**: Co-normed with WAIS-III and WMS-III (Wechsler, 2001)
+- **Limitation**: Inaccurate at both extremes of IQ distribution. Predecessor to TOPF; use TOPF if available.
+- **Key citation**: Wechsler, D. (2001). *Wechsler Test of Adult Reading*. Pearson.
+
+---
+
+## Performance Validity Tests (PVTs)
+
+### Test of Memory Malingering (TOMM)
+
+- **Construct**: Effort/performance validity (visual recognition memory format)
+- **Administration time**: Trial 1 ~10 min; Full (Trials 1 + 2 + Retention): ~20--30 min
+- **Scoring**: Correct responses out of 50 per trial
+- **Standard cutoff**: <45 on Trial 2 or Retention Trial
+- **Classification accuracy (standard cutoff)**: Specificity .96--1.00; Sensitivity .15--.50 (Tombaugh, 1996)
+- **Trial 1 cutoff (<=40)**: Sensitivity .83; Specificity .93 (Denning, 2012). Recommended as efficient screen.
+- **TOMMe10 (first 10 items, >=2 errors)**: Sensitivity .74; Specificity .93 (Armistead-Jehle & Gervais, 2020)
+- **Key citation**: Tombaugh, T. N. (1996). *Test of Memory Malingering*. Multi-Health Systems.
+
+### Word Memory Test (WMT)
+
+- **Construct**: Effort/performance validity (verbal recognition memory format)
+- **Administration time**: ~15--20 min
+- **Scoring**: Immediate Recognition, Delayed Recognition, Consistency
+- **Classification accuracy**: More sensitive than TOMM (Green, 2003), but higher false-positive rate in genuine cognitive impairment. 67% of MCI patients fail at standard cutoffs (Green, 2003). Hard-easy comparison improves specificity to ~95%.
+- **Caution**: Not appropriate as sole PVT in dementia evaluations -- use in combination with embedded measures
+- **Key citation**: Green, P. (2003). *Word Memory Test for Windows*. Green's Publishing.
+
+### Embedded PVTs
+
+- **Reliable Digit Span (RDS)**: Sum of longest forward + longest backward digit span passed on both trials. Cutoff >= 7 (Greiffenstein et al., 1994). Specificity ~90%.
+- **CVLT-II Forced Choice Recognition**: Cutoff <=15 (Delis et al., 2000). Specificity ~95%.
+- **WCST Failure to Maintain Set (FMS)**: Elevated FMS with otherwise intact performance suggests suboptimal engagement.
+- **Recommendation**: Use at least 2 embedded PVTs to supplement standalone measures (Larrabee, 2012; Sweet et al., 2011)