The Neurobehavioral Cognitive Status Examination (NCSE), a screening examination that assesses cognition in a brief but quantitative fashion, uses independent tests to evaluate functioning within five major cognitive ability areas: language, constructions, memory, calculations, and reasoning. The examination separately assesses level of consciousness, orientation, and attention. This instrument quickly identifies intact areas of functioning, yet provides more detailed assessment in areas of dysfunction. Standardization data are provided for 119 healthy adults (age range, 20 to 92 years) and for 30 patients receiving neurosurgical care for brain lesions (range, 25 to 88 years). Cognitive profiles for several common neuropsychiatric conditions illustrate the usefulness of this examination in clinical practice.

Studies to determine the validity of the Mini-Mental State Examination (MMSE) and the Cognitive Capacity Screening Examination (CCSE) have indicated unacceptably high false-negative rates for these tests. To determine whether a new examination, the Neurobehavioral Cognitive Status Examination (NCSE), is more sensitive in the detection of cognitive dysfunction, we compared the three examinations in 30 patients with documented brain lesions. The CCSE had a false-negative rate of 53%; the MMSE, of 43%; and the NCSE, of 7%. The sensitivity of the NCSE is derived from two features of its design: the use of independent tests to assess skills within five major areas of cognitive functioning, and the use of graded tasks within each of these cognitive domains.

Block-design construction tasks reliably assess cognitive deficits due to brain injury. We examined the important aspects of this task with four experiments using normal subjects. Two problem-solving strategies are identified: an analytic strategy in which subjects mentally segment each block in the design to be constructed and a synthetic strategy, which involves wholistic pattern matching. Three experiments found a predominate analytic strategy. The time to place a single test block in a display decreased the greater the number of interior edges for that block in the design. Also, two-colored blocks requiring an orientation judgment were placed slower than solid blocks. The fourth experiment predicted overall construction times for a design from the number of solid blocks and interior edges of its blocks. These studies suggest refinements in the blockdesign test for investigating constructional disability in brain-damaged patients. We recommend such analyses of other neuropsychological tests.

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Neuropsychological data were obtained on 81 patients with cerebral lesions and on 87 patients presenting signs and symptoms of cerebral dysfunction but who received nonneurological discharge diagnoses. Two methods of combining neuropsychological test results were compared for percentage of accuracy in classifying subjects into appropriate groups. A standard deviation averaging method using 2'-score conversion tables for raw score data was found to be superior to the Halstead impairment index for the nonncurologic group only. The difference was attributed to the tendency of the Halstead index to misclassify older, normal subjects as brain damaged. The cutting score used by the averaging method (-1 standard deviation) was considered to be pathognomonic in that very few nonneurological subjects scored lower than this point.