Vanshika

Gahlot
Akshi Gup
ta
Malvika W
adhawan
Chandni
Chauhan
Nitya Du
bey

NIMHANS
Neuropsychological Battery
 Table of Content
Introduction
Assessment of Speed
Assessment of Attention
Assessment of Executive Functioning
Assessment of Comprehension

Assessment of Learning & Memory

Assessment of Language & visuospatial abilities
Interpretation and Application in Clinical Settings
Introduction
The NIMHANS Neuropsychological Battery is a comprehensive
set of tests developed by the National Institute of Mental
Health and Neurosciences (NIMHANS), Bangalore, to assess
cognitive functions in individuals with various neurological and
psychiatric conditions. This battery of tests is specifically
designed to cater to the Indian population, taking into
consideration cultural and linguistic differences, making it one
of the most widely used neuropsychological assessment tools in
India.
 Historical Perspective of the NIMHANS Neuropsychological
Battery

01 Origins (1990s) 02 Early Development

Developed due to the lack of Initiated by B.S. Rao, T.
culturally relevant Subbakrishna, and K. Gopakumar at
neuropsychological tests in India. NIMHANS, Bengaluru.
Western tests often failed to Aimed to create a comprehensive
account for India's cultural, neuropsychological battery for
educational, and linguistic diversity. Indian populations.
The mismatch led to inaccurate Direct translations of Western
cognitive assessments in Indian tests were insufficient, leading to
clinical settings. the development of new or adapted
tests.
Need for Culturally Appropriate Tools Establishing Norms
Cultural Relevance: Many Western tests contained Extensive research conducted to establish
unfamiliar elements, making them difficult to normative data representative of the
interpret for Indian individuals, especially those
Indian population.
from rural areas.
Educational Influence: India’s wide educational Norms were developed based on variables
disparities required a battery that could assess like age, educational levels, and linguistic
cognition without being biased by literacy or formal backgrounds.
education. Enabled accurate diagnosis by comparing
Language Differences: India’s diverse languages
test performance to peers from similar
(over 22 official languages) necessitated the
development of tests that could be easily translated demographic backgrounds.
and adapted.
Expansion and Validation
The NIMHANS Neuropsychological Battery underwent extensive validation for various neurological and
psychiatric disorders, including traumatic brain injury (TBI), stroke, epilepsy, dementia, Parkinson's
disease, and schizophrenia. Its reliability and cultural relevance made it a widely implemented tool in
hospitals, academic research, and clinical practice across India. Over time, the battery became the
gold standard for neuropsychological assessments in the country, offering a comprehensive,
culturally sensitive method for evaluating cognitive functions in diverse populations and setting a
benchmark for clinical diagnostics and research. With its establishment, clinicians gained a reliable
resource for accurate diagnosis and treatment planning, ultimately improving patient outcomes.
Furthermore, the battery’s continuous evolution and adaptation to emerging research findings ensure
its relevance in the ever-changing landscape of neuropsychology.
05 Child Battery (2004) International Recognition
Gained international attention
Developed by Kan Rao, for addressing cultural
Chandramouli, and Thrennasrasu differences in cognitive
following the success of the adult testing.
version. Some countries with similar
cultural or demographic
Focused on neuropsychological
challenges have adapted the
assessment from a developmental
battery for their populations.
perspective. A recognized tool for
Useful for studying cognitive studying cognitive deficits in
development and growth profiles in non-Western settings.
children at different age levels.
 Purpose and Application of the
NIMHANS Battery

Evaluates cognitive domains in TBI, stroke, dementia,

epilepsy, Parkinson’s disease, schizophrenia, and
developmental disorders.
Maps cognitive deficits and behavioral issues to
brain dysfunction.
Aids in accurate diagnosis, disease progression
monitoring, and treatment planning.
Culturally and linguistically suited for Indian
populations; internationally recognized.
 DOMAIN FUNCTION TEST

Motor speed Finger Tapping Test

SPEED
Mental Speed Digit Symbol Substitution Test

Focused Attention Colour Limit Test

ATTENTION Sustained Attention Digit Vigilance Test
Divided Attention Triads Test

Control oral word tests

Verbal Fluency Association test
Category Fluency animal naming test
Design FLuency design fluency test
Working Memory N-back test
EXECUTIVE FUNCTIONING
Planning Self-Ordered pointing test
Set Shifting Tower of London
Response Inhibition Wisconsin Card
Verbal Comprehension Sorting Test
Stroop test

COMPREHENSION verbal Comprehension Token Test

Auditory Verbal Learning Test

LEARNING AND MEMORY Verbal
Logical Memory test

VISUO-SPATIOL CONSTRUCTION Visual Complex Figure test

LEARNING AND MEMORY Visual Design Learning test

Assessment of
Speed
 SPEED

Motor speed refers to the ability to execute physical movements quickly and
efficiently, often measured through tasks that assess hand or body movements, like
tapping or drawing. It reflects how well the brain and muscles coordinate to perform
actions and can be affected by neurological conditions, aging, or motor disorders.

Mental speed refers to the quickness of cognitive processing—how fast the brain can
perceive, interpret, and respond to information. It’s crucial for tasks like decision-
making, problem-solving, and reaction time. Reduced mental speed can be a sign of
cognitive decline, brain injury, or conditions like ADHD or dementia.

Both motor and mental speed are important for understanding overall cognitive and
neurological health. Assessing them can help identify deficits in brain function and
guide treatment strategies.
 Tests Used in the NIMHANS Battery
for Speed

Finger Tapping Test Digit Symbol Test

Also known as the Digit Symbol

This test assesses motor speed and Substitution Test (DSST), this assesses
coordination. In this test, the individual mental speed, attention, and cognitive
is asked to tap a key or button as flexibility. The test involves a key grid
rapidly as possible with one finger where each number (1-9) is paired with a
(typically the index finger) for a specified unique symbol. The individual is then
duration, such as 10 or 20 seconds. The given a list of numbers and must fill in
number of taps completed within the time the corresponding symbols as quickly as
frame is recorded. This provides a possible within a time limit. This test
measure of how quickly the individual can measures how quickly the individual can
execute repetitive motor movements. process information and execute a
mental task involving symbol
substitution.
Assessment of
Attention
 Attention

Attention is the cognitive process that allows individuals

to focus on specific stimuli or tasks for an extended
period. Disorders like ADHD, traumatic Brain Injury, and
Stroke can impair attention, making it a crucial domain to
assess.
 Subtypes of Attention

Sustained Selective Divided Alternating

Attention Attention Attention Attention
Ability to
Ability to focus
maintain Ability to Ability to switch
on relevant
consistent manage more focus between
stimuli while
behavioural than one task different taks
ignoring
reponses during simultaneously
distractions.
continous,
repetitive tasks
 Color Trails Test
The Color Trails Test measures focused attention and cognitive flexibility by having
participants connect numbered circles in sequence and alternate colors. It evaluates

Tests used attentional control and is useful for identifying cognitive impairments.

in Digit Vigilance Test

NIMHANS The Digit Vigilance Test assesses sustained attention by requiring participants to

for identify a target digit within a sequence of random digits over time. It helps diagnose
attention issues, particularly in ADHD and traumatic brain injury.
Attention
Triads Test
The Triads Test evaluates **divided attention** by requiring responses to multiple
stimuli (numbers, colors, shapes) simultaneously. It assesses cognitive flexibility and
multitasking, useful for detecting frontal lobe deficits and early-stage dementia.
EXECUTIVE FUNCTIONING
Executive functions refer to higher-level
cognitive processes that are crucial for
goal-directed behavior.
These functions are primarily
managed by the frontal lobes
and include planning, problem-
solving, cognitive flexibility, and
inhibitory control.
Key Components of Executive Function
Verbal Fluency: The ability to generate words within a certain time frame
based on specific criteria, such as starting with a particular letter or belonging
to a certain category.

Category Fluency: A subtype of verbal fluency where individuals are asked to

generate as many words as possible from a specific category within a set time
frame.

Design Fluency: The ability to generate novel designs or patterns, often

assessed through tasks that require drawing or creating visual stimuli.

Working Memory: The capacity to hold and manipulate information in mind over
short periods while performing cognitive tasks.

Planning: The ability to formulate, evaluate, and select a course of action to

achieve specific goals.

Set Shifting: The capacity to switch between thinking about two different
concepts or to think about multiple concepts simultaneously.

Response Inhibition: The ability to suppress impulsive responses and delay

gratification in favor of more appropriate or beneficial responses.
 This Test measures working memory and
This test evaluates selective attention and cognitive control by presenting participants
cognitive flexibility by asking participants to with a sequence of stimuli and requiring
read the color of the ink of a word rather them to identify matches from "n" steps
than the word itself The difference in time earlier (e.g., 2-back). This test evaluates the
between reading the words and naming the ability to hold and manipulate information,
making it useful for assessing cognitive
colors provides insight into attentional
performance in attention deficits and
control and inhibition.

Stroop Test
tests used in learning disabilities.

N back Test
the nimhans
battery for The Animal Naming Test evaluates
The Self-Ordered Pointing Test evaluates
working memory and executive functioning
executive category fluency and semantic memory by
requiring participants to name as many
by asking participants to point to items in a
sequence without repeating selections. This
fucntioning animals as possible within 60 seconds. The
total number of responses provides
task assesses organizational skills and insights into verbal fluency and cognitive
planning, helping identify cognitive deficits processing speed, which can indicate
in individuals with frontal lobe damage or potential semantic memory deficits in
psychiatric disorders. conditions such as Alzheimer's disease.

Self Ordered Pointing Test Animals Name Test

 Wisconsin Card Sorting Test Design Fluency Test Control Oral Word Test

Though not always part of all This test requires participants to The COWT measures verbal fluency
versions of the NIMHANS battery, it create unique visual patterns, assessing by asking participants to generate
is frequently used to assess cognitive visuospatial creativity and executive words starting with a specific
flexibility, problem-solving, and the functioning, often used to evaluate
letter or from a particular
ability to adapt to changing rules. right hemisphere cognitive abilities.
category within a time limit. It
The participant is asked to match offering insights into executive
assesses language processing and
cards, but the matching principle function impairments in populations
executive control, often used in
changes periodically, requiring with brain injuries or psychiatric
cognitive assessments.
adaptability disorders.

Tower of London Test Association Test

The Tower of London test assesses

planning and problem-solving by having This test measures the ability to
participants arrange colored disks on pegs form meaningful connections
to match a target configuration, following between words or concepts,
specific rules. This task measures planning assessing semantic memory and
abilities and foresight, making it effective associative thinking. It's useful
for identifying executive function deficits
for evaluating creativity and
in individuals with brain injuries or
problem-solving.
neurological diseases.
 Clinical Significance
Attention Disorders: Impaired performance on tests like the Digit Span or Stroop Test may
indicate difficulties in attention. These could be symptoms of conditions like ADHD, frontal lobe
damage, or diffuse brain injuries.
Executive Dysfunction: Poor performance in tests like the Verbal Fluency or WCST may indicate
frontal lobe damage or disorders like dementia, traumatic brain injury, or schizophrenia. For
example, patients with Alzheimer’s or frontotemporal dementia often show deficits in executive
function tasks.
Applications in Clinical Settings: These tests are commonly used in clinical settings to assess
patients with suspected frontal lobe dysfunction, ADHD, and other cognitive disorders. Results
help in diagnosis, treatment planning, and rehabilitation strategies.
Assessment of
Comprehension
 Verbal comprehension - Token Test
Verbal Comprehension is the ability to understand spoken language, assessed
through interviews and aphasia batteries. The Token Test measures this skill by
using tokens of various colors, sizes, and shapes to evaluate a participant's
ability to follow spoken commands of increasing complexity. This test is
essential for identifying verbal comprehension issues related to Wernicke's
area.

In the Token Test, participants are instructed to manipulate tokens according

to commands given by the examiner. The instructions become progressively
more difficult, and participants receive up to two repetitions if they fail to
comply. Scoring is based on correctly followed commands, with deductions for
repetitions, and the maximum score is 36. This test effectively helps clinicians
assess language comprehension and identify potential deficits.
 ASSESSMENT OF
learning & MEMORY
 learning
TYPES OF
LEARNING - is defined as a relatively permanent change in
behavior, knowledge, or skills that occurs as a result of experience.
It involves the processes through which individuals acquire new
information or modify existing knowledge, behaviors, and skills in
response to their environment.
ITS TYPES -
Classical Conditioning: Learning through association, where a
neutral stimulus becomes linked to a meaningful stimulus (e.g.,
Pavlov’s dogs).
Operant Conditioning: Learning based on the consequences of
behavior, where behaviors are shaped by rewards or
punishments (e.g., Skinner’s experiments).
Observational Learning: Learning by watching and imitating
others (e.g., Bandura’s Bobo doll experiment).
 sensory memory

01.
The initial stage of memory that holds
sensory information for a very short time
(milliseconds to seconds). Allows us to
briefly retain impressions of sensory
stimuli, such as sights and sounds.

MEMORY short term memory

02.
It temporarily holds information for a brief

Memory is a fundamental period (about 20 to 30 seconds). Limited to

about 7±2 items (Miller's Law). Used for

cognitive process that immediate tasks like problem-solving or

following conversations.

allows us to encode, store,

long term memory
and retrieve information. It
03.
A more permanent storage system that
plays a crucial role in can hold vast amounts of information over
extended periods (from minutes to a
learning, decision-making, lifetime).

and forming our identities

working memory

04.
A specific type of short-term memory that is
used for processing and manipulating
information. Involves active maintenance of
information needed for cognitive tasks like
reasoning and comprehension.
 Tests Used in the NIMHANS Battery
for Learning & Memory
Rey’s Auditory Verbal
Learning Test (RAVLT) Logical Memory Test Design Learning Test
The Logical Memory Test The Design Learning Test
Rey’s Auditory Verbal Learning
measures immediate and evaluates immediate memory
Test (RAVLT) assesses verbal
delayed recall of a span, new learning, delayed
learning and memory by recall, and recognition of
meaningful story adapted for
evaluating an individual's ability nonverbal material. Comprising
the Indian population using
to learn and recall a list of 15 13 simple patterns, the test
familiar names. Participants
words across multiple trials. The includes a learning phase where
listen to a short passage
test includes immediate recall participants copy each pattern
containing 21 facts, followed
trials, an interference task to and an immediate recall phase
by immediate recall. After a
disrupt memory, delayed recall with multiple trials. After a
30-minute delay, they are
after a brief interval, and a four-hour delay, a delayed
asked to recall the facts
recognition trial to identify recall phase assesses the
again without prior warning.
original words among number of designs accurately
The scores reflect the number recalled. This test is beneficial
distractors. Commonly used in
of correctly recalled facts in for assessing visual memory
neuropsychological assessments, both immediate and delayed and recall abilities in
RAVLT helps identify memory conditions, making this test individuals.
deficits and track cognitive useful for assessing verbal
changes over time. memory in clinical settings.
Asse ss m en t o f
Visu os pa tial
Learning
 VISUSPATIAL ABILITY
Visuospatial ability is the cognitive skill that allows individuals to understand and mentally manipulate
visual and spatial relationships between objects. This includes recognizing object locations, distances,
and their interrelations, which is essential for tasks like navigation, drawing, assembling puzzles, and
copying designs. Deficits in this ability are often linked to right hemisphere brain damage, such as from
strokes or traumatic brain injuries, affecting daily activities like driving and navigating unfamiliar
environments.

Complex Figure Test

The Complex Figure Test assesses visuospatial memory by having participants recall and draw a complex
figure from memory. After an initial copying phase, subjects are asked to recall the figure immediately
after three minutes, during which they may engage in an unrelated task. They then draw the figure again
after a 30-minute delay, during which they are given another unrelated task without prior notice of the
recall requirement. Participants must draw freehand, using no rulers, although erasers are allowed. Scoring is
based on accuracy and placement, with a maximum score of 2 for accurately drawn and placed units, down
to 0 for omitted or unrecognizable units. The entire procedure lasts about 15 minutes, including time for a non-
visual task during the delay
Interpretation and
Application in
Clinical Settings
 CLINICAL APPLICATIONS
The NIMHANS Neuropsychological Battery has several clinical applications, particularly in the assessment
of cognitive functions in individuals with neurological and psychiatric disorders. Some key applications
include:
1. Diagnosis of Cognitive Impairments: It helps in diagnosing cognitive deficits related to conditions
like dementia, traumatic brain injury, epilepsy, stroke, and neurodegenerative diseases such as
Parkinson’s or Alzheimer’s disease.
2. Monitoring Disease Progression: The battery can track cognitive decline or improvement over time,
making it useful for monitoring the progression of neurodegenerative conditions or the
effectiveness of treatment interventions.
3. Pre- and Post-surgical Evaluation: It is often used in pre-surgical and post-surgical evaluations,
particularly for patients undergoing procedures like epilepsy surgery, to assess changes in cognitive
functions post-intervention.
4. Psychiatric Evaluations: The battery aids in differentiating between cognitive deficits due to
psychiatric disorders (such as schizophrenia, depression) versus those caused by organic brain
damage.
5. Rehabilitation and Cognitive Remediation: The test results guide personalized rehabilitation and
cognitive remediation programs, providing a foundation for targeted therapeutic interventions based
on an individual's specific cognitive strengths and weaknesses.
6. Developmental Disorders: It can also be used to assess cognitive function in developmental
conditions such as learning disabilities or ADHD, helping to design interventions for educational and
developmental support.
Normative
The sample included normal volunteers recruited
Data from relatives of NIMHANS patients, staff, students,
and community members, all with no history of
neurological, psychiatric illnesses, or family histories
of alcohol dependence, schizophrenia, or bipolar
disorder. Participants scoring within a specific range
on the General Health Questionnaire (GHQ-12) were
included. The sample was categorized by age (16-30,
31-50, and 51-65 years), education (illiterate, up to 10
years of education, and more than 10 years), and
gender, ensuring equal representation of males and
females within each education category. Each age-
gender category in the literate group included at
least 30 subjects, as did the illiterate group.
 SCORING
The NIMHANS Neuropsychological Battery is a comprehensive tool
designed to assess various cognitive functions such as attention, memory,
executive functions, visuospatial abilities, and language. Scoring is
typically done using raw scores for individual subtests, which are then
compared to normative data adjusted for factors such as age, education,
and cultural background. Each test's raw score is converted to a
standardized score, allowing clinicians to assess cognitive impairments
relative to the population norms. The final interpretation considers the
individual's overall cognitive profile, identifying specific areas of
strength and weakness to inform diagnosis and treatment planning in
neurological or psychiatric conditions.
Thank
You