Personality Tests and Tests for Dementia, Attention, and Delirium

Personality Tests and Tests for Dementia, Attention, and Delirium

1. Personality Tests

Personality tests evaluate an individual’s emotional and behavioral aspects. They focus on describing stable aspects of a person’s character that persist into adulthood, such as temperament and behavior patterns. Throughout the 20th century, various tests were developed to assess both specific personality traits and overall personality. These tests are now categorized as objective or projective personality tests.

1.1. Objective Personality Tests

Objective personality tests are standardized self-report instruments that utilize multiple-choice or true/false formats to evaluate different facets of personality. These tests aim to identify personality types, traits, states, self-concept, and even psychopathology for effective treatment planning. Below is a summary of the frequently administered objective personality tests.

Overview of Commonly Administered Objective Personality Tests.

Test	Description
Minnesota Multiphasic Personality Inventory-2 (MMPI-2)	• Purpose: to identify adult psychopathology and assist in the diagnosis of mental disorders.• Intended population: Adults.• Test format: 567 true/false items written at an 8th-grade reading level.• Scales: ten basic or clinical scales (hypochondriasis, depression, conversion hysteria, psychopathic deviant, masculinity-femininity, paranoia, psychasthenia, schizophrenia, hypomania, and social introversion), plus validity scales, including the following:Lie scale (L)—detects the selection of an unusually large percentage of unusual or infrequent responses.Correction scale (K)—detects tendency to downplay psychological symptoms.Infrequency scale (F)—measures degree to which examinee is willing to report psychological symptoms.Variable Response Inconsistency (VRIN) and True Response Inconsistency (TRIN).Alternative forms: An adolescent version (MMPI-A) is available.
Millon Clinical Multiaxial Inventory, Fourth Edition	• Purpose: to assess DSM-5 personality disorders and clinical symptoms of adults.• Intended population: persons 18 years and older.• Test format: 195 true or false items written at a 5th-grade reading level.• Scales: 25 scales that include 15 Clinical Personality Pattern scales, three Severe Clinical Syndrome scales, three Modifying indices, an Inconsistency scale, and a Validity scale.• Additional forms: Millon Adolescent Clinical Inventory (MACI).
Myers-Briggs Type Indicator	• Purpose: measures psychological preferences based on Carl Jung’s psychological types. Can be used to help clients deepen selfawareness and understand similarities and differences in workplace or family personalities, and to help individuals in career counseling to match their personality to a career.• Intended population: individuals 14 years and older.• Test format: 93 items, written at a 7th-grade reading level.• Scales: eight scales representing four related dimensions:Extraversion versus Introversion: Where your energy is directed?Sensing versus Intuition:  How do you perceive the world around you?Thinking versus Feeling: How do you make decisions?Judging versus Perceiving: How do you deal with the external world?• Alternative forms: Form Q has 144 items and is administered to adults 18 years and older.
California Psychological Inventory, Form 434 (CPI 434)	• Purpose: describes basic personality traits of nonpathological, welladjusted individuals. May be used to increase client insight and predict success in many vocational areas.• Intended population: individuals 13 years and older.• Test format: 434 items, half of the items are drawn from the MMPI.•Scales: 20 Folk-Concept Scales (dominance, capacity for status, sociability, social presence, self-acceptance, independence, empathy, responsibility, socialization, self-control, good impression, communality, well-being, tolerance, achievement via conformance, achievement via independence, intellectual efficiency, psychological mindedness, flexibility, and femininity or masculinity).Three Vector Scales (externality-internality, norm favoring versus norm questioning, and self-realization).13 Special-Purpose Scales (management potential, work orientation, creative temperament, masculinity scales, femininity scales, anxiety, social desirability, acquiescence, leadership, amicability, law enforcement orientation, tough-mindedness, and narcissism).
The Sixteen Personality Factors Questionnaire (16PF)	• Purpose: measures the 16 basic personality traits of normal people as defined by Raymond Cattell.• Intended population: individuals 16 years and older.• Test format: 185 multiple-choice items written at a 4th-grade reading level.• Scales: 16 primary scales (five global scales and three validity scales). The primary scales are dichotomous (e.g., relaxed versus tense), with both high and low scores representing a particular personality characteristic.• Alternative forms: high School Personality Questionnaire, Children’s Personality Questionnaire.
The NEO Personality Inventory, Third Edition (NEO PI-3)	• Purpose: to obtain a detailed assessment of normal personality based on the Big Five personality factors: neuroticism, extroversion, openness to experience, agreeableness, and conscientiousness.• Intended population: teenagers and older.• Test format: 240 personality items answered on a five-point agree– disagree continuum and three validity items. Scales: five scales that correspond with each of the Big Five personality factors.
Coopersmith Self-Esteem Inventories (SEI)	• Purpose: designed to measure children’s self-esteem.• Intended population: children ages 8 to 15 years.• Test format: 58 statements in which the test-taker answers “like me” or “unlike me.”• Scales: four subscales that measure self-esteem in regard to peers, parents, school, and personal interests. One lie scale that measures defensiveness.• Alternative forms: Adult Form.

1.2. Projective Personality Tests

Projective personality tests delve into the unconscious attitudes and motivations of individuals by interpreting their responses to ambiguous stimuli. These tests are based on psychoanalytic psychology and aim to identify psychopathology and aid in treatment planning. The following table provides an overview of the commonly used projective personality tests.

Overview of Commonly Administered Projective Personality Tests.

Test	Description
Rorschach inkblot test	• Consists of 10 inkblot cards. The client is asked to talk about what he or she sees on each card.• Scoring of the response uses three components: the location of the portion the client responds to, the determinants that the client used to describe what he or she saw, and the content of the client’s response.
Thematic Apperception Test (TAT)	• Consists of 31 cards that display vague pictures. The client is asked to create a story about the picture on the card with a beginning, middle, and end.• The TAT lacks an agreed-on scoring system.
House-Tree-Person (HTP)	• A projective drawing technique that asks the client to draw a house, a tree, and a person. Drawing characteristics are then interpreted; guidelines for interpretation are available.
Sentence completion tests	• Ask the client to complete a statement such as “I am happy when. . . .” There is no objective scoring method.• Common sentence completion tests include Sentence Completion Series, the EPS Sentence Completion Technique, and the Rotter Incomplete Sentence Blank.

2. Test for Dementia

Assessing dementia involves evaluating cognitive functions and identifying any signs of decline. The testing and diagnosis of dementia typically involve a comprehensive assessment conducted by healthcare and counseling professionals. Here are some common steps and techniques used in the process:

• Medical and Laboratory Tests

• Medical History: Gathering information about the individual’s medical history, including any existing health conditions, medications, and family history of dementia.
• Physical Examination: A thorough physical examination to assess overall health and identify any underlying conditions that may contribute to cognitive impairment.
• Brain Imaging: Neuroimaging techniques such as magnetic resonance imaging (MRI) or computed tomography (CT) scans may be used to examine the brain structure and identify any signs of atrophy or other abnormalities associated with dementia.
• Laboratory Tests: Blood tests may be conducted to rule out other potential causes of cognitive impairment, such as vitamin deficiencies, thyroid dysfunction, or infections.

• Clinical interviewing

Clinical interviewing is the most commonly used assessment technique in counseling. Interviewing refers to the process by which a professional counselor uses clinical skills to obtain client information that will facilitate the course of counseling. Typically, clinical interviews are used to gather information concerning a client’s demographic characteristics, presenting problems, current life situation, family, educational status, occupational background, physical health, and mental health history. Many different types of interviews exist, and they can all be classified as structured, semistructured, or unstructured.

• Structured interviews use a series of pre-established questions that the professional counselor presents in the same order during each interview. The structured interview tends to be detailed and exhaustive as it covers a broad area of topics. Because the questions are predetermined and asked in a sequential manner, structured interviews provide consistency across different clients, counselors, and time periods. However, they do not provide the flexibility to ask follow-up questions or explore client issues more in depth. 
• Semi-structured interviews use pre-established questions and topic areas to be addressed; however, the professional counselor can customize the interview by modifying questions, altering the interview sequence, or adding follow-up questions. Although semistructured interviews allow for more flexibility, they are more prone to interviewer error and bias. Therefore, the results are considered less reliable than structured interviews.
• Unstructured interviews do not use pre-established questions and tend to rely on the client’s lead to determine a focus for the interview. Typically, professional counselors rely on open-ended questioning and reflective skills when conducting an unstructured interview. This type of interview provides the most flexibility and adaptability, but the results are the least reliable and most subject to interviewer error.

• Cognitive Testing

The healthcare professional will administer various cognitive tests to evaluate memory, thinking abilities, language skills, problem-solving, and attention. Examples of commonly used tests include the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA).

• Neuropsychological Evaluation

This comprehensive assessment involves a series of tests and measures to evaluate different aspects of cognitive function, including memory, language, attention, executive functioning, and visuospatial skills. It provides a more detailed profile of the individual’s cognitive strengths and weaknesses.

• Kaufman Assessment Battery for Children (KABC-II)

• Purpose: designed to evaluate preschoolers, minority groups, and children with learning disabilities. Provides information about nonverbal intellectual abilities.
• Intended population: children ages 3 to 18 years.
• Subtests: five subtests (simultaneous, sequential, planning, learning, and knowledge). Has a broad theoretical base that allows the test administrator to use the Luria neuropsychological model and the Cattell/Horn/Carroll (CHC) approach to interpret the subtests.
• Scoring: yields four global scores (sequential processing, simultaneous processing, achievement, and mental processing composite). Uses a mean of 100 and a standard deviation of 15.

• Functional Assessment

Assessing the individual’s ability to perform daily activities and tasks is important to evaluate their functional abilities and determine the level of impairment.

3. Test for Attention

Testing attention typically involves a combination of objective assessments and clinical observations. Here are some commonly used methods to test attention:

• Continuous Performance Test (CPT)

This test presents a series of stimuli, such as letters or numbers, on a computer screen or in a printed format. The participant is instructed to respond when specific target stimuli appear while ignoring non-target stimuli. The test measures sustained attention and vigilance by assessing the ability to maintain focus over an extended period of time.

• Digit Span Test

In this test, the participant is asked to repeat a sequence of digits either in the same order presented (forward digit span) or in reverse order (backward digit span). The test measures working memory and attention by assessing the ability to hold and manipulate information in memory.

• Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV)

• Intended population: individuals ages 16 to 89 years.
• Subtests: contains 15 subtests (symbol search, coding, cancellation, arithmetic, digit span, letter-number sequencing, matrix reasoning, picture completion, block design, visual puzzles, figure weights, comprehension, similarities, vocabulary, and information).
• Scoring: subtests generate a full-scale score and four composite scores (verbal comprehension, perceptual reasoning, processing speed, working memory).

• Trail Making Test

This test consists of two parts. In Part A, the participant is instructed to connect a series of numbered circles in sequential order as quickly as possible. Part A primarily assesses visual attention and sequencing ability. In Part B, the participant alternates between numbered and lettered circles, connecting them in ascending order (e.g., 1-A-2-B-3-C, and so on). Part B additionally evaluates cognitive flexibility and set-shifting ability.

• Stroop Test

The Stroop Test involves presenting words or color patches in incongruent conditions. For example, color names are presented in colored ink, and participants are asked to name the ink color while inhibiting the automatic response of reading the word. This test measures selective attention, response inhibition, and cognitive control.

• Attention Network Test (ANT)

The ANT assesses different attentional networks, including alerting, orienting, and executive control. It presents visual stimuli in different contexts, such as cues that indicate the target location, and measures reaction times and accuracy in response to the stimuli. The ANT provides information about specific attentional processes and their interactions.

4. Test for Delirium

Testing for delirium involves a comprehensive assessment that includes both clinical evaluation and cognitive testing. Here are some commonly used methods and tools for testing delirium:

• Confusion Assessment Method (CAM)

The CAM is a widely used diagnostic tool for delirium. It involves a structured interview that assesses the presence of key features of delirium, including acute onset and fluctuating course, inattention, disorganized thinking, and altered level of consciousness.

• Mini-Mental State Examination (MMSE)

While primarily designed to assess cognitive impairment in general, the MMSE can also provide some insight into attention and orientation, which are affected in delirium. It includes tasks such as orientation to time and place, attention and concentration, memory recall, and language skills.

• Delirium Rating Scales

Several rating scales have been developed specifically for assessing delirium severity and monitoring its progression. Examples include the Delirium Rating Scale-Revised-98 (DRS-R-98) and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU).

• Attention Tests

Various tests are used to specifically evaluate attention deficits, such as the Trail Making Test, Digit Span Test, and the Stroop Test. These tests measure different aspects of attention, including sustained attention, selective attention, and working memory.