In this manner, the cognitive status of the patient is defined with increasing precision throughout the evaluation. Standardized tests are adapted to provide additional qualitative information while retaining the standardized procedures necessary for normative comparison.
Both qualitative and quantitative information are thus obtained. A more detailed description of the Boston process approach can be found in Milberg et al. Rosemarie M. Bowler, Muriel D. Lezak, in Handbook of Clinical Neurology , Neuropsychology is the study of brain—behavior relationships.
Its history may be traced to an assertion by Hippocrates — bc relating brain and mind and then by Galen ad — , who first described brain anatomy. The practice of neuropsychology, as we know it today, owes much to the work of Alexander Luria — , who, in conjunction with his mentor, Lev Vygotsky — , postulated that each area in the central nervous system served one of three basic functions: 1 the brainstem was involved in regulating arousal; 2 the posterior areas of the cortex were involved in reception, integration, and sensory analysis; and 3 the frontal and prefrontal lobes were involved in planning, executing, and carrying out the behavior Luria, , Luria conceptualized brain—behavior relationships in terms of functional systems representing interactive patterns of brain operations between defined areas of the brain.
The findings from these examinations spurred brain research as wounds due to penetrating missile shrapnel allowed examiners to relate small areas of brain damage to specific behavioral and cognitive deficits. Thurstone, C. Seashore, and others that he thought would identify patients with frontal-lobe dysfunction.
Ralph Reitan, then a psychologist working with Halstead, added to Halstead's battery a test of communication abilities developed by J. From the early s on, other psychologists were developing tests important for neuropsychology in the USA and elsewhere. Arthur Benton, at the University of Iowa, devised many relatively brief tests of specific cognitive functions, as did Elizabeth Warrington and her colleagues McCarthy and Warrington, in England and Brenda Milner , in Canada. In Australia, Kevin Walsh wrote about the necessity of going beyond test scores to include the qualitative aspects of patients' examination responses if a patient's condition is to be truly understood, an examination approach evolved independently by Edith Kaplan and her co-workers in Boston Kaplan, Before the days of sophisticated neuroimaging, neuropsychology was mostly used for the identification and localization of a cerebral lesion.
The first systematic applications of neuropsychologic assessment thus dealt with diagnosis. Over time, neuropsychologists not only became more skilled at localizing brain lesions on the basis of neuropsychologic test data, but developed specific criteria for predicting the nature of behavioral changes and functional loss.
In their efforts to separate psychiatric patients from those who were neurologically impaired, some clinicians in the s and s created single tests or test scoring systems purporting to achieve this goal, i. Neuropsychologic assessment procedures have developed rapidly during the last three decades, reflecting the growing appreciation of its value for neurodiagnostic questions and for the care and treatment of neurologically impaired patients, and for patients needing cognitive and behavioral rehabilitation Lezak et al.
Moreover, neuropsychologic assessment has made significant contributions to basic science research and to clinical knowledge in the neurologic sciences, psychiatry, and in clinical and cognitive psychology Frackowiak et al.
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The current integrated approach to neuropsychologic assessment is a complex undertaking requiring basic clinical psychology knowledge and training, knowledge of brain function and integration and how it relates to common and critical patterns of behavior, and an understanding of the tests and assessment techniques used to assess brain dysfunction.
As noted by Vanderploeg ,. Regardless of the structure of the evaluation, the process neither begins nor ends with giving tests alone Vanderploeg, ; see Milberg et al. Elbert W. Formal neuropsychology is based on science and hence the chapter reviews the nature of science. The essence of science is to demonstrate the existence of knowledge by means of objective observation methods that are repeatable, testable, and verify predictions. There are two forms of science: discovery and justification. Discovery introduces constructs or theories and methods to science, which are often incorrect.
Consequently, to be reliable, science must justify its procedures by a validation process that usually determines their accuracy. All discovered methods and information must be justified to be reliable. Thus, justification is the essence of science.
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To accomplish this process, science requires instrumentation. This chapter lays particular emphasis on instrumentation, because the basis of neuropsychology is its instrumentation. This instrumentation was derived from psychology, although the form of the instrumentation in neuropsychology pertains to testing procedures related to brain functioning.
Download as PDF. Set alert. About this page. A more recent article on neuropsychological evaluations in adults is available. Abstract Neuropsychological Assessment Uses in Primary Care Outcomes References Article Sections Abstract Neuropsychological Assessment Uses in Primary Care Outcomes References Referring a patient to a neuropsychologist for evaluation provides a level of rigorous assessment of brain function that often cannot be obtained in other ways.
The neuropsychologist integrates information from the patient's medical history, laboratory tests, and imaging studies; an in-depth interview; collateral information from the family and other sources; and standardized assessment instruments to draw conclusions about diagnosis, prognosis, and response to therapy. Family physicians can use this information in the diagnosis and treatment of patients with depression, dementia, concussion, and similar conditions, as well as to address concerns about decision-making capacity.
Certain assessment instruments, such as the Mini-Mental State Examination and Patient Health Questionnaire—9, are readily available and easily performed in a primary care office. Distinguishing among depression, dementia, and other conditions can be challenging, and consultation with a neuropsychologist at this level can be diagnostic and therapeutic.
The neuropsychologist typically helps the patient, family, and primary care team by establishing decision-making capacity; determining driving safety; identifying traumatic brain injury deficits; distinguishing dementia from depression and other conditions; and detecting malingering. Neuropsychologists use a structured set of therapeutic activities to improve a patient's ability to think, use judgment, and make decisions cognitive rehabilitation. Repeat neuropsychological evaluation can be invaluable in monitoring progression and treatment effects.
Family physicians often assess patients in whom there are concerns about behavioral health. Challenges arise in differentiating psychiatric disease from medical conditions e. The family physician is trained to address these issues and to make use of diagnostic tools that identify and treat these conditions. There are times, however, when the family physician requires consultation in evaluating and treating these patients. Neuropsychological assessment, as part of a comprehensive clinical assessment, is useful in distinguishing Alzheimer disease from vascular dementia. Neuropsychological assessment is particularly valuable in patients with subtle deficits and is useful in treating patients with multiple sclerosis, Parkinson disease, traumatic brain injury, stroke, and human immunodeficiency virus encephalopathy.
Neuropsychological assessment in patients with cognitive concerns is predictive in determining future motor vehicle crash risk, although assessment alone does not reduce this risk. Neuropsychological assessment is able to identify depression in patients with neurologic impairment, and monitor response to treatment. Neuropsychological assessment is valuable in diagnosing and following patients with concussion.
Many assessment instruments can be used to identify psychological conditions and direct treatment in primary care. Screening for depression, anxiety, and dementia has been discussed in the family medicine literature.
Neuropsychology - an overview | ScienceDirect Topics
Some of the most common screening instruments used in primary care are listed in Table 1 , 4 — 10 and their role in the diagnosis and treatment of neuropsychological conditions is defined in Figures 1 through 4. Information from references 4 through This article is directed toward adult patients in whom a more formal assessment of the interaction among neurologic, psychological, and behavioral function is warranted. Neuropsychologists assess brain function and impairment by drawing inferences from a patient's objective test performance.
Tests of neuropsychological function are often able to detect subtle cognitive deficits that are undetected by electrophysiologic or imaging methods. Furthermore, neuropsychological services use a structured set of therapeutic activities designed to improve a patient's ability to think, use judgment, and make decisions cognitive rehabilitation , and show benefit in treating these deficits.
Identify characteristic profile associated with various neurobehavioral syndromes as an aid in differential diagnosis. Distinguish between normal and early dementia, and among varieties of dementia e. Evaluate the contribution of medication adverse effects and nutritional deficiencies. Establish possible localization, lateralization, and etiology of a brain lesion. Use as an aid before surgical interventions e. Determine neuropsychological deficits as an aid in treatment decisions and recommendations. Behavioral modification with regard to a specific deficit e.
Detect early problems in diseases with neurocognitive manifestations e. Provide treatment recommendations to patient, family, and health care professional. Remediate and compensate for deficits identified on neuropsychological evaluation. Monitor cognitive changes associated with recovery, disease progression, and treatment. Aid patient, family, and health care team with information about decision-making capacity.
Determine if psychological disorders are present, including somatoform disorder vs. Assist in the evaluation of symptom validity and potential malingering or feigning.
Neuropsychological assessment of children and adults with traumatic brain injury
Information from references 15 , 17 , and A neuropsychologist integrates many sources of information and standardized assessment instruments designed to evaluate specific aspects of brain functioning Table 3. Reason for evaluation; presenting symptoms. Medical, surgical, and behavioral health history. Medication history. Previous neuropsychological assessments. Educational and occupational background. Family medical and mental health history.
In-depth interview typically one to two hours. In addition to the history mentioned above, interviews typically include birth and early development, abuse or neglect, childhood experiences, travel history, course of cognitive or neurologic symptoms, current work or academic performance, substance use, emotional functioning, personality characteristics, family dynamics, interpersonal relationships, legal circumstances, patient perspectives on illness and treatment, motivation, and observations of nonverbal neurobehavioral signs.