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The attempts to derive the links between the damage to specific brain areas and problems in behaviour are known throughout the history for 3 millenia. However, the first systematic neuropsychological assessment and a battery of the behavioural tasks to investigate specific aspects of behavioural regulation was developed by Alexander Luria in 1942-1948. Luria was working with big samples of brain-injured Russian solders during and after the second World War. Among many insights from Luria's rehabilitation practice and observations, was the fundamental discovery of the involvement of frontal lobes of the cortex in plasticity, initiation, planning and organization of behaviour. His Go/no-go task, which was one of the tasks screening for the frontal lobe damage, "count by 7", hands-clutching, clock-drawing task, drawing of repeatitive patterns, word associations and categories recall and others became standard components of neuropsychological assessment and mental status screening. Considering the originality and multiplicity of neuropsychological components offered by Alexander Luria, he is recognized as a father of neuropsychological assessment. Alexander Luria's neuropsychological battery was adapted in the United States in the form of Luria-Nebraska neuropsychological battery in 1970s. Then the tasks used in this battery were borrowed in more modern neuropsychological batteries and in the Mini–mental state examination test for screening of demenia.
Neuropsychological assessment was traditionally carried out to assess the extent of impairment to a particular skill and to attempt to determine the area of the brain which may have been damaged following brain injury or neurological illness. With the advent of neuroimaging techniques, location of space-occupying lesions can now be more accurately determined through this method, so the focus has now moved on to the assessment of cognition and behaviour, including examining the effects of any brain injury or neuropathological process that a person may have experienced.
A core part of neuropsychological assessment is the administration of neuropsychological tests for the formal assessment of cognitive function, though neuropsychological testing is more than the administration and scoring of tests and screening tools. It is essential that neuropsychological assessment also include an evaluation of the person's mental status. This is especially true in assessment of Alzheimer's disease and other forms of dementia. [1] Aspects of cognitive functioning that are assessed typically include orientation, new-learning/memory, intelligence, language, visuoperception, and executive function. However, clinical neuropsychological assessment is more than this and also focuses on a person's psychological, personal, interpersonal and wider contextual circumstances.
Assessment may be carried out for a variety of reasons, such as:
Miller outlined three broad goals of neuropsychological assessment. Firstly, diagnosis, to determine the nature of the underlying problem. Secondly, to understand the nature of any brain injury or resulting cognitive problem (see neurocognitive deficit) and its impact on the individual, as a means of devising a rehabilitation programme or offering advice as to an individual's ability to carry out certain tasks (for example, fitness to drive, or returning to work). And lastly, assessments may be undertaken to measure change in functioning over time, such as to determine the consequences of a surgical procedure or the impact of a rehabilitation programme over time. [2]
Certain types of damage to the brain will cause behavioral and cognitive difficulties. Psychologists can start screening for these problems by using either one of the following techniques or all of these combined:
This includes gathering medical history of the patient and their family, presence or absence of developmental milestones, psychosocial history, and character, severity, and progress of any history of complaints. The psychologist can then gauge how to treat the patient and determine if there are any historical determinants for his or her behavior.
Psychologists use structured interviews in order to determine what kind of neurological problem the patient might be experiencing. There are a number of specific interviews, including the Short Portable Mental Status Questionnaire, Neuropsychological Impairment Scale, Patient's Assessment of Own Functioning, and Structured Interview for the Diagnosis of Dementia. [3]
Scores on standardized tests of adequate predictive validity predictor well current and/or future problems. Standardized tests allow psychologists to compare a person's results with other people's because it has the same components and is given in the same way. It is therefore representative of the person's's behavior and cognition. The results of a standardized test are only part of the jigsaw. Further, multidisciplinary investigations (e.g. neuroimaging, neurological) are typically needed to officially diagnose a brain-injured patient. [4]
Testing one's intelligence can also give a clue to whether there is a problem in the brain-behavior connection. The Wechsler Scales are the tests most often used to determine level of intelligence. The variety of scales available, the nature of the tasks, as well as a wide gap in verbal and performance scores can give clues to whether there is a learning disability or damage to a certain area of the brain. [3]
Other areas are also tested when a patient goes through neuropsychological assessment. These can include sensory perception, motor functions, attention, memory, auditory and visual processing, language, problem solving, planning, organization, speed of processing, and many others. Neuropsychological assessment can test many areas of cognitive and executive functioning to determine whether a patient's difficulty in function and behavior has a neuropsychological basis. [5]
Tsatsanis and Volkmar believe that assessment can provide unique information about the type of disorder a patient has which allows the psychologist to come up with a treatment plan. Neuropsychological assessment can clarify the nature of the disorder and determine the cognitive functioning associated with a disorder. Assessment can also allow the psychologist to understand the developmental progress of the disorder in order to predict future problems and come up with a successful treatment package. Different assessments can also determine if a patient will be at risk for a particular disorder. However, assessing a patient at one time is not enough to go ahead and continue treatment because of the changes in behavior that can occur frequently. A patient must be retested multiple times in order to make sure that the current treatment is still the right treatment. For neuropsychological assessments, researchers discover the different areas of the brain that is damaged based on the cognitive and behavioral aspects of the patient. [4]
The most beneficial factor of neuropsychological assessment is that is provides an accurate diagnosis of the disorder for the patient when it is unclear to the psychologist what exactly he/she has. This allows for accurate treatment later on in the process because treatment is driven by the exact symptoms of the disorder and how a specific patient may react to different treatments. The assessment allows the psychologist and patient to understand the severity of the deficit and to allow better decision-making by both parties. [6] It is also helpful in understanding deteriorating diseases because the patient can be assessed multiple times to see how the disorder is progressing.
One area where neuropsychological assessments can be beneficial is in forensic cases where the defendant's competency is being questioned due to possible brain injury or damage. A neuropsychological assessment may show brain damage when neuroimaging has failed. It can also determine whether the individual is faking a disorder (malingering) in order to attain a lesser sentence. [7]
Most neuropsychological testing can be completed in 6 to 12 hours or less. This time, however, does not include the role of the psychologist interpreting the data, scoring the test, making formulations, and writing a formal report. [7]
 | The examples and perspective in this section deal primarily with the United States and do not represent a worldwide view of the subject.(October 2012) |
Neuropsychological assessments are usually conducted by doctoral-level (Ph.D., Psy.D.) psychologists trained in neuropsychology, known as clinical neuropsychologists. The definition and scope of a clinical neuropsychologist is outlined in the widely accepted Houston Conference Guidelines. [8] They will usually have postdoctoral training in neuropsychology, neuroanatomy, and brain function. Most will be licensed and practicing psychologists in their particular field. [4] Recent developments in the field allow for highly trained individuals such as psychometrists to administer selected instruments, though determinations regarding testing results remain the responsibility of the doctor.
Neuropsychology is a branch of psychology concerned with how a person's cognition and behavior are related to the brain and the rest of the nervous system. Professionals in this branch of psychology focus on how injuries or illnesses of the brain affect cognitive and behavioral functions.
Rehabilitation of sensory and cognitive function typically involves methods for retraining neural pathways or training new neural pathways to regain or improve neurocognitive functioning that have been diminished by disease or trauma. The main objective outcome for rehabilitation is to assist in regaining physical abilities and improving performance. Three common neuropsychological problems treatable with rehabilitation are attention deficit/hyperactivity disorder (ADHD), concussion, and spinal cord injury. Rehabilitation research and practices are a fertile area for clinical neuropsychologists, rehabilitation psychologists, and others.
Neuropsychological tests are specifically designed tasks that are used to measure a psychological function known to be linked to a particular brain structure or pathway. Tests are used for research into brain function and in a clinical setting for the diagnosis of deficits. They usually involve the systematic administration of clearly defined procedures in a formal environment. Neuropsychological tests are typically administered to a single person working with an examiner in a quiet office environment, free from distractions. As such, it can be argued that neuropsychological tests at times offer an estimate of a person's peak level of cognitive performance. Neuropsychological tests are a core component of the process of conducting neuropsychological assessment, along with personal, interpersonal and contextual factors.
Cognitive neuropsychology is a branch of cognitive psychology that aims to understand how the structure and function of the brain relates to specific psychological processes. Cognitive psychology is the science that looks at how mental processes are responsible for the cognitive abilities to store and produce new memories, produce language, recognize people and objects, as well as our ability to reason and problem solve. Cognitive neuropsychology places a particular emphasis on studying the cognitive effects of brain injury or neurological illness with a view to inferring models of normal cognitive functioning. Evidence is based on case studies of individual brain damaged patients who show deficits in brain areas and from patients who exhibit double dissociations. Double dissociations involve two patients and two tasks. One patient is impaired at one task but normal on the other, while the other patient is normal on the first task and impaired on the other. For example, patient A would be poor at reading printed words while still being normal at understanding spoken words, while the patient B would be normal at understanding written words and be poor at understanding spoken words. Scientists can interpret this information to explain how there is a single cognitive module for word comprehension. From studies like these, researchers infer that different areas of the brain are highly specialised. Cognitive neuropsychology can be distinguished from cognitive neuroscience, which is also interested in brain-damaged patients, but is particularly focused on uncovering the neural mechanisms underlying cognitive processes.
Alexander Romanovich Luria was a Soviet neuropsychologist, often credited as a father of modern neuropsychology. He developed an extensive and original battery of neuropsychological tests during his clinical work with brain-injured victims of World War II, which are still used in various forms. He made an in-depth analysis of the functioning of various brain regions and integrative processes of the brain in general. Luria's magnum opus, Higher Cortical Functions in Man (1962), is a much-used psychological textbook which has been translated into many languages and which he supplemented with The Working Brain in 1973.
Clinical neuropsychology is a sub-field of cognitive science and psychology concerned with the applied science of brain-behaviour relationships. Clinical neuropsychologists use this knowledge in the assessment, diagnosis, treatment, and or rehabilitation of patients across the lifespan with neurological, medical, neurodevelopmental and psychiatric conditions, as well as other cognitive and learning disorders. The branch of neuropsychology associated with children and young people is pediatric neuropsychology.
In cognitive science and neuropsychology, executive functions are a set of cognitive processes that are necessary for the cognitive control of behavior: selecting and successfully monitoring behaviors that facilitate the attainment of chosen goals. Executive functions include basic cognitive processes such as attentional control, cognitive inhibition, inhibitory control, working memory, and cognitive flexibility. Higher-order executive functions require the simultaneous use of multiple basic executive functions and include planning and fluid intelligence.
Frontal lobe disorder, also frontal lobe syndrome, is an impairment of the frontal lobe of the brain due to disease or frontal lobe injury. The frontal lobe plays a key role in executive functions such as motivation, planning, social behaviour, and speech production. Frontal lobe syndrome can be caused by a range of conditions including head trauma, tumours, neurodegenerative diseases, neurodevelopmental disorders, neurosurgery and cerebrovascular disease. Frontal lobe impairment can be detected by recognition of typical signs and symptoms, use of simple screening tests, and specialist neurological testing.
Edith F. Kaplan was an American psychologist. She was a pioneer of neuropsychological tests and did most of her work at the Boston VA Hospital. Kaplan is known for her promotion of clinical neuropsychology as a specialty area in psychology. She examined brain-behavioral relationships in aphasia, apraxia, developmental issues in clinical neuropsychology, as well as normal and abnormal aging. Kaplan helped develop a new method of assessing brain function with neuropsychological assessment, called "The Boston Process Approach."
Muriel Elaine Deutsch Lezak was an American neuropsychologist best known for her book Neuropsychological Assessment, widely accepted as the standard in the field. Her work has centred on the research, assessment, and rehabilitation of brain injury. Lezak was a professor of neurology at the Oregon Health and Science University School of Medicine.
Elizabeth Kerr Warrington FRS is a British neuropsychologist specialised in the study of dementia. She holds a PhD in Psychology visual processing and is now an emeritus professor of clinical neuropsychology at the University College London. She formerly worked as the Head of the Department of Neuropsychology at the National Hospital for Neurology and Neurosurgery where she is also a member of the Dementia Research Centre. She was made a Fellow of the Royal Society in 1986.
In psychology and neuroscience, executive dysfunction, or executive function deficit, is a disruption to the efficacy of the executive functions, which is a group of cognitive processes that regulate, control, and manage other cognitive processes. Executive dysfunction can refer to both neurocognitive deficits and behavioural symptoms. It is implicated in numerous psychopathologies and mental disorders, as well as short-term and long-term changes in non-clinical executive control. Executive dysfunction is the mechanism underlying ADHD Paralysis, and in a broader context, it can encompass other cognitive difficulties like planning, organizing, initiating tasks and regulating emotions. It is a core characteristic of ADHD and can elucidate numerous other recognized symptoms.
Some of the research that is conducted in the field of psychology is more "fundamental" than the research conducted in the applied psychological disciplines, and does not necessarily have a direct application. The subdisciplines within psychology that can be thought to reflect a basic-science orientation include biological psychology, cognitive psychology, neuropsychology, and so on. Research in these subdisciplines is characterized by methodological rigor. The concern of psychology as a basic science is in understanding the laws and processes that underlie behavior, cognition, and emotion. Psychology as a basic science provides a foundation for applied psychology. Applied psychology, by contrast, involves the application of psychological principles and theories yielded up by the basic psychological sciences; these applications are aimed at overcoming problems or promoting well-being in areas such as mental and physical health and education.
The Luria–Nebraska Neuropsychological Battery (LNNB) is a standardized test that identifies neuropsychological deficiencies by measuring functioning on fourteen scales. It evaluates learning, experience, and cognitive skills. The test was created by Charles Golden in 1981 and based on previous work by Alexander Luria that emphasizes a qualitative instead of quantitative approach. The original, adult version is for use with ages fifteen and over, while the Luria–Nebraska Neuropsychological Battery for Children (LNNB-C) can be used with ages eight to twelve; both tests take two to three hours to administer. The LNNB has 269 items divided among fourteen scales, which are motor, rhythm, tactile, visual, receptive speech, expressive speech, writing, reading, arithmetic, memory, intellectual processes, pathognomonic, left hemisphere, and right hemisphere. The test is graded on scales that are correlated to regions of the brain to help identify which region may be damaged. The Luria–Nebraska has been found to be reliable and valid; it is comparable in this sense to other neuropsychological tests in its ability to differentiate between brain damage and mental illness. The test is used to diagnose and determine the nature of cognitive impairment, including the location of the brain damage, to understand the patient's brain structure and abilities, to pinpoint causes of behavior, and to help plan treatment.
The Delis–Kaplan Executive Function System (D-KEFS) is a neuropsychological test used to measure a variety of verbal and nonverbal executive functions for both children and adults. This assessment was developed over the span of a decade by Dean Delis, Edith Kaplan, and Joel Kramer, and it was published in 2001. The D-KEFS comprises nine tests that were designed to stand alone. Therefore, there are no aggregate measures or composite scores for an examinee's performance. A vast majority of these tests are modified, pre-existing measures ; however, some of these measures are new indices of executive functions.
The Wechsler Test of Adult Reading (WTAR) is a neuropsychological assessment tool used to provide a measure of premorbid intelligence, the degree of Intellectual function prior to the onset of illness or disease.
The Boston Process Approach is a neurological assessment tool developed by Edith Kaplan and her colleagues, Harold Goodglass, Nelson Butters, Laird Cermak, and Norman Geschwind at the Boston Veterans Medical Center. The main purpose of the Boston Process Approach is to assess brain damage as well as cognitive impairments in patients through a series of tests that are related to memory, attention, intelligence, and other aspects of information processing. This approach is one of the more flexible and qualitative neurological assessments because it emphasizes how a patient performs a task instead of whether they succeeded or failed at it.
Ralph M. Reitan was an American neuropsychologist and one of the founding fathers of American clinical neuropsychology having brought the notion of brain-behavior relationships to the forefront of the field. He is best known for his role in developing the Halstead-Reitan Neuropsychological Battery and his strong belief in empiricism and evidence-based practice. He was a strong advocate of use of a fixed battery in neuropsychological assessment, published prolifically, and mentored many students who also became prominent in the field. As an author, he has been collected by libraries.
Pasquale Calabrese born 27 February 1961 in Naples, Italy, is an Italian professor of clinical neurosciences at the University of Basel, Faculty of Psychology, Department of Molecular and Cognitive Neurosciences. He is a neuroscientist, experimental neurologist and medical neuropsychologist.
Developmental neuropsychology combines the fields of neuroscience and developmental psychology, while drawing from various other related disciplines. It examines the relationship of behavior and brain function throughout the course of an individual's lifespan, though often emphasis is put on childhood and adolescence when the majority of brain development occurs. Research tends to focus on development of important behavioral functions like perception, language, and other cognitive processes. Studies in this field are often centered around children or other individuals with developmental disorders or various kinds of brain related trauma or injury. A key concept of this field is that looks at and attempts to relate the psychological aspects of development, such as behavior, comprehension, cognition, etc., to the specific neural structures; it draws parallels between behavior and mechanism in the brain. Research in this field involves various cognitive tasks and tests as well as neuroimaging. Some of the many conditions studied by developmental neuropsychologists include congenital or acquired brain damage, autism spectrum disorder, attention deficit disorder, executive dysfunction, seizures, intellectual disabilities, obsessive compulsive disorder, stuttering, schizophrenia, developmental aphasia, and other learning delays such as dyslexia, dysgraphia, and dyspraxia.
