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. 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: Clinical evaluation, to understand the
pattern of cognitive strengths as well as any difficulties a person may have,
and to aid decision making for use in a medical or rehabilitation environment.
Scientific investigation, to examine an hypothesis about the structure and
function of cognition to be tested, or to provide information that allows
experimental testing to be seen in context of a wider cognitive profile.
Medico-legal assessment, to be used in a court of law as evidence in a legal
claim or criminal investigation. 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 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 a certain tasks. 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. Diagnosis of a neuropsychological
disorder 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: = History taking =
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.
= Interviewing = 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. = Test-taking =
The scores on standardized tests taken by children is a strong predictor of
future or current neuropsychological problems. Standardized tests allow
psychologists to compare a child’s results with other children’s because it
has the same components and is given in the same way. It is representative of
the child’s behavior and cognition. The results of a standardized test are only
a tool used to discover if there is a disorder. Further testing is needed to
officially diagnose the patient. Intelligence testing
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. Testing other areas
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. Information gathered from assessment
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. It is
important to remember, however, that 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. Benefits of assessment
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.
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 criminal’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 in order to attain a lesser sentence.
Neuropsychological assessments usually do not take much time, with most testing
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.
Qualifications for conducting assessments
Neuropsychological assessments are usually conducted by doctoral-level
psychologists trained in neuropsychology. They will usually have
postdoctoral training in neuropsychology, neuroanatomy, and brain
function. Most will be licensed and practicing psychologists in their
particular field. 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.
See also Clinical neuropsychology
Neurocognitive Neuroimaging
Neuropsychological Syndromes Psychological testing such as
psychometrics References
Further reading Baer, Lee; Blais, Mark A., eds..
Handbook of Clinical Rating Scales and Assessment in Psychiatry and Mental
Health. Springer. ISBN 978-1-58829-966-6. Retrieved 17 June
2014. Davis, Andrew, ed.. Handbook of
Pediatric Neuropsychology. New York: Springer Publishing. ISBN
978-0-8261-0629-2. Retrieved 28 May 2013. Lay summary – Archives of Clinical
Neuropsychology. Lezak, Muriel D.; Howieson, Diane B.;
Bigler, Erin D.; Tranel, Daniel. Neuropsychological Assessment. Oxford:
Oxford University Press. ISBN 978-0-19-539552-5. Retrieved 17 June
2014. Lay summary – Journal of the International Neuropsychological
Society. Loring, David W., ed.. INS Dictionary of
Neuropsychology. New York: Oxford University Press. ISBN
978-0-19-506978-5. Lay summary. This standard reference book includes entries
by Kimford J. Meador, Ida Sue Baron, Steven J. Loring, Kerry deS. Hamsher,
Nils R. Varney, Gregory P. Lee, Esther Strauss, and Tessa Hart.
Miller, Daniel C.. Essentials of School Neuropsychological Assessment. John
Wiley & Sons. ISBN 978-1-118-17584-2. Retrieved 9 June 2014.
Reddy, Linda A.; Weissman, Adam S.; Hale, James B., eds.. Neuropsychological
Assessment and Intervention for Youth: An Evidence Based Approach to Emotional
and Behavioral Disorders. American Psychological Association. ISBN
978-1-4338-1266-8. OCLC 810409783. Retrieved 15 June 2014. This collection
of articles for practitioners includes chapters by Linda A. Reddy, Adam S.
Weissman, James B. Hale, Allison Waters, Lara J. Farrell, Elizabeth Schilpzand,
Susanna W. Chang, Joseph O’Neill, David Rosenberg, Steven G. Feifer, Gurmal
Rattan, Patricia D. Walshaw, Carrie E. Bearden, Carmen Lukie, Andrea N.
Schneider, Richard Gallagher, Jennifer L. Rosenblatt, Jean Séguin, Mathieu
Pilon, Matthew W. Specht, Susanna W. Chang, Kathleen Armstrong, Jason
Hangauer, Heather Agazzi, Justin J. Boseck, Elizabeth L. Roberds, Andrew S.
Davis, Joanna Thome, Tina Drossos, Scott J. Hunter, Erin L. Steck-Silvestri,
LeAdelle Phelps, William S. MacAllister, Jonelle Ensign, Emilie Crevier-Quintin,
Leonard F. Koziol, and Deborah E. Budding.
Riccio, Cynthia A.; Sullivan, Jeremy R.; Cohen, Morris J.. Neuropsychological
Assessment and Intervention for Childhood and Adolescent Disorders. John
Wiley & Sons. doi:10.1002/9781118269954. ISBN 978-0-470-18413-4. Retrieved 15
June 2014. Lay summary. Strauss, Esther; Sherman, Elizabeth M.;
Spreen, Otfried. A Compendium of Neuropsychological Tests:
Administration, Norms, and Commentary. Oxford: Oxford University Press. ISBN
978-0-19-515957-8. Retrieved 14 July 2013.
Sherman, Elizabeth M.; Brooks, Brian L., eds.. Pediatric Forensic
Neuropsychology. Oxford: Oxford University Press. ISBN
978-0-19-973456-6. Retrieved 14 July 2013. Lay summary – Archives of Clinical
Neurology. Whishaw, Ian Q.; Kolb, Bryan.
Fundamentals of human neuropsychology. New York: Worth Publishers. ISBN
978-0-7167-9586-5. Retrieved 17 June 2014. Lay summary – Journal of
Undergraduate Neuroscience Education. External links
UNC School of Medicine Department of Neurology. "Neuropsychological
Evaluation FAQ". University of North Carolina Chapel Hill. Retrieved 17 June
2014.