Diagnostics - Literature
Chapter 1 – The practice of neuropsychological assessment (pages 3-
12 (full chapter except for the section "What can we expect of
neuropsychological assessment in the 21th century?"))
Timeline
19th century
- Controlled observations
- First generation of neuroscientist laid out the basic schema of brain-behavior relationships
that hold today
First half of 20th century
- War-damaged brains The need for screening and diagnosis of brain injured and
behaviorally disturbed servicemen during the first World War and for their rehabilitation
afterwards created large-scale demands for neuropsychology programs
- Psychology contributions to neuropsychological assessment:
Educational psychologists (e.g. Binet & Spearman) developed tests for measuring
concepts such as intelligence Later some of this test have been incorporated into
the neuropsychological test cannon (e.g. Raven’s Progressive Matrices, the Wechsler
Intelligence Scales, and the Wide Range Achievement Tests)
Experimental studies of cognitive functions in both humans and other animals.
Latter half of 20th century
- Experimental psychologists became aware of the wealth of information about cognitive
functions to be gained from studying brain injured persons, especially those with localized
lesions.
21th century
- New imaging techniques permit viewing functioning brain structures and thus the neural
foundations of behavior
Neuropsychological examination purposes
6 different purposes, many assessments serve two or more purposes, requiring the examiner to
integrate the strategies to gain the needed information about the patient in the most focused and
succinct manner possible.
1. Diagnosis
- NPA can be useful for discriminating between psychiatric and neurological symptoms
- Same brain lesion can have a distinctively different psychosocial outcome OR some people
with brain damage still perform really well on cognitive tasks NPA is needed besides
imaging
- NPA is useful in early detection or prediction of dementing disorders
- Screening is identifying persons who are most likely at risk for some specified condition or in
need of further diagnostic study In the last decade screening tests have been developed
for identifying neurocognitive and neurobehavioral changes in TBI (traumatic brain injury)
patients
,2. Patient care and planning
- Many patients are referred for detailed information about their cognitive status, behavioral
changes, and personality traits-often with questions about their adaptation to their
impairments, so that they and the people responsible for their well-being know how the
neurological condition has affected their behavior. Accurate descriptive information on
cognitive and emotional status is essential for careful treatment of many neurological
disorders
- Rational planning usually depends on an understanding of patients' abilities and limitations,
the types of psychological changes they undergo and the influence of these changes on their
perception of themselves and on their behavior
- With all the data of a comprehensive neuropsychological examination taken together (e.g.
the patient’s history, background, and present situation; the qualitative observations; and the
quantitative scores) the examiner should have a realistic appreciation of how the patient
reacts to deficits and can best compensate for them, and whether and how retraining could
be profitably undertaken.
- NPA is well-suited for following the course (beloop) of many neurological diseases and
neuropsychiatric conditions.
- Important to test at multiple points to measure changes in cognitive functioning
- Perplexity is self-distrust that seems to reflect feelings of strangeness and confusion
accompanying previously familiar habits, thoughts, and sensations that are now experienced
differently, and from newly acquired tendencies to make errors
- Also family members need to know patient’s condition in order to respond appropriately
3. Treatment-1: treatment planning and remediation
- More of work of neuropsychologist is involved in treatment or research on treatment
- Sensitive, broad gauged, and accurate neuropsychological assessment is necessary for
determining the most appropriate treatment for each rehabilitation candidate with brain
dysfunction.
- Rehabilitation treatment and care is often shared by professionals from many disciplines (e.g.
psychiatrists, speech pathologists, rehabilitation counselors, and occupational and physical
therapists) a current and centralized appraisal of patients’ neuropsychological status enables
these treatment specialists to maintain common goals and understanding of the patient.
4. Treatment-2: evaluation
- Rehabilitation and retraining are very costly services cost-effectiveness discussion is done
by neuropsychologist
- Best demonstrated in surgery or brain stimulation, but also for drug efficacy.
5. Research
- NPA has been used to study the organization of brain activity and its translation into behavior,
and to investigate specific brain disorders and behavioral disabilities.
- Many of the tests used in NPA are originally developed for the examination of normal
cognitive functioning/brain functioning
- Neuropsychological research has also been crucial for understanding normal behavior and
brain functions and the association of cognition with the underlying functional architecture of
the brain.
6. Forensic neuropsychology
- Neuropsychological assessment undertaken for legal proceedings has become quite
commonplace in personal injury actions in which monetary compensation is sought for claims
of bodily injury and loss of function (letselschade)
, - In criminal cases, a neuropsychologist may assess a defendant when there is reason to
suspect that brain dysfunction contributed to the misbehavior or when there is a question
about mental capacity to stand trial (wilsbekwaamheid)
- Whether the problem of malingering and symptom exaggeration in neuropsychological
examinations is as great as the proliferation of techniques for identifying faked responding
would suggest remains unanswered the neuropsychologist must be alert in detecting if the
criminals performs below their optimal levels
The Multipurpose Examination
- Usually a neuropsychological examination serves more than one purpose.
- Integral to all NPA procedures is an evaluation of the patient’s needs and circumstances from
a psychological perspective that considers: quality of life, emotional status, and potential for
social integration
The validity of neuropsychological assessment
- Is the NPA ecological valid?
- Ecological validity typically refers to how well the neuropsychological assessment data reflect
everyday functioning, or predict future behavior or behavioral outcomes
- Neuropsychological assessments consistently demonstrate positive correlations with real-
world outcomes.
- They prove effective in predicting conditions such as dementia, substance abuse treatment
outcomes, and functional recovery after spinal cord injury, orthopedic disorders, and
traumatic brain injury (TBI).
- These assessments are relevant in determining employability among HIV+ patients and
assessing deficits in multiple sclerosis.
- They play a crucial role in evaluating driving competence and forecasting performance in
activities of daily living (ADL).
- Neuropsychological assessments contribute to ensuring geriatric safety and independence.
- They are valuable in predicting psychosocial outcomes and return to work after TBI.
- The extensive body of research underscores the versatility and reliability of
neuropsychological assessments across diverse behavioral conditions and functional domains
, Chapter 2 – Basic concepts (pages 15-39 (full chapter except for the
section "Personality/emotionality variables"))
Examining the brain
Neurological examination (historical approach)
- The neurologist examines body structures
- In the neurological examination of behavior, the clinician reviews behavior patterns
generated by neuroanatomical subsystems, measuring patients’ responses in relatively coarse
gradations, and taking note of important responses that might be missing.
- The mental status of the neurological exam is specially focused on ‘higher’ behavioral
functions such as language, memory, attention and praxis
Neuropsychological assessment
- Another method of examining the brain, but in far more detail than the mental status portion
of a neurological exam.
- Similarities with psychological assessment: it relies on many of the same techniques,
assumptions, and theories, along with many of the same tests.
- Definition: Neuropsychological assessment is, in short, a means of measuring in a
quantitative, standardized fashion the most complex aspects of human behavior —attention,
perception, memory, speech and language, building and drawing, reasoning, problem solving,
judgment, planning, and emotional processing.
- The goal of NPA is to map brain functioning
Laboratory Techniques for Assessing Brain Function
Earliest instruments for studying brain function are electrophysiological:
- Electroencephalography (EEG)
Most useful in diagnosing seizure disorders, sleep disturbances and for monitoring
depth of anesthesia
EEG is not only used to discover brain diseases but also to study normal cognition, for
example frequency rates have been associated with attentional activity for decades
- Evoked and event-related potentials (EP, ERP)
Both can identify hemispheric specialization and assess processing speed and
efficiency
- Electrodermal activity
Measured as skin conductance response (SCR)
Measures autonomic nervous system functioning and provides a sensitive and robust
measure of emotional responses and feelings
Electrodermal activity and other autonomic measures (such as heart rate, respiration,
and pupil dilation) have also been used to demonstrate various nonconscious forms
of brain processing For example, when patients with prosopagnosia (who cannot
recognize familiar faces at a conscious level) were shown pictures of family members
and other familiar individuals, they said they did not recognize the faces; however,
these patients showed a robust SCR—a nonconscious recognition response.
Magnetoencephalography (MEG), the magnetic cousin of EEG
- Works with magnetic fields
Chapter 1 – The practice of neuropsychological assessment (pages 3-
12 (full chapter except for the section "What can we expect of
neuropsychological assessment in the 21th century?"))
Timeline
19th century
- Controlled observations
- First generation of neuroscientist laid out the basic schema of brain-behavior relationships
that hold today
First half of 20th century
- War-damaged brains The need for screening and diagnosis of brain injured and
behaviorally disturbed servicemen during the first World War and for their rehabilitation
afterwards created large-scale demands for neuropsychology programs
- Psychology contributions to neuropsychological assessment:
Educational psychologists (e.g. Binet & Spearman) developed tests for measuring
concepts such as intelligence Later some of this test have been incorporated into
the neuropsychological test cannon (e.g. Raven’s Progressive Matrices, the Wechsler
Intelligence Scales, and the Wide Range Achievement Tests)
Experimental studies of cognitive functions in both humans and other animals.
Latter half of 20th century
- Experimental psychologists became aware of the wealth of information about cognitive
functions to be gained from studying brain injured persons, especially those with localized
lesions.
21th century
- New imaging techniques permit viewing functioning brain structures and thus the neural
foundations of behavior
Neuropsychological examination purposes
6 different purposes, many assessments serve two or more purposes, requiring the examiner to
integrate the strategies to gain the needed information about the patient in the most focused and
succinct manner possible.
1. Diagnosis
- NPA can be useful for discriminating between psychiatric and neurological symptoms
- Same brain lesion can have a distinctively different psychosocial outcome OR some people
with brain damage still perform really well on cognitive tasks NPA is needed besides
imaging
- NPA is useful in early detection or prediction of dementing disorders
- Screening is identifying persons who are most likely at risk for some specified condition or in
need of further diagnostic study In the last decade screening tests have been developed
for identifying neurocognitive and neurobehavioral changes in TBI (traumatic brain injury)
patients
,2. Patient care and planning
- Many patients are referred for detailed information about their cognitive status, behavioral
changes, and personality traits-often with questions about their adaptation to their
impairments, so that they and the people responsible for their well-being know how the
neurological condition has affected their behavior. Accurate descriptive information on
cognitive and emotional status is essential for careful treatment of many neurological
disorders
- Rational planning usually depends on an understanding of patients' abilities and limitations,
the types of psychological changes they undergo and the influence of these changes on their
perception of themselves and on their behavior
- With all the data of a comprehensive neuropsychological examination taken together (e.g.
the patient’s history, background, and present situation; the qualitative observations; and the
quantitative scores) the examiner should have a realistic appreciation of how the patient
reacts to deficits and can best compensate for them, and whether and how retraining could
be profitably undertaken.
- NPA is well-suited for following the course (beloop) of many neurological diseases and
neuropsychiatric conditions.
- Important to test at multiple points to measure changes in cognitive functioning
- Perplexity is self-distrust that seems to reflect feelings of strangeness and confusion
accompanying previously familiar habits, thoughts, and sensations that are now experienced
differently, and from newly acquired tendencies to make errors
- Also family members need to know patient’s condition in order to respond appropriately
3. Treatment-1: treatment planning and remediation
- More of work of neuropsychologist is involved in treatment or research on treatment
- Sensitive, broad gauged, and accurate neuropsychological assessment is necessary for
determining the most appropriate treatment for each rehabilitation candidate with brain
dysfunction.
- Rehabilitation treatment and care is often shared by professionals from many disciplines (e.g.
psychiatrists, speech pathologists, rehabilitation counselors, and occupational and physical
therapists) a current and centralized appraisal of patients’ neuropsychological status enables
these treatment specialists to maintain common goals and understanding of the patient.
4. Treatment-2: evaluation
- Rehabilitation and retraining are very costly services cost-effectiveness discussion is done
by neuropsychologist
- Best demonstrated in surgery or brain stimulation, but also for drug efficacy.
5. Research
- NPA has been used to study the organization of brain activity and its translation into behavior,
and to investigate specific brain disorders and behavioral disabilities.
- Many of the tests used in NPA are originally developed for the examination of normal
cognitive functioning/brain functioning
- Neuropsychological research has also been crucial for understanding normal behavior and
brain functions and the association of cognition with the underlying functional architecture of
the brain.
6. Forensic neuropsychology
- Neuropsychological assessment undertaken for legal proceedings has become quite
commonplace in personal injury actions in which monetary compensation is sought for claims
of bodily injury and loss of function (letselschade)
, - In criminal cases, a neuropsychologist may assess a defendant when there is reason to
suspect that brain dysfunction contributed to the misbehavior or when there is a question
about mental capacity to stand trial (wilsbekwaamheid)
- Whether the problem of malingering and symptom exaggeration in neuropsychological
examinations is as great as the proliferation of techniques for identifying faked responding
would suggest remains unanswered the neuropsychologist must be alert in detecting if the
criminals performs below their optimal levels
The Multipurpose Examination
- Usually a neuropsychological examination serves more than one purpose.
- Integral to all NPA procedures is an evaluation of the patient’s needs and circumstances from
a psychological perspective that considers: quality of life, emotional status, and potential for
social integration
The validity of neuropsychological assessment
- Is the NPA ecological valid?
- Ecological validity typically refers to how well the neuropsychological assessment data reflect
everyday functioning, or predict future behavior or behavioral outcomes
- Neuropsychological assessments consistently demonstrate positive correlations with real-
world outcomes.
- They prove effective in predicting conditions such as dementia, substance abuse treatment
outcomes, and functional recovery after spinal cord injury, orthopedic disorders, and
traumatic brain injury (TBI).
- These assessments are relevant in determining employability among HIV+ patients and
assessing deficits in multiple sclerosis.
- They play a crucial role in evaluating driving competence and forecasting performance in
activities of daily living (ADL).
- Neuropsychological assessments contribute to ensuring geriatric safety and independence.
- They are valuable in predicting psychosocial outcomes and return to work after TBI.
- The extensive body of research underscores the versatility and reliability of
neuropsychological assessments across diverse behavioral conditions and functional domains
, Chapter 2 – Basic concepts (pages 15-39 (full chapter except for the
section "Personality/emotionality variables"))
Examining the brain
Neurological examination (historical approach)
- The neurologist examines body structures
- In the neurological examination of behavior, the clinician reviews behavior patterns
generated by neuroanatomical subsystems, measuring patients’ responses in relatively coarse
gradations, and taking note of important responses that might be missing.
- The mental status of the neurological exam is specially focused on ‘higher’ behavioral
functions such as language, memory, attention and praxis
Neuropsychological assessment
- Another method of examining the brain, but in far more detail than the mental status portion
of a neurological exam.
- Similarities with psychological assessment: it relies on many of the same techniques,
assumptions, and theories, along with many of the same tests.
- Definition: Neuropsychological assessment is, in short, a means of measuring in a
quantitative, standardized fashion the most complex aspects of human behavior —attention,
perception, memory, speech and language, building and drawing, reasoning, problem solving,
judgment, planning, and emotional processing.
- The goal of NPA is to map brain functioning
Laboratory Techniques for Assessing Brain Function
Earliest instruments for studying brain function are electrophysiological:
- Electroencephalography (EEG)
Most useful in diagnosing seizure disorders, sleep disturbances and for monitoring
depth of anesthesia
EEG is not only used to discover brain diseases but also to study normal cognition, for
example frequency rates have been associated with attentional activity for decades
- Evoked and event-related potentials (EP, ERP)
Both can identify hemispheric specialization and assess processing speed and
efficiency
- Electrodermal activity
Measured as skin conductance response (SCR)
Measures autonomic nervous system functioning and provides a sensitive and robust
measure of emotional responses and feelings
Electrodermal activity and other autonomic measures (such as heart rate, respiration,
and pupil dilation) have also been used to demonstrate various nonconscious forms
of brain processing For example, when patients with prosopagnosia (who cannot
recognize familiar faces at a conscious level) were shown pictures of family members
and other familiar individuals, they said they did not recognize the faces; however,
these patients showed a robust SCR—a nonconscious recognition response.
Magnetoencephalography (MEG), the magnetic cousin of EEG
- Works with magnetic fields
