B&C: Clinical neuropsychology notes
Lecture 1: introduction to clinical neuropsychology
In today’s lecture:
- What is (clinical) neuropsychology?
o Historical development
o Theoretical background; methods
- Clinical neuropsychology in Europe
o Training and practice
o Fields where clinical neuropsychologists work
- Assessment
- Treatment and rehabilitation
- Case example
- Misconceptions about clinical neuropsychology
Clinical neuropsychology
= ‘scientific area that studies the relations between brain and behavior especially the clinical
applicability of assessment, treatment, and care of individuals with (presumed) cognitive
(dys)function because of developmental disorders, neurological disorders (brain diseases or
damage), or psychiatric disorders’
- Brain (dys)functioning
- Contextual factors; psychosocial, developmental, somatic (pain), performance
validity
- Everyday functioning; home, social, work/study, family etc.
All these factors have an influence on the latent variables, you must be aware that
complaints are depended on different aspects
Behavior in a broad sense
Behavioral symptoms…
… latent variables that objectively can be assessed through tests, think of latent variables as
intelligence, memory functions, language functions
… that subjectively can be observed by the patient and significant others, although these
may not be the same as the results on neurological tests
Before and after neuroimaging
Neuroimaging was developed in the late 1960s/early 1970s and that had big consequence
on neurological assessment/ clinical neuropsychology, here is a quick overview of the
history:
- Assessment, before neuroimaging they couldn’t see inside the brain and they
measured the skill, the unevenness of the skull led to hypothesis about dents and
bumps and assets and benefits of the behavior
- Systematic patient descriptions, after a while systematic patient descriptions became
important, they used patients and their brain damage for scientific purposes
- Application in psychiatry; development of theories on brain-behavior relationships,
they started using tests in clinical practice, but this led to ‘organicity’; ‘is there a hole
, in the brain’, they thought that if you had a bad score on a test the organ might have
been damaged
- Developing theories, hypothesis -> testing theories about cognitive functioning, for
some the focus was observing behavior and not using all kinds of objectively tests
- Re-orientation, neuroimaging was developed, localization of brain damage was not
the main interest, but what was left and what the patient was still able of doing, ‘it’s
not about the hole, it’s about the doughnut!’, ‘… it’s not about damage of the brain,
it’s about assessment, treatment and, care of individuals with cognitive
(dys)functions, because of brain disorders…’
Clinical neuropsychology modern time
- Has become highly relevant in modern-day (mental) health care
o Increase in people with brain damage or dysfunction:
▪ Decrease in mortality rates because of improvements in medical care
▪ Aging
▪ More interest in quality of life, not the diagnosis became important,
but the care did
o -> led to the idea that a clinical neuropsychologist is a scientist practitioner
whose focus lies on behavior and cognition
o -> a clinical neuropsychologist is not a brain researcher
- The brain has ‘persuasion’, neuropsychology and the brain are called ‘fancy’
-
(Educational trajectory in clinical neuropsychology)
- Starting with bachelor program psychology
o Brain & cognition
o Development & mental health
- Then you can take a clinical master specialization ‘gezondheidszorgpsychologie’
o Neuropsychological assessment
o Cognitive neuropsychiatry
o Rehabilitation training
o Internship and thesis
- Dutch postmaster program ‘gezondheidszorgpsycholoog (GZ) (BIG)’
- Dutch postmaster program ‘klinishce neuropsychologie (KNP) (BIG)’
or
- German postmaster program ‘psychotherapie’
- German advanced training in ‘klinische neuropscyhologie’
(Work in clinical neuropsychology)
Possible in all age groups: children – adults – elderly
In a wide range of clinical settings: general hospitals, university hospitals, specialized
neurologic clinics (Alzheimer, epilepsy, sleep etc.), mental health care, specialized psychiatric
clinics, rehabilitation centers, private practices, schools etc.
Clinical neuropsychology is quite multidisciplinary
The international classification of functioning-ICF (WHO, 2001)
- Health condition
o Body structure and function
, o Activity
▪ Environmental factors
▪ Personal factors
o Participation
All these factors are responsible for how brain damage or dysfunction might present itself in
daily life
ICF is useful in clinical neuropsychology
- Description of consequences of brain disease/disorder at three different levels:
impairment – limitation – restriction (‘handicap’)
- Identify moderating factors
- Relevant for understanding subjective complaints and problems in daily life (school –
work – social functioning)
- Identify target for treatment or optimalisation
Professional associations
- The Netherlands: NVN
- Germany: GNP
- Europe: FESN
- Worldwide: INS
bio-psycho-social model
➔ testing hypothesis
- multi-informed
o patient
o significant others
- multi-method
o tests
o questionnaires
o clinical interview
o observation
- multi-conceptual
o neuropsychological
o personality
o contextual environment
diagnostic cycle
you get a referral and start a cycle between these four components:
- analysis complaints
- analysis of problems
- analysis of cause
- analysis of indication
then afterwards you will decide on a treatment
example: ‘patient complains about memory problems’
- analysis complaints
o names of family members
, o taking medicine
o farther Alzheimer disease
o feels lonely
- analysis of problems
o normal aging
o dementia
o depression
- analysis of cause
o memory deficits
o Alzheimer disease
- analysis of indication
o caregiving
o medication
decide on a treatment plan
assessment is more than test administration
cycle between these four components:
(Information and skills)
- information
o clinical interview
o observant information
o medical record
- test results
o cognition
o development
o lifespan
(knowledge)
- etiology
o neurologic
o somatic
o psychological/psychiatric
o etc.
- functional neuroanatomy
Lecture 1: introduction to clinical neuropsychology
In today’s lecture:
- What is (clinical) neuropsychology?
o Historical development
o Theoretical background; methods
- Clinical neuropsychology in Europe
o Training and practice
o Fields where clinical neuropsychologists work
- Assessment
- Treatment and rehabilitation
- Case example
- Misconceptions about clinical neuropsychology
Clinical neuropsychology
= ‘scientific area that studies the relations between brain and behavior especially the clinical
applicability of assessment, treatment, and care of individuals with (presumed) cognitive
(dys)function because of developmental disorders, neurological disorders (brain diseases or
damage), or psychiatric disorders’
- Brain (dys)functioning
- Contextual factors; psychosocial, developmental, somatic (pain), performance
validity
- Everyday functioning; home, social, work/study, family etc.
All these factors have an influence on the latent variables, you must be aware that
complaints are depended on different aspects
Behavior in a broad sense
Behavioral symptoms…
… latent variables that objectively can be assessed through tests, think of latent variables as
intelligence, memory functions, language functions
… that subjectively can be observed by the patient and significant others, although these
may not be the same as the results on neurological tests
Before and after neuroimaging
Neuroimaging was developed in the late 1960s/early 1970s and that had big consequence
on neurological assessment/ clinical neuropsychology, here is a quick overview of the
history:
- Assessment, before neuroimaging they couldn’t see inside the brain and they
measured the skill, the unevenness of the skull led to hypothesis about dents and
bumps and assets and benefits of the behavior
- Systematic patient descriptions, after a while systematic patient descriptions became
important, they used patients and their brain damage for scientific purposes
- Application in psychiatry; development of theories on brain-behavior relationships,
they started using tests in clinical practice, but this led to ‘organicity’; ‘is there a hole
, in the brain’, they thought that if you had a bad score on a test the organ might have
been damaged
- Developing theories, hypothesis -> testing theories about cognitive functioning, for
some the focus was observing behavior and not using all kinds of objectively tests
- Re-orientation, neuroimaging was developed, localization of brain damage was not
the main interest, but what was left and what the patient was still able of doing, ‘it’s
not about the hole, it’s about the doughnut!’, ‘… it’s not about damage of the brain,
it’s about assessment, treatment and, care of individuals with cognitive
(dys)functions, because of brain disorders…’
Clinical neuropsychology modern time
- Has become highly relevant in modern-day (mental) health care
o Increase in people with brain damage or dysfunction:
▪ Decrease in mortality rates because of improvements in medical care
▪ Aging
▪ More interest in quality of life, not the diagnosis became important,
but the care did
o -> led to the idea that a clinical neuropsychologist is a scientist practitioner
whose focus lies on behavior and cognition
o -> a clinical neuropsychologist is not a brain researcher
- The brain has ‘persuasion’, neuropsychology and the brain are called ‘fancy’
-
(Educational trajectory in clinical neuropsychology)
- Starting with bachelor program psychology
o Brain & cognition
o Development & mental health
- Then you can take a clinical master specialization ‘gezondheidszorgpsychologie’
o Neuropsychological assessment
o Cognitive neuropsychiatry
o Rehabilitation training
o Internship and thesis
- Dutch postmaster program ‘gezondheidszorgpsycholoog (GZ) (BIG)’
- Dutch postmaster program ‘klinishce neuropsychologie (KNP) (BIG)’
or
- German postmaster program ‘psychotherapie’
- German advanced training in ‘klinische neuropscyhologie’
(Work in clinical neuropsychology)
Possible in all age groups: children – adults – elderly
In a wide range of clinical settings: general hospitals, university hospitals, specialized
neurologic clinics (Alzheimer, epilepsy, sleep etc.), mental health care, specialized psychiatric
clinics, rehabilitation centers, private practices, schools etc.
Clinical neuropsychology is quite multidisciplinary
The international classification of functioning-ICF (WHO, 2001)
- Health condition
o Body structure and function
, o Activity
▪ Environmental factors
▪ Personal factors
o Participation
All these factors are responsible for how brain damage or dysfunction might present itself in
daily life
ICF is useful in clinical neuropsychology
- Description of consequences of brain disease/disorder at three different levels:
impairment – limitation – restriction (‘handicap’)
- Identify moderating factors
- Relevant for understanding subjective complaints and problems in daily life (school –
work – social functioning)
- Identify target for treatment or optimalisation
Professional associations
- The Netherlands: NVN
- Germany: GNP
- Europe: FESN
- Worldwide: INS
bio-psycho-social model
➔ testing hypothesis
- multi-informed
o patient
o significant others
- multi-method
o tests
o questionnaires
o clinical interview
o observation
- multi-conceptual
o neuropsychological
o personality
o contextual environment
diagnostic cycle
you get a referral and start a cycle between these four components:
- analysis complaints
- analysis of problems
- analysis of cause
- analysis of indication
then afterwards you will decide on a treatment
example: ‘patient complains about memory problems’
- analysis complaints
o names of family members
, o taking medicine
o farther Alzheimer disease
o feels lonely
- analysis of problems
o normal aging
o dementia
o depression
- analysis of cause
o memory deficits
o Alzheimer disease
- analysis of indication
o caregiving
o medication
decide on a treatment plan
assessment is more than test administration
cycle between these four components:
(Information and skills)
- information
o clinical interview
o observant information
o medical record
- test results
o cognition
o development
o lifespan
(knowledge)
- etiology
o neurologic
o somatic
o psychological/psychiatric
o etc.
- functional neuroanatomy
