Diagnostics Lectures
October - December 2024
Clinical Neuropsychology
Leiden University
,Lecture 1 → Introduction
,● Basic principles of diagnostics in CNP
○ Cognition, emotion, behavior in relation to the dysfunctioning
of the brain
○ Referral & research question (empirical cycle)
○ Neuropsychologist as a scientist practitioner
○ Taxonomy
■ Recognition/diagnosis → what are the problems, what is intact/impaired?
■ Explanation → why do the problems occur, how are they maintained?
■ Prediction → in what way will the problems of the patient develop in the
future?
■ Indication → how can the problems be treated?
■ Evaluation → are the problems sufficiently addressed by the treatment?
○ The diagnostic process is dynamic → hypothesis can be generated, tested,
updated at multiple stages in the empirical cycle
○ Anamnesis
■ Semi structured conversation
■ Focus on type, course, severity of complaints
■ Focus on predictions based on “first” hypotheses
● Hypotheses based on brain-behavior relationships
■ Ask for limitations in daily life
■ Always ask for specific examples to avoid misunderstandings
● Memory complaints
● Long term & short term memory
, ■ During anamnesis → observation!
○ Symptoms vs syndromes
■ Symptoms are not syndromes
■ Ordering complaints of the patients
■ Recognition of syndromes & patterns of impairment
■ Do not only search for confirmation, ask for symptoms that would fit other
hypotheses to reject incorrect ones
■ Take base rate information into account
○ Heteroanamnesis
■ Information from someone close, otherwise health care professional
■ Informed consent
■ Additional source of information to increase reliability
■ Insight & awareness of disease
■ Attention for inconsistencies
■ Opportunity to observe
○ Determining which hypotheses to test
■ Operationalization → how should we test the premises of the hypotheses
○ Choosing instruments to measure cognitive functions
■ Preferably at least 2 per cognitive domain
■ Relationships between attention, memory, executive function
■ Impossibilities of the patient (physical impairments)
■ Quality of the instruments
● Validity → extent to which a test accurately measures what it is
supposed to measure
● Reliability → small measurement
error and high test-retest reliability
● Norms → availability of an
appropriate norm group based on
age, gender, education
● COTAN reviews the quality of
common tests & questionnaires in
NL
October - December 2024
Clinical Neuropsychology
Leiden University
,Lecture 1 → Introduction
,● Basic principles of diagnostics in CNP
○ Cognition, emotion, behavior in relation to the dysfunctioning
of the brain
○ Referral & research question (empirical cycle)
○ Neuropsychologist as a scientist practitioner
○ Taxonomy
■ Recognition/diagnosis → what are the problems, what is intact/impaired?
■ Explanation → why do the problems occur, how are they maintained?
■ Prediction → in what way will the problems of the patient develop in the
future?
■ Indication → how can the problems be treated?
■ Evaluation → are the problems sufficiently addressed by the treatment?
○ The diagnostic process is dynamic → hypothesis can be generated, tested,
updated at multiple stages in the empirical cycle
○ Anamnesis
■ Semi structured conversation
■ Focus on type, course, severity of complaints
■ Focus on predictions based on “first” hypotheses
● Hypotheses based on brain-behavior relationships
■ Ask for limitations in daily life
■ Always ask for specific examples to avoid misunderstandings
● Memory complaints
● Long term & short term memory
, ■ During anamnesis → observation!
○ Symptoms vs syndromes
■ Symptoms are not syndromes
■ Ordering complaints of the patients
■ Recognition of syndromes & patterns of impairment
■ Do not only search for confirmation, ask for symptoms that would fit other
hypotheses to reject incorrect ones
■ Take base rate information into account
○ Heteroanamnesis
■ Information from someone close, otherwise health care professional
■ Informed consent
■ Additional source of information to increase reliability
■ Insight & awareness of disease
■ Attention for inconsistencies
■ Opportunity to observe
○ Determining which hypotheses to test
■ Operationalization → how should we test the premises of the hypotheses
○ Choosing instruments to measure cognitive functions
■ Preferably at least 2 per cognitive domain
■ Relationships between attention, memory, executive function
■ Impossibilities of the patient (physical impairments)
■ Quality of the instruments
● Validity → extent to which a test accurately measures what it is
supposed to measure
● Reliability → small measurement
error and high test-retest reliability
● Norms → availability of an
appropriate norm group based on
age, gender, education
● COTAN reviews the quality of
common tests & questionnaires in
NL
