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Clinical Neuropsychology Radboud Notes
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Lecture notes of 54 pages for the course B & C 2: Clinical Neuropsychology at RU (class notes)
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1LECTURE 1: INTRODUCTION TO 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 as a result of developmental
disorders, neurological disorders (brain diseases or damage) or psychiatric
disorders.
(behavioral symptoms: latent variables that can be objectively assessed through
tests or that subjectively can be subjectively observed by the patient and
significant others.)
a) What does it mean to say that a neuropsychologist must be a
scientist-practitioner? How does this relate to the diagnostic
cycle of neuropsychological diagnostics?
- A clinical neuropsychologist is a science practitioner whose focus lies on
behavior and cognition.
They are familiar with a wide range of neurological and psychiatric syndromes that
cause disorders in cognitive functions, emotions and behavior.
- A clinical neuropsychologist is NOT a BRAIN researcher.
The brain has “persuasion”, neuropsychology and the brain are ‘fancy” for the last
10 years, it has been on the news and needs a big development in clinical practice
and universities. Educational trajectory in clinical neuropsychology is a very
important aspect (bachelors, postmaster…)
Clinical neuropsychologists work with ALL age groups (children, adults, elderly) but
may focus on one.
They work in a wide range of clinical settings: general hospitals, university
hospitals, specialized neurologic clinics (Alzhgeimer, epilepsy, sleep…), mental
health care, specialized psychiatric clinics, rehabilitation centers, private practices,
schools, etc.
Clinical neuropsychology is multidisciplinary:
ICF (international classification of functioning) - neurologist, neurophysiologist,
neurosurgeon, neuroradiologist, rehabilitation physician, psychiatrist.
(because it’s a medical setting, many times neuropsychologist must be aware of the
ICF)
, 2
DSM-5 (diagnostic and statistical manual) (in mental health care) - health
psychologist, clinical psychologist, psychological technician, nurse, teacher, speech
therapist, fysiotherapist)
Neuropsychological assessment uses hypothesis testing. Neuropsychologists run
through a diagnostic cycle that consists of 4 stages:
➡️ referral
- Complaints analysis (interview with the patient and interview with the
informant)
- Problem analysis (includes tests)
- Diagnosis (data from the first two stages are integrated for diagnosis or the
drawing of conclusions)
- Indication for treatment (usually in consultation with the patient and the
professional, the need for further diagnosis or options for treatment is
examined)
treatment ⬅️
They formulate a hypothesis for each of these stages and they test them using data
from patient interviews, observations, neuropsychological tests and
questionnaires.
During the cycle, hypotheses can be adjusted or rejected.
The entire diagnostic cycle is not always completed, after the complaints have been
analyzed a decision might be taken to not continue with the problem analysis.
Definition for clinical neuropsychology : “Applied science that studies the
relationship between brain (dys)functions and behavior in patients and the
application in assessment and treatment”
, 3
All kinds of brain functioning and dysfunctioning. All kinds of contextual factors:
psychosocial, somatic (pain), developmental, performance validity. Everyday
functioning of the patient: at home, work/study, with his family, social life. These all
have an influence on the latent variables that are seen in a neuropsychological
assessment. The complaints and dysfunctions may be caused by these three broad
categories (the objectively measured test scores are dependent on these three
aspects)
International Classification of Functioning (ICF)
used in a medical setting (besides psychiatry)
Very useful in clinical neuropsychology
because it gives a description of the consequences of brain disorders at 3
different levels:
- impairment
- limitation
- restriction (handicap)
The health condition is described by
- Body structure and function of the patient
- Activity
- Participation of the patient in daily life
(dependent on environmental factors or personal factors)
All of these aspects are responsible for the way brain dysfunction may present
itself in daily life
b) Formulate the difference between a referral and a diagnostic
question.
A neuropsychological assessment always starts with a referral question. Often a
patient is referred by a medical specialist, fellow psychologists, lawyer, paramedic…
if the referral question is not well-defined, the neuropsychologist consults with the
referrer.
question that is too broad: “please asses the cognition”
well-worded question: “are the cognitive disorders in line with Korsakoff’s
syndrome?” or “what are the neuropsychological effects of the ischemic left frontal
CVA?
During the examination, the neuropsychologist also formulates additional
questions if the current examination renders it necessary.
, 4
c) What is the difference between a neuropsychologist, a
health-care psychologist and a clinical neuropsychologist?
In the Netherlands when you become a health psychologist, for the master there
are 2 post academic educational programs to become an independent working
psychologist in health care. The first step is doing a 2 year program in health
psychology and becoming a health psychologist. And after graduating from this 2
year program you can become either a clinical psychologist or a registered clinical
neuropsychologist. The health care psychologist program is more general.
d) Master the concepts of NVN, INS, NIP, AST, Cotan.
NVN: Professional association in the Netherlands of neuropsychology
FESN: Federation of the European Societies of Neuropsychology
INS: Worldwide international neuropsychological society
Cotan is a commission that judges the psychological tests in the Netherlands
AST is for assessment in clinical practice
e) Master the concepts of reliability and validity, and all their
facets.
These are two important psychometric properties of a test:
Reliability: the accuracy of the instrument (the extent to which the results of a
test remain the same when they are collected at a different time or by different
researchers)
- same results when taken at a different time by the same patient?
- different researchers must obtain comparable results under the same
conditions – indicated by Correlation Coefficient
- the degree of correspondence between the results of different researchers
is called inter-rater reliability (presented as Cohen’s kappa).
Validity: the applicability of a test (whether the test measures what it’s supposed
to measure)
- face validity: extent to which a test initially seems to measure what it is
supposed to measure.
- content validity: extent to which a test is representative of the topic that is
to be measured.
- construct validity: extent to which the result of a test actually reflects the
cognitive function (the construct) that is being assessed.
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