Index
Chapter 1 | The practice of neuropsychological assessment ................................................................. 3
Examination purposes ......................................................................................................................... 3
The validity of neuropsychological assessment .................................................................................. 4
Chapter 2 | Basic concepts ...................................................................................................................... 4
Examining the brain............................................................................................................................. 4
Dimensions of behaviour..................................................................................................................... 4
Cognitive functions .............................................................................................................................. 5
Classes of cognitive functions ............................................................................................................. 6
Executive functions ............................................................................................................................. 7
Chapter 3 | The behavioural geography of the brain ............................................................................. 8
The cellular substrate .......................................................................................................................... 8
The structure of the brain ................................................................................................................... 9
The cerebral cortex and behaviour ................................................................................................... 13
Functional organization of the posterior cortex ............................................................................... 15
Functional organization of the anterior cortex ................................................................................. 17
Clinical limitations of functional localization..................................................................................... 19
Chapter 6 | The neuropsychological examination: interpretation ....................................................... 20
Test scores ......................................................................................................................................... 20
Chapter 7 | Neuropathology for Neuropsychologists ........................................................................... 21
Traumatic brain injury ....................................................................................................................... 21
Cerebrovascular disorders................................................................................................................. 26
Vascular disorders ............................................................................................................................. 29
Epilepsy.............................................................................................................................................. 30
Dementing disorders ......................................................................................................................... 31
Cortical dementias............................................................................................................................. 31
Subcortical dementias ....................................................................................................................... 32
Other progressive disorders of the CNS which may have important NP effects .............................. 35
Toxic conditions ................................................................................................................................. 37
Infectious processes .......................................................................................................................... 40
Brain tumours .................................................................................................................................... 41
Oxygen deprivation ........................................................................................................................... 43
Metabolic and endocrine disorders .................................................................................................. 43
Nutritional deficiencies ..................................................................................................................... 44
1
,What is summarized:
Chapter 1, pages 3-12 (full chapter except for the section "What can we expect of neuropsychological
assessment in the 21th century?").
Chapter 2, pages 15-39 (full chapter except for the section "Personality/emotionality variables").
Chapter 3, pages 41-100 (full chapter).
Chapter 6, pages 165-169 (section "Test scores" until "Evaluation Issues").
Chapter 7, pages 179-344 (full chapter).
2
, Chapter 1 | The practice of neuropsychological
assessment
During the first half of the 20th century, war-damaged brains gave the beginning to the
development of clinical neuropsychology. There was a need for screening and diagnosis of brain
injured and behaviourally disturbed servicemen during WW1. The wars in east Asia, Mideast and WW2
promoted the development of increasingly sophisticated examination and treatment techniques.
Examination purposes
Diagnosis
The use of neuropsychological assessment as a diagnostic tool has diminished, while its
contributions to patient care, treatment, understanding behavioural phenomena and brain function
have grown. This is in part due to the development of highly sensitive and reliable non-invasive
neurodiagnostic techniques. Neuropsychologists are needed to evaluate the extent of impairments or
behavioural changes in people with brain lesions. Though there is general consensus on location of
lesion and certain impairment, the consequences do differ between people.
Neuropsychological assessment can further aid in prodromal or early detection and prediction of
disorders and their outcome. Screening is another aspect of diagnosis, used to identify persons most
likely at risk for some specified condition or in need of further diagnostic study.
Patient care and planning
Patients may be referred for neuropsychological assessment to gather information about their
cognitive status, behavioural alterations and adjustments to their disabilities. The people responsible
for their wellbeing and family members may need to know how the neurological condition has affected
the patients’ behaviour. A family member may now be irritable or sensitive to sounds and more easily
fatigued.
Brain impaired patients must have factual information about their functioning to understand
themselves and to set realistic goals. Perplexity is the self-doubt of the brain injured person.
Treatment – planning and remediation
Today, much of the work of neuropsychologists is involved in treatment or research on
treatment. In the rehabilitation setting, the application of neuropsychological knowledge and
treatment techniques are needed for fitting treatment. Rehabilitation care is often shared by many
disciplines, neuropsychological status enables these treatment specialists to maintain common goals
and understanding of the patient.
Treatment – evaluation
Rehabilitation and retraining services are costly and need a lot of time. It needs to be evaluated
whether these programs are worth the cost and time. Neuropsychological evaluation can often best
demonstrate the neurobehavioural response to surgical interventions or to brain stimulation. Testing
for drug efficacy and side effects also requires neuropsychological data.
Research
Neuropsychological research has been crucial for understanding normal behaviour, brain
functions and the association of cognition with the underlying functional architecture of the brain.
3
, Forensic neuropsychology
Most forensic questions referred to a neuropsychologist will either ask for a diagnostic opinion
or a description of the subject’s neuropsychological status. This can be used to estimate the victim’s
rehabilitation potential. This may influence the request for compensation.
In criminal cases a neuropsychologist may assess a defendant when there is reason to think that brain
dysfunction contributed to the misbehaviour or when there is question about their mental capacity to
stand trial. Neuropsychologists must always be alert to the possibility of malingering.
The validity of neuropsychological assessment
A repeatedly raised question about the usefulness of neuropsychological assessments
concerns its ecological validity, this means how well the assessment data reflect everyday functioning.
Though, most studies that looked into this were able to affirm that neuropsychological assessments
are most of the time accurate for everyday functioning or predicting behavioural outcome.
Chapter 2 | Basic concepts
Examining the brain
Historically, the clinical approach of neurological examination focused on behaviour.
Additionally, a neurologist would examine the patients’ brain or bodily functions. The mental status
portion was mainly focused on higher behavioural functions such as language, memory, attention and
praxis. Neuropsychological assessment is another, more detailed, method of examining the brain and
studying behaviour. It relies on many of the same techniques as psychology. The difference is that
neuropsychology takes the brain as the point of departure for behaviour.
One of the earliest instruments for studying brain function is electroencephalography (EEG). It is
especially useful in diagnosing seizure disorders and sleep disturbances. Magnetoencephalography
(MEG) is the magnetic cousin of EEG that records magnetic rather than electrical fields. MEG can have
a higher resolution than EEG, and it can more precisely identify the source of epileptic discharges. They
both do not have very good spatial resolution and MEG is expensive.
Electrodermal activity reflects autonomic nervous system functioning and provides a sensitive
and very robust measure of emotional responses and feelings. This is measured through skin
conductance response (SCR). Other type of autonomous measures: heart rate, respiration and pupil
dilation. These have shown various nonconscious forms of brain processing (for example, pupil
responds to stimulus but patient has no memory of the previously exposed stimulus due to amnesia).
Since the mid-1970s, neuroimaging has become a critical part of the diagnostics for most neurological
patients. A CT scan might be best suited for acute head injury, while MRI might be the best in chronic
stages of head injury, when one is most concerned about white matter integrity. PET scans visualize
brain metabolism directly, indicating the level of brain activity in a given area. fMRI capitalizes that
increasing neuronal activity requires more oxygen by blood flow.
Dimensions of behaviour
Behaviour may be conceptualized in terms of three functional systems: cognition, emotionality and
executive functions. In neuropsychology, cognition receives the most attention. This is because it tends
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