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Neuropsychology is a branch of psychology that aims to understand how the structure and function of the
brain relates to specific psychological processes. It is strongly scientific in its approach and shares an information processing view of the mind with cognitive psychology and cognitive science. It is one of the most eclectic of the psychological disciplines,
overlapping at times with areas such as neuroscience, philosophy (particularly philosophy of mind), neurology, psychiatry and computer science (particularly by making use of artificial neural networks). In practice neuropsychologists tend to work in academia (involved in basic or clinical research), clinical settings
(involved in assessing or treating patients with neuropsychological problems - see clinical neuropsychology), forensic settings (often assessing people for legal reasons
or court cases or working with offenders, or appearing in court as expert witness) or industry (often as consultants where
neuropsychological knowledge is applied to product design). Definition source: http://en.wikipedia.org/wiki/Neuropsychology
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Clinical Neuropsychology 101 (An Introduction) The clinical specialty of neuropsychology bridges interest in the biological functioning of neural cells in the brain,
spinal cord, and body with the study of psychological disorders. The neuropsychologist uses objective, scientific techniques
to link behaviors to underlying normal and abnormal biological (i.e., brain) processes. The clinical neuropsychologist studies
patterns of abnormal behavior to infer the biological abnormalities that might be producing or contributing to those behaviors.
Traditionally defined, neuropsychology is the study of (and the assessment, understanding, and modification of) brain-behavior
relationships. Neuropsychology seeks to understand how the brain, through structure and neural networks, produces and controls
behavior and mental processes, including emotions, personality, thinking, learning and remembering, problem solving, and consciousness.
The field is also concerned with how behavior may influence the brain and related physiological processes, as in the emerging
field of psychoneuroimmunology (the study that seeks to understand the complex interactions between brain and immune systems,
and the implications for physical health). Neuropsychology seeks to gain knowledge about brain and behavior relationships through the study of both healthy and
damaged brain systems. It seeks to identify the underlying biological causes of behaviors, from creative genius to mental
illness, that account for intellectual processes and personality. Clinical neuropsychology seeks such understanding, particularly,
in the case of how damaged or diseased brain structures alter behaviors and interfere with mental and cognitive functions. The neuropsychologist uses objective tools--neuropsychological tests--to tie the biological and behavioral aspects
together. Through the use of tests, the clinical neuropsychologist is able to differentiate whether or not a behavioral abnormality
is more likely caused by a biological abnormality in the brain or by an emotional or learned process. If we presume that the brain is the starting point for why and how we process all mental information (not just cognitive,
but interpersonal communications, self-concept, emotional reactivity, personality, learned responses, etc.), then in some
aspect, all psychology is neuropsychology. Neurolinguistics, for example, is the study of how language shapes our self-concepts
and our interpersonal communications. Neurodevelopmental psychology is the study of how behavioral and mental characteristics
change with nervous system growth. Even psychological concepts of dreaming (and dream content), level of attention, and conscious
experience are subserved by brain processes. Neuropsychology is a structured, objective, and scientific discipline for peeking into individual brains by way of
formally observing behaviors. Clinical neuropsychology seeks, ultimately, to understand the individual mind and brain (and
its normal as well as errant behaviors). The discipline uses experimental and objective procedures to compare performance
among persons with known differences in their biological brain structures (within the limited criteria currently available
for defining these differences), and to search for the myriad sources of brain variance that produce individual differences
in behavior. These sources include biological factors (e.g., genetic, diseases, and injuries) as well as psychological factors
(e.g., learned behaviors and personality) and social factors (e.g., economics, family structure, and cultural values). In the application of clinical neuropsychology, understanding the biological sources of individual differences, particularly,
helps identify brain-based disorders in memory, personality, self-awareness (conscious experience), cognition, and emotional
expression. Working backwards, then, from a look at abnormal behavior obtained using formal tests, reasonable inferences about
brain disorders can be reached. Understanding these neurofunctional changes (i.e., abnormalities) as a result of brain changes
(i.e., injury) defines parameters for current and future behavioral expectations in the lifestyle of the individual. Combined
with additional understanding of biopsychosocial factors that coalesce into behavioral expression, the neuropsychologist can
gain a comprehensive impression of what is normal or abnormal behavior. As our knowledge of recovery from brain injury improves,
such understanding provides realistic expectations for remediation (restoration or adjustment) of disordered behavior. Neuropsychological understanding is achieved through a comprehensive exploration of the neurophysiological foundation
of behavior and seemingly infinite potential contributing factors. Everyone’s brain is wired differently, a product
of native biological structure, past experiences, physical health, learned responses and personality, injuries and diseases,
and a host of other factors. Clinically, it is the role of the neuropsychologist to sort out the factors that influence how
the brain is working in order to understand disease expression, progress, and recovery. ___________________________________________ Capsule Description of the Clinical Neuropsychological Assessment Clinical neuropsychology is . . . Neuropsychological
assessment is . . . ____________________________________________ Neuropsychological Screening for Brain Dysfunction Normally, a neuropsychological examination explores in depth an individual's performance in a wide range of functional
domains. There are instances, however, in the early phases of diagnostic exploration when the presence of a brain injury or
disease is not compelling but when a suspicion reasonably might be considered. In such cases, along with other diagnostic
procedures, a neuropsychological screening examination may be employed. A neuropsychological screening examination is a considerably
abbreviated version of a full neuropsychological assessment, looking only at key sensitive areas of function. The purpose of a neuropsychological screening examination is to determine if there is reasonable evidence, beyond
initial clinical impression, for a diagnosis of brain injury or brain disease. Even though it is "screening," the examination
must be definitive in this regard. To miss a neurological diagnosis on the basis of a screening examination could be quite
unfortunate. Once a screening points to reasonable probability that a neurological condition exists, a full neuropsychological
examination would be indicated to attain further diagnostic, prognostic, and treatment planning information. A referral for
neurological examination would also be appropriate at this point. Both screening and full neuropsychological examinations offer the opportunity for diagnosis of probability of brain
dysfunction (as opposed to diagnosis of psychodynamic, personality, and/or emotional disorder not associated with neurological
causes). For a screening examination, assessing probability of brain dysfunction is about as far as the diagnosis goes. A
full neuropsychological examination, on the other hand, is necessary to delineate the wide variety of functional manifestations
of brain damage or disease. Such detail is necessary to understand the life consequences of functional impairment (e.g., work,
school, relationships, driving potentials, competency, and so forth). Ability to understand personality, mental health, and behavioral characteristics of the individual when there is a
brain injury requires a full neuropsychological examination. A broad range of functional domains must be evaluated. Also,
designing a cognitive, rehabilitative, or psychological treatment program for a person with brain injury or disease requires
comprehensive understanding of broad neuropsychological characteristics. Formal neuropsychological testing is typically a relatively minimal component of a screening examination. The psychologist
performing a screening examination may rely as much on history, behavioral observations, patterns of subjective complaints,
and other history to establish a reasonable suspicion of an organic pathological state of the brain. Screening neuropsychological examination is indicated when: Full neuropsychological examination is indicated when: What Do Neuropsychological Tests Measure? A neuropsychological assessment consists of administering
tests that examine a set of more-or-less independent functional domains that are controlled by brain systems. While neuropsychologists
agree on a general range of functional domains, some categories may be combined in different examinations. Nevertheless, neuropsychological
assessment generally taps most of these areas of functioning that potentially may be impacted by brain disorders. Attention and Processing Speed -- The capability to focus and sustain attention in mental activity is reflected in
processing speed, simple accuracy in a sustained focus task, divided thinking among tasks, mental manipulation and control,
and resistance to internal or external distraction. Motor Performance -- The ability to perform gross and fine motor tasks, and the ability to perform purposeful tasks
is of particularly significant interest in evaluating differences between the two sides of the body. Apraxia refers to the
inability to perform a movement resulting from a neurological defect. Sensory Acuity -- The ability to detect basic visual, auditory, and tactile sensations is critical to processing information
at higher levels. Working Memory -- Working memory is closely related to attention in that it involves keeping a limited amount of information
active, frequently up-dated, and rapidly accessible for a brief time span. Most people have a working memory capacity of about
seven items. Learning and Memory -- The ability to encode new information, store information in a relational memory system, and
retrieve information is measured in verbal/auditory and in spatial/visual modalities. Intelligence -- Intelligence is a summary and multifaceted concept of general mental capability, reflecting the ability
to comprehend, adapt to, and interact with the environment. Patterns among components of intelligence, those reflecting "hold"
versus "don't hold" skills, provide a strong basis for inferring changes in current intelligence from inferred premorbid intelligence.
Intelligence is not a specific domain but a composite of several domains. It is usually included in neurofunctional assessment,
however, as a comprehensive functional index and, because it is multifaceted, may not reflect some forms of brain injury or
disorder. Language -- The ability to receive and express thought through various forms of symbolic manipulation is measured
in various language tests. Receptive language is measured in reading and ability to comprehend spoken language. Expressive
language is measured in writing and ability to formulate oral language. Calculation -- Ability to manipulate mathematical symbols and perform operations may reflect skill level or loss of
skills the individual once had. The specific nature of calculation difficulties can suggest specific areas of brain dysfunction. Visuospatial Analysis -- The ability to receive, interpret, and apply meaning to visual information is measured in
constructional skills and visual perceptual tests. Problem Solving and Judgment -- Problem solving refers to advanced, higher-order information processing where knowledge
is assessed and manipulated to find solutions to problems and make informed and reasoned judgments. Arithmetical thinking
is a kind of problem solving. Abstract Thinking -- The ability to use generalized information and apply it to specific situations involves abstract
or conceptual thinking. Mood and Temperament -- The ability of the individual to function in daily living situations depends on cognitive
style, personality traits, beliefs, comportment, mental organization, and emotional status and variability. Executive Functions -- Metacognition is the ability to achieve insight and self-awareness; to reflect on, initiate,
evaluate, and regulate (activate and inhibit) thinking and behavior; to think flexibly; and to make decisions integrating
judgment and feedback. Copyright ©1999, 2000, 2001 Dennis P. Swiercinsky, Ph.D. Text information on this web page is protected and may not be copied or distributed without the written
consent of the owner. Graphics on this site, unless noted otherwise, are in the public domain. Date This Page Last Changed: 07/11/01
Source: http://www.brainsource.com/neuropsy.htm ********************************************** Neuropsych
Testing Tests Commonly Used In a Neuropsychological Examination Neuropsychologists use scientifically
validated objective tests to evaluate brain functions. While neurological examination and CT, MRI, EEG, and PET scans look
at the structural, physical, and metabolic condition of the brain, the neuropsychological examination is the only way to formally
assess brain function. Neuropsychological tests cover the range of mental processes from simple motor performance
to complex reasoning and problem solving. In almost all objective tests, quantitative results are compared with some normative
standard, including data from groups of non-brain injured persons and groups of persons with various kinds of brain injury.
If the norms are based on age and educational achievement, valid comparison can be made between an individual's performance
and that of persons in known diagnostic categories as well as persons who do not have a diagnosis of brain injury. Qualitative assessment of neuropsychological
tests provides a look at the processes an individual may use in producing the quantitative scores. Analysis of the
pattern of performance among a large number of tests is key to a neuropsychological assessment. Thus, the selection of tests
used in a neuropsychological test battery should sample a wide range of functional domains. The combination of objective scores,
behavioral process observations, and consistency in emerging pattern of results, along with comprehensive clinical history,
constitute the art and science of neuropsychological assessment. Most neuropsychologists select a unique combination of tests
focused on the diagnostic and examination questions of interest for an individual. The following alphabetical listing includes
some of the more frequently used tests employed in a neuropsychological assessment. Brief descriptions indicate the intent
of each test . Some tests are included here that are not, strictly speaking, neuropsychological tests, but that may be used
in a comprehensive examination. In order to keep test content and applications confidential to preserve their clinical usefulness,
this information is restricted to general comments. Test Name Purpose of Test Ammons
Quick Test This
test has been used for many years to help assess premorbid intelligence. It is a passive response picture-vocabulary test. Aphasia
Tests (various) Several
aphasia and language tests examine level of competency in receptive and expressive language skills. (e.g., Reitan-Indiana
Aphasia Screening Test) Beck
Depression or Anxiety Scales These
scales provide quick assessment of subjective experience of symptoms related to depression or anxiety. Bender
Visual Motor Gestalt Test This
test evaluates visual-perceptual and visual-motor functioning, yielding possible signs of brain dysfunction, emotional problems,
and developmental maturity. Boston
Diagnostic Aphasia Examination Broad
diagnosis of language impairment in adults. Boston
Naming Test Assessing
the ability to name pictures of objects through spontaneous responses and need for various types of cueing. Inferences can
be drawn regarding language facility and possible localization of cerebral damage. California
Verbal Learning Test This
procedure examines several aspects of verbal learning, organization, and memory. Forms for adults and children. Cognitive
Symptom Checklists Self-evaluation
of areas of cognitive impairment for adolescents and adults. Continuous
Performance Test Tests
that require intense attention to a visual-motor task are used in assessing sustained attention and freedom from distractibility.
(e.g., Vigil; Connors Continuous Performance Test) Controlled
Oral Word Association Test Different
forms of this procedure exist. Most frequently used for assessing verbal fluency and the ease with which a person can think
of words that begin with a specific letter. Cognistat
(The Neurobehavioral Cognitive Status Examination) This
screening test examines language, memory, arithmetic, attention, judgment, and reasoning. It is typically used in screening
individuals who cannot tolerate more complicated or lengthier neuropsychological tests. d2
Test of Attention This
procedure measures selective attention and mental concentration. Delis-Kaplan
Executive Function System Assesses
key areas of executive function (problem-solving, thinking flexibility, fluency, planning, deductive reasoning) in both spatial
and verbal modalities, normed for ages 8-89. Dementia
Rating Scale Provides
measurement of attention, initiation, construction, conceptualization, and memory to assess cognitive status in older adults
with cortical impairment. Digit
Vigilance Test A
commonly used test of attention, alertness, and mental processing capacity using a rapid visual tracking task. Figural
Fluency Test Different
forms of this procedure exist, evaluating nonverbal mental flexibility. Often compared with tests of verbal fluency. Finger
Tapping (Oscillation) Test This
procedure measures motor speed. By examining performance on both sides of the body, inferences may be drawn regarding possible
lateral brain damage. Grooved
Pegboard This
procedure measures performance speed in a fine motor task. By examining both sides of the body, inferences may be drawn regarding
possible lateral brain damage. Halstead
Category Test This
test measures concept learning. It examines flexibility of thinking and openness to learning. It is considered a good measure
of overall brain function. Various forms of this test exist. Halstead-Reitan
Neuropsychological Battery A
set of tests that examines language, attention, motor speed, abstract thinking, memory, and spatial reasoning is often used
to produce an overall assessment of brain function. Some neuropsychologists use some or all of the original set of tests in
this battery. Hooper
Visual Organization Test This
procedure examines ability to visually integrate information into whole perceptions. It is a sensitive measure of moderate
to severe brain injury. Kaplan
Baycrest Neurocognitive Assessment Assesses
cognitive abilities in adults, including attention, memory, verbal fluency, spatial processing, and reasoning/conceptual shifting. Kaufman
Functional Academic Skills Test A
brief, individually administered test designed to determine performance in reading and mathematics as applied to daily life
situations. Kaufman
Short Neuropsychological Assessment Measures
broad cognitive functions in adolescents and adults with mental retardation or dementia. Luria-Nebraska
Neuropsychological Battery This
is a set of several tests designed to cover a broad range of functional domains and to provide a pattern analyses of strengths
and weakness across areas of brain function. The tests reflect a quantitative model of A. R. Luria's qualitative assessment
scheme. MMPI-2
(Minnesota Multiphasic Personality Inventory) This
well-known and well-respected personality assessment is often used to accompany neuropsychological tests to assess personality
and emotional status that might lend understanding to reactions to neurofunctional impairment. Memory
Assessment Scales This
is a comprehensive battery of tests assessing short-term, verbal, and visual memory. MicroCog This
computerized assessment measures nine functional cognitive areas sensitive to brain injury Millon
Clinical Multiaxial Inventory A
self-report assessment of personality disorders and clinical syndromes. This is sometimes used as an adjunct instrument in
comprehensive neuropsychological assessment. Mooney
Problem Checklist This
instrument helps individuals express their personal problems. It covers health and physical development; home and family;
morals and religion; courtship, sex, and marriage. Multilingual
Aphasia Examination This
set of subtests provides comprehensive assessment of a wide range of language disorders. North
American Reading Test This
reading test is often used to help assess premorbid intelligence, for comparison with current intelligence as measured by
more comprehensive tests. Quick
Neurological Screening Test This
is a rapid assessment to identify possible neurological signs, primarily in motor, sensory, and perceptual areas. Paced
Auditory Serial Attention Test Tests
for attention deficits including concentration, speed of processing, mental calculation, and mental tracking. Sensitive for
diagnosing cognitive impairment in individuals 16 and up. Paulhus
Deception Scales This
instrument measures the tendency to give socially desirable responses, useful for identifying individuals who distort their
responses. Personality
Adjective Checklist This
self-report measure evaluate several personality patterns, primarily focusing on personality disorders Repeatable
Battery for the Assessment of Neuropsychological Status Designed
as a brief, repeatable measure of cognitive decline or stability over time, appropriate for trauma, disease, or stroke. Rey
Auditory Verbal Learning Test This
procedure evaluates the ability to learn word lists. It is the forerunner of other tests of verbal learning using lists of
words. Rey
Complex Figure Test This
drawing and visual memory test examines ability to construct a complex figure and remember it for later recall. It measures
memory as well as visual-motor organization. Rey
15-item Memory Test This
test is used to evaluate potential for malingering in memory. Rey-Osterrieth
Complex Figure Test Analyzes
aspects of visuospatial ability and memory in all ages. Rivermead
Behavioural Memory Test Evaluates
impairments in everyday memory related to real life situations. Rogers
Criminal Responsibility Scale This
instrument is designed to assess the impairment of an individual at the time a crime was committed. Rorschach
Projective Technique This
familiar inkblot test is used to evaluate complex psychological dynamics. Persons with brain injury have been shown to produce
certain kinds of responses that can complement other tests and help to understand personality changes associated with brain
injury. Ruff
Figural Fluency Test This
visual procedure complements verbal fluency tests in assessing ability to think flexibly but using visual stimuli rather than
words. Sensory
Screening Test Various
procedures include the assessment of tactile sensitivity to various objects, the ability to recognize objects by touch, and
the ability to detect numbers written on the hands by touch alone. By examining both sides of the body, inferences may be
drawn regarding possible lateral brain damage. SCL-90
(Symptom Checklist 90) This
checklist evaluates the individual's subjective complaints. Shipley
Institute of Living Scale Comparison
of vocabulary knowledge and ability to figure out abstract sequential patterns has been established as a sensitive measure
of general brain functioning. Stroop
Test This
brief procedure examines attention, mental speed, and mental control. Symbol
Digit Modalities Test Screening
test for children and adults to detect cognitive impairment. Tactual
Performance Test Assesses
speed of motor performance, tactile perception, spatial problem-solving, and spatial memory in all ages. Test
of Memory Malingering This
test is used to evaluate potential for malingering in memory. Test
of Memory and Learning (TOMAL) This
test for children and adolescents measures numerous aspects of memory, assessing learning, attention, and recall. Test
of Memory Malingering For
ages 16-84, this visual recognition test helps discriminate malingered from true memory impairments. Thematic
Apperception Test This
projective test is most commonly used to examine personality characteristics that may aid in understanding psychological or
emotional adjustment to brain injury. Tower
of London A
test for all ages, assessing higher-level problem-solving, valuable for examining executive functions and strategy planning. Trail
Making Tests A and B These
tests measure attention, visual searching, mental processing speed, and the ability to mentally control simultaneous stimulus
patterns. These tests are sensitive to global brain status but are not too sensitive to minor brain injuries. Validity
Indicator Profile A
complex, computer-analyzed test for evaluating effort and motivation in test taking. Verbal
(Word) Fluency Tests (various) There
are a variety of verbal fluency tests in use. Each is designed to measure the speed and flexibility of verbal thought processes.
(e.g., Controlled Oral Word Association Test; Thurstone Verbal Fluency) Wechsler
Adult Intelligence Scale—III This
set of 13 separate "subtests" produces measures of memory, knowledge, problem solving, calculation, abstract thinking, spatial
orientation, planning, and speed of mental processing. In addition to summary measures of intelligence, performance on each
subtest yields implications for different neurofunctional domains. The set of tests takes about an hour or more to administer.
The WAIS-III is often the foundation for a comprehensive neuropsychological assessment. Wechsler
Intelligence Scale for Children—III Comparable
to the Wechsler Adult Intelligence Scale, this procedure contains subtests that measure similar domains in children. Wechsler
Memory Scale—III This
set of 18 separate "subtests" yields information about various kinds of memory and learning processes. Summary memory indices
are provided in addition to the individual scores of the subtests. The whole set of tests takes about an hour to administer.
The WMS-III provides a comprehensive assessment of memory. It is co-normed with the WAIS-III and is usually used in conjunction
with it. Wechsler
Test of Adult Reading Provides
estimate of pre-morbid intellectual functioning in persons 18-89, normed with the WAIS-III and WMS-III. Wide
Range Achievement Test Provides
level of performance in reading, spelling, and written arithmetic. The reading and spelling tests are often used in estimating
premorbid intellectual functioning. Wisconsin
Card Sort Test Similar
in concept to the Category Test, this procedure also measures the ability to learn concepts. It is considered a good measure
of frontal lobe functioning. Wonderlic
Personnel Test This
personnel test is not a neuropsychological instrument per se, but is used to help evaluate vocational abilities and potential
for comparison with other neuropsychological tests in making practical prognostic decisions. Word
Memory Test A
validity procedure designed to detect response bias that might indicate exaggeration of impairment or symptom feigning. |
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