The objectives of neuropsychological assessment in clinical practice are to assess and diagnose disturbances of mentation and behavior and to relate these findings to their neurological implications and to the issues of clinical treatment and prognosis.
Variety of behavioral measures (“tests”) are administered in a standardized, controlled fashion, and the results are used to infer an individual’s underlying ability and current functioning in a number of broad cognitive domains.
The major cognitive domains typically assessed in a neuropsychological examination include :
- visual-spatial thinking,
- psychosensory and motor abilities,
- “frontal lobe” or executive functions,
- academic achievement,
- and personality or emotional functions.
Performance on tests of cognitive abilities are compared with normative performance levels of the general population. Negative deviation from these normal population levels may suggest impairment, either constitutional or acquired, in a given cognitive domain. Cognitive strengths resulting from training as well as natural ability are reflected by performances that exceed those of the general population.
Insult to various regions of the brain due to either injury or disease may result in characteristic patterns of deficit. These patterns may be used to develop hypotheses about the neurological processes involved as well as to generate descriptions of cognitive, emotional, and functional competence.
In confusing or complex cases, neuropsychological assessment can be useful for teasing out the relative contributions of neurological conditions (e.g., cellular degeneration, neurochemical disruption), emotional states (e.g., anxiety, depression), and psychiatric illnesses (e.g., personality disorder, psychoses).
Methods of Neuropsychological Assessment
All relevant medical records, especially results of neurological examination, imaging studies, and electrophysiological (EEG) results.
Includes review of cognitive, sensorimotor, and neurovegetative complaints as well as medical, psychiatric, and substance abuse history. Family members may be interviewed when necessary.
Qualitative assessment of mentation, motor function, speech, motivation for optimal test performance, emotion, manner of relating, and humor.
These may be “paper and pencil” tasks or measures requiring performance of a relevant skill (e.g., assembly of blocks or puzzles, reaction time tasks).