What is Neuropsychology?

Neuropsychology is a specialist branch of medical practice concerned with the behavioural expression of brain function (e.g. attention, language, reasoning, executive, praxis, memory, perception) following disease, injury, trauma, illness, ageing, and others.  As an applied discipline, its chief contribution to the clinical examination of a patient is the objective/practical quantifying of cognitive skills/abilities, carried out in the context of an individualised assessment, and using a number of psychometric tests sensitive to variations in the workings of basic neurobiological mechanisms (e.g. learning) known to react differentially following organic damage in diverse regions of the brain.

What type of patients does Clinical Neuropsychology deal with?

There are different reasons why a neuropsychological assessment may be required (e.g. diagnosis, patient care and planning, rehabilitation and treatment issues, research).  Typically, a clinical neuropsychologist will see a wide range of patients with traumatic brain injury (TBI) sustained through insidious (Alzheimer disease, tumours, industrial poisoning, alcohol/drug damage), or sudden (motor vehicle accident (MVA), assault, stroke, aneurysm, fall), onset. 

While a neurological examination will be able to document a person's physical/functional disabilities (e.g. after a motor vehicle accident), a number of patients with head trauma will in time come to show cognitive and behavioural difficulties.  There is no need for a neuropsychological assessment if a patient is still in coma, but it may become relevant later when coma has lifted, and cognitive residuals are suspected to interfere with activities of daily living (e.g. work, parenting, etc).

What is the procedure for a Neuropsychological assessment?

The practice of neuropsychological assessment is rooted in the clinical neurosciences (neuroanatomy, neurophysiology, neurochemistry), and actuarial methods of analysis.  Information needed to produce a comprehensive report comes from three sources:

• Detailed interview with a close informant (e.g. relative, friend, neighbour, parent, children, sibling).

• Ratings on behavioural inventories during/after the testing session.

• Performance on standardised 'pen & paper' tests that sample a wide range of cognitive, emotional and functional abilities.  Results are scaled against normative tables from large-scale empirical surveys, with enough stratified information to estimate what might have been expected in the general population, given a person's projected pre-injury intellect, and socio-demographic particulars.

Assessments are mindful of the possible presence of post-traumatic stress disorder, depression, and other threats to validity (simulation, intoxication, incapacity), while the most important functions (e.g. memory) are repeatedly tested using alternative procedures to safeguard reliability.

To bolster ecological validity, the clinical examination is carried out in a person’s own environment (e.g., home).  Standardised test results can be contrasted with observed behaviour in familiar surroundings, providing valuable insight in the preparation of an accurate and realistic appraisal of neuropsychological functioning after brain injury.

What kind of report will you get?

Depending on the reason for its commission, the final report can be comprehensive, covering a wide range of issues to address concerns formulated at the outset (e.g. in Solicitor's instructions).  The final report comes in a standardised legal format, and general sections provide a summary of medical, educational, and employment history, together with a brief analysis of mental status at time of testing. Profiles of a person's cognitive fitness are then gradually developed, matching performance on core tests of general and/or specific skills, along with competencies in everyday situations (e.g. driving a car, home safety, balancing a cheque book).

At a more general level, the report can be a systematic piece of information on the nature of particular conditions (what is Alzheimer and dementia, what is post-concussional syndrome and mild traumatic brain injury, etc) and their likely effects on a number of issues.