Encyclopedia of Behavioral Medicine

Living Edition
| Editors: Marc Gellman

Neuropsychology

  • Richard HoffmanEmail author
Living reference work entry
DOI: https://doi.org/10.1007/978-1-4614-6439-6_267-2

Synonyms

Definition

Neuropsychology is a subdivision of the field of psychology that is concerned with the investigation of brain-behavior relationships. The broad category of neuropsychology can be further divided into experimental neuropsychology and clinical neuropsychology, with this latter specialty definable as an applied science focusing on the behavioral sequelae and manifestations of brain dysfunction.

Description

Neuropsychology is currently one of the fastest-growing scientific specialty areas in the field of psychology, and the subspecialty area of human clinical neuropsychology is of direct relevance to behavior medicine practitioners and researchers as well as physicians in clinical practice, especially neurologists and neurosurgeons. Neuropsychologists in clinical practice use a variety of specially constructed tests and test batteries to assess the functional effects of brain trauma, infection, neoplasias, and structural changes to the brain (including vascular abnormalities and strokes) as well as degenerative central nervous system disorders, cortical and subcortical dementias, and progressive disorders of the nervous system, such as multiple sclerosis, Huntington’s disease, and Parkinson’s disease. Specialized neuropsychological test batteries have been constructed to investigate the neurocognitive effects of alcohol and drugs of abuse, assess the functional effects of epilepsy and diabetes, and assess the effects of neurotoxins and hypoxia. More recently, neuropsychological assessment has played a key role in delineating cognitive sequelae related to medical disorders such as autonomic nervous system disorders, cardiovascular diseases, endocrine and metabolic disorders, rheumatologic conditions, and immune-mediated disease. In the field of neuropsychiatry, the neuropsychology of schizophrenia and mood and affective disorders has been extensively studied, and neuropsychological impairments have been identified that are independent of medication effects or the psychiatric illnesses themselves.

Modern clinical neuropsychology is very much a hybrid specialty, with influences from – and ties to – neurology, neurosurgery, neuroimaging (especially functional neuroimaging), neuropsychiatry, cognitive psychology, neuroscience, and clinical psychology as well as significant advances that have been made in experimental neuropsychology, particularly in the areas of memory and learning. This is reflected in the broad range of functional domains that are examined in neuropsychological assessment, as noted in Table 1.
Table 1

Domains of brain-behavior functioning in neuropsychological assessment

Orientation and general mental status

Estimation of premorbid status

Potential for malingering/symptom validity testing

Sensory deficits and paresthesias

Motor and gait disturbances

Psychomotor activity and speed of information processing

Processing efficiency and reaction time

Response inhibition

Visual search and visuomotor scanning

Psychomotor efficiency

Speed of information processing

Motor speed

Grip strength

Disorders of perceptual function/apraxias

Attention and concentration

Mental speed

Visual attention

Auditory attention

Divided attention/visual monitoring and visual sequencing

Vigilance and sustained attention

Selective attention/freedom from distractibility

Working memory

Verbal abilities and language skills

Disorders of language functions/aphasias

Receptive language

Expressive language

Object naming/anomias

Verbal fluency

Phonemic fluency

Semantic fluency

Learning and memory

Visual learning and immediate memory

Verbal learning and immediate memory

Visual delayed memory

Verbal delayed memory

Long-term declarative memory and remote memory

Nondeclarative and procedural memory

Implicit memory

Incidental memory

Semantic and episodic autobiographical memory

Recognition and working memory speed

Spatial memory

Visual perception

Spatial cognition

Visuospatial skills and construction skills

Drawing skills

Visual discrimination

Visuospatial construction

Visuospatial integration

Facial recognition matching

Executive functions and conceptual skills

Metacognitive functions

Cognitive flexibility

Abstract reasoning/concept formation

Planning and sequencing ability

Judgment

Decision-making

Novel problem-solving

Overall intellectual abilities

Crystallized intelligence

Fluid intelligence

Academic achievement skills

Emotional functioning, personality, and affect

Instrumental activities of daily living/competencies

Compensatory strategies

Specialized neuropsychological test batteries have been developed for child and pediatric populations in addition to the adult and aged adult populations, and neuropsychological assessment is of great value in the assessment of developmental and learning disorders of childhood. Child and pediatric neuropsychology has close ties to both child neurology and behavioral pediatrics, in addition to child psychiatry and contemporary learning models in child psychology.

Neuropsychology is a relatively new area of scientific inquiry. Sir William Osler first used the term “neuropsychology” in 1913, but neuropsychology as an emerging scientific discipline can trace its roots to the contemporary psychology, experimental/cognitive psychology, and neurology of the mid-1930s. In 1935, Ward Halstead at the University of Chicago – in close collaboration with neurologists and neurosurgeons – carefully observed the behavior of brain-damaged patients and constructed a battery of ten functional tests or neuropsychological tests designed to provide a comprehensive assessment of the functional impairment seen in individuals with known injury to the brain. This was the first true battery of neuropsychological tests, later refined by Ralph Reitan at the University of Indiana (working closely with neurosurgery colleagues), culminating in the Halstead-Reitan neuropsychological test battery, which is still in use today. A contemporary of Halstead’s in Russia, the neurologist and psychoanalyst A.R. Luria, carefully studied aphasia in the 1930s and later did extensive single-case studies in the 1940s of the effect of brain injury on the behavior of individuals, many who were injured in World War II. The legacy of Luria is reflected in contemporary neuropsychological assessment that emphasizes an individualized, hypothesis-testing approach to neuropsychological assessment, including careful observation of the qualitative responses of the patient examinee.

The earliest neuropsychological test batteries were designed to accurately and efficiently assess the type and extent of specific brain problems and the area or areas of the brain affected and were quite successful in doing so. At the present time, neuropsychological assessment can extend localization information already available from neuroimaging studies and also address in addition many more issues related to treatment planning, educational planning, and the impact of brain problems on a variety of tasks of daily living, some of which are listed in Table 2.
Table 2

Common diagnostic questions that neuropsychological assessment can help answer

Does the patient have an impaired memory and, if so, what does that mean for that patient and for the treating physicians?

Is dementia present and, if so, what kind of dementia and how severe is it?

Can the patient understand and follow health-care provider instructions regarding their medical care?

What is the patient capable of doing vocationally and can the patient return to work following a neurological injury? What components need to be included in the patient’s rehabilitation plan? Is the patient a candidate for a cognitive rehabilitation program, and what should be included in this program?

Does the patient have only psychological or psychiatric problems, or do they have brain problems as well?

What problems remain for the patient following successful physical recovery from a head injury, stroke, or other brain injury?

What is the patient’s capacity in a legal sense (can they drive a car safely, manage their money adequately, participate fully in legal matters such as criminal or civil trials, can they maintain professional licensure)?

What are the cognitive and functional effects of progressive illnesses as time progresses (dementias, brain tumors, progressive deteriorating disorders such as Huntington’s, etc.)?

What is normal aging versus neurological disease/dementia?

Is the temporal lobe epilepsy patient a candidate for resection surgery?

Does the patient have specific learning disabilities/attention deficit disorder? What needs to be included in educational programming and follow-up?

Is the patient in need of a conservator or guardian? Are there neuropsychological deficits that require supervision, additional support, or placement out of the home (such as nursing home placement)?

There are currently a wide variety of specialized neuropsychological test batteries that have been constructed to examine specific diseases or disorders, many of which are designed to be administered following one or more cognitive screening tests. There are also dozens of single neuropsychological tests designed to assess very specific areas of brain functioning. Many of the newer test batteries are hypothesis driven and symptom specific such that individual patients with the same medical diagnosis or disorder may be given different component subtests depending upon their specific presenting symptoms and performance on the initial tests given (the flexible battery approach). There also remain several fixed neuropsychological test batteries where all patients – or all patients with a given diagnosis or disorder – are given the same tests. Irrespective of whether a fixed or flexible battery approach is employed, the performance of the examinee is customarily compared relative to normative data of individuals without neurological disorder matched by age, gender, and education in order to arrive at reliable and valid conclusions. There has been a great deal of interest in the past decade in developing neuropsychological test instruments and neuropsychological test batteries that can be administered and scored using desktop or laptop computers, in some cases including the generation of short reports comparing patient performance to available norms as well as facilitating the creation of databases of neuropsychological patient test performance. Further development in this area, possibly including interfacing neuropsychological test data with existing neuroimaging data, may prove invaluable in both clinical practice and research.

Cross-References

References and Further Reading

  1. Armstrong, C., & Morrow, L. (Eds.). (2010). Handbook of medical neuropsychology; applications of cognitive neuroscience. New York: Springer.Google Scholar
  2. Davis, A., & D’Amato, C. (Eds.). (2010). Handbook of pediatric neuropsychology. New York: Springer.Google Scholar
  3. Grant, I., & Adams, K. M. (Eds.). (2009). Neuropsychological assessment of neuropsychiatric and neuromedical disorders. New York: Oxford University Press.Google Scholar
  4. Joseph, R. (Ed.). (2013). Neuropsychology, neuropsychiatry, and behavioral neurology. New York: Springer Science and Business Media.Google Scholar
  5. Kolb, B., & Whishaw, I. Q. (2015). Fundamentals of human neuropsychology (7th ed.). New York: Worth Publishers.Google Scholar
  6. Kreutzer, J., DeLuca, J., & Caplan, B. (2011). Encyclopedia of clinical neuropsychology. New York: Springer.Google Scholar
  7. Lezak, M. D., Howieson, D., Bigler, E., & Tranel, D. (2012). Neuropsychological assessment (5th ed.). New York: Oxford University Press.Google Scholar
  8. McCarthy, R. A., & Warrington, E. K. (2013). Cognitive neuropsychology: A clinical introduction (2nd ed.). San Diego: Academic.Google Scholar
  9. Morgan, J., & Ricker, J. (Eds.). (2016). Textbook of clinical neuropsychology. New York: Taylor & Francis.Google Scholar
  10. Reynolds, C. R., & Fletcher-Janzen (Eds.). (2013). Handbook of clinical child neuropsychology. New York: Springer.Google Scholar
  11. Waldstein, S. R., & Elias, M. F. (Eds.). (2015). Neuropsychology of cardiovascular disease. New York: Psychology Press.Google Scholar

Copyright information

© Springer Science+Business Media LLC 2018

Authors and Affiliations

  1. 1.Academic Health CenterSchool of Medicine-Duluth Campus University of MinnesotaDuluthUSA

Section editors and affiliations

  • Mustafa al’Absi
    • 1
  1. 1.University of Minnesota Medical SchoolDuluthUSA