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.
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.
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
Visual search and visuomotor scanning
Speed of information processing
Disorders of perceptual function/apraxias
Attention and concentration
Divided attention/visual monitoring and visual sequencing
Vigilance and sustained attention
Selective attention/freedom from distractibility
Verbal abilities and language skills
Disorders of language functions/aphasias
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
Semantic and episodic autobiographical memory
Recognition and working memory speed
Visuospatial skills and construction skills
Facial recognition matching
Executive functions and conceptual skills
Abstract reasoning/concept formation
Planning and sequencing ability
Overall intellectual abilities
Academic achievement skills
Emotional functioning, personality, and affect
Instrumental activities of daily living/competencies
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.
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.
References and Further Reading
- Armstrong, C., & Morrow, L. (Eds.). (2010). Handbook of medical neuropsychology; applications of cognitive neuroscience. New York: Springer.Google Scholar
- Davis, A., & D’Amato, C. (Eds.). (2010). Handbook of pediatric neuropsychology. New York: Springer.Google Scholar
- Grant, I., & Adams, K. M. (Eds.). (2009). Neuropsychological assessment of neuropsychiatric and neuromedical disorders. New York: Oxford University Press.Google Scholar
- Joseph, R. (Ed.). (2013). Neuropsychology, neuropsychiatry, and behavioral neurology. New York: Springer Science and Business Media.Google Scholar
- Kolb, B., & Whishaw, I. Q. (2015). Fundamentals of human neuropsychology (7th ed.). New York: Worth Publishers.Google Scholar
- Kreutzer, J., DeLuca, J., & Caplan, B. (2011). Encyclopedia of clinical neuropsychology. New York: Springer.Google Scholar
- Lezak, M. D., Howieson, D., Bigler, E., & Tranel, D. (2012). Neuropsychological assessment (5th ed.). New York: Oxford University Press.Google Scholar
- McCarthy, R. A., & Warrington, E. K. (2013). Cognitive neuropsychology: A clinical introduction (2nd ed.). San Diego: Academic.Google Scholar
- Morgan, J., & Ricker, J. (Eds.). (2016). Textbook of clinical neuropsychology. New York: Taylor & Francis.Google Scholar
- Reynolds, C. R., & Fletcher-Janzen (Eds.). (2013). Handbook of clinical child neuropsychology. New York: Springer.Google Scholar
- Waldstein, S. R., & Elias, M. F. (Eds.). (2015). Neuropsychology of cardiovascular disease. New York: Psychology Press.Google Scholar