The attempts to derive the links between the damage to specific brain areas and problems in behaviour are known throughout the history for 3 millennia. However, the first systematic neuropsychological assessment and a battery of the behavioural tasks to investigate specific aspects of behavioural regulation was developed by Alexander Luria in 1942-1948. Luria was working with big samples of brain-injured Russian soldiers during and after the second World War. Among many insights from Luria's rehabilitation practice and observations, was the fundamental discovery of the involvement of frontal lobes of the cortex in plasticity, initiation, planning and organization of behaviour. His Go/no-go task, which was one of the tasks screening for the frontal lobe damage, "count by 7", hands-clutching, clock-drawing task, drawing of repeatitive patterns, word associations and categories recall and others became standard components of neuropsychological assessment and mental status screening. Considering the originality and multiplicity of neuropsychological components offered by Alexander Luria, he is recognized as a father of neuropsychological assessment.
Alexander Luria's neuropsychological battery was adapted in the United States in the form of Luria-Nebraska neuropsychological battery in 1970s. Then the tasks used in this battery were borrowed in more modern neuropsychological batteries and in the Mini–mental state examination test for screening of demenia.
Neuropsychological assessment was traditionally carried out to assess the extent of impairment to a particular skill and to attempt to determine the area of the brain which may have been damaged following brain injury or neurological illness. With the advent of neuroimaging techniques, location of space-occupying lesions can now be more accurately determined through this method, so the focus has now moved on to the assessment of cognition and behaviour, including examining the effects of any brain injury or neuropathological process that a person may have experienced.
A core part of neuropsychological assessment is the administration of neuropsychological tests for the formal assessment of cognitive function, though neuropsychological testing is more than the administration and scoring of tests and screening tools. It is essential that neuropsychological assessment also include an evaluation of the person's mental status. This is especially true in assessment of Alzheimer's disease and other forms of dementia.[1] Aspects of cognitive functioning that are assessed typically include orientation, new-learning/memory, intelligence, language, visuoperception, and executive function. However, clinical neuropsychological assessment is more than this and also focuses on a person's psychological, personal, interpersonal and wider contextual circumstances.
Assessment may be carried out for a variety of reasons, such as:
Miller outlined three broad goals of neuropsychological assessment. Firstly, diagnosis, to determine the nature of the underlying problem. Secondly, to understand the nature of any brain injury or resulting cognitive problem (see neurocognitive deficit) and its impact on the individual, as a means of devising a rehabilitation programme or offering advice as to an individual's ability to carry out certain tasks (for example, fitness to drive, or returning to work). And lastly, assessments may be undertaken to measure change in functioning over time, such as to determine the consequences of a surgical procedure or the impact of a rehabilitation programme over time.[2]
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Information gathered from assessment[edit]
Tsatsanis and Volkmar believe that assessment can provide unique information about the type of disorder a patient has which allows the psychologist to come up with a treatment plan. Neuropsychological assessment can clarify the nature of the disorder and determine the cognitive functioning associated with a disorder. Assessment can also allow the psychologist to understand the developmental progress of the disorder in order to predict future problems and come up with a successful treatment package. Different assessments can also determine if a patient will be at risk for a particular disorder. However, assessing a patient at one time is not enough to go ahead and continue treatment because of the changes in behavior that can occur frequently. A patient must be retested multiple times in order to make sure that the current treatment is still the right treatment. For neuropsychological assessments, researchers discover the different areas of the brain that is damaged based on the cognitive and behavioral aspects of the patient.[4]
Benefits of assessment[edit]
The most beneficial factor of neuropsychological assessment is that is provides an accurate diagnosis of the disorder for the patient when it is unclear to the psychologist what exactly he/she has. This allows for accurate treatment later on in the process because treatment is driven by the exact symptoms of the disorder and how a specific patient may react to different treatments. The assessment allows the psychologist and patient to understand the severity of the deficit and to allow better decision-making by both parties.[6] It is also helpful in understanding deteriorating diseases because the patient can be assessed multiple times to see how the disorder is progressing.
One area where neuropsychological assessments can be beneficial is in forensic cases where the defendant's competency is being questioned due to possible brain injury or damage. A neuropsychological assessment may show brain damage when neuroimaging has failed. It can also determine whether the individual is faking a disorder (malingering) in order to attain a lesser sentence.[7]
Most neuropsychological testing can be completed in 6 to 12 hours or less. This time, however, does not include the role of the psychologist interpreting the data, scoring the test, making formulations, and writing a formal report.[7]
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