1. Chapter 18
Neuropsychology

2. Perspectives and History
Definitions
Study of relations between brain function and behavior
Understanding, assessing, and treating
Non-invasive study of brain function

3. Perspectives and History
Roles of neuropsychologists
Establish diagnoses
Predictions on prognosis for recovery
Interventions and rehabilitation
Predict course of illness

4. Perspectives and History
Theories of brain function
19th century: discovery of cortical areas
Localization of function
Belief that certain areas of the brain are related to certain functions
First sign of this theory: Franz Gall and phrenology
Bumps and indentations on skull account for individual differences
Equipotentiality: cortex functions as a whole

5. Perspectives and History
Functional Model
Idea that the areas of the brain interact to produce behavior
Nature of the behavioral deficit will depend on
Which functional system has been affected
The localization of damage within this functional system
Reorganization
Recovery from brain damage possible

6. Perspectives and History
Neuropsychological assessment
Began as simple testing for presence of brain damage
Not much notice given to correlations between damage and associated functions
Growth post World War II
High patient numbers
Rise of clinical psychology
Development of test batteries

7. The Brain Structure and function 2 hemispheres 4 lobes per hemisphere
Left: controls right side of body, controls language functions, logical inference, detail analysis
Right: controls left side of body, controls visual-spatial skills, creativity, perception of direction, musicality
4 lobes per hemisphere
Frontal: higher and executive functions
Temporal: hearing, linguistic expression
Parietal: tactile, kinesthetic, and spatial perception
Occipital: vision

8. The Brain

9. The Brain Impairment Trauma Cerebrovascular accidents Concussions
Contusions
Lacerations
Cerebrovascular accidents
Strokes
Occlusions
Can result in aphasia (language impairment), apraxia (inability to perform voluntary movements), and agnosia (disturbed sensory perception)
Cerebral hemorrhage

10. The Brain Impairment Tumors Degenerative diseases
Huntington’s
Parkinson’s
Alzheimer’s
Nutritional deficiencies
Toxic disorders
Chronic alcohol abuse

11. The Brain

12. The Brain Consequences/symptoms of neurological damage
Impaired orientation
Impaired memory
Impaired intellectual functions
Impaired judgment
Shallow and labile affect
Loss of emotional and mental resilience
Frontal lobe syndrome

13. The Brain Brain-Behavior Relationships
Lesions in different areas of the brain will produce different behavior deficits
Damage effects
Intellectual deterioration
Decline from psychological factors
Decline from injuries
Difficult to detect without established baselines

14. Methods of Neuropsychological Assessment
Major approaches
Standard/ Fixed test battery
Advantages
All basic neuropsychological abilities
Standard database creation over time
Establishes patterns
Disadvantages
Time consuming and expensive
Patient fatigue
Inflexibility

15. Methods of Neuropsychological Assessment
Major approaches
Process/ flexible test battery
Advantages
Tailored to patient
Alterable for hypothesis
Disadvantages
Clinician’s discretion/decisions
Hampers systematic data collection

16. Methods of Neuropsychological Assessment
Interpretation of results
Context of normative data
Difference scores
Pathognomonic signs
Pattern analysis
Statistical formulas

17. Methods of Neuropsychological Assessment
Neurodiagnostic procedures
Neurological exams
Spinal taps
X-Rays
Electroencephalographs (EEGs)
CAT/ PET scans
MRI

18. Methods of Neuropsychological Assessment
Neurodiagnostic procedures
Diagnose and locate damage or disease
Not equally able to determine impairment
Risk/ reward to each

19. Methods of Neuropsychological Assessment
Cognitive functioning
WAIS-IV
Subtests: WAIS-R/ WAIS-R-NI
Information
Comprehension
Vocabulary
Abstract reasoning
Similarities
Wisconsin Card Sorting Test (WCST)

20. The Wisconsin Card Sorting Test

21. Methods of Neuropsychological Assessment
Cognitive functioning
Visual Perception Processing
Rey-Osterrieth Complex Figure Test
WAIS-IV
Block design
Judgment of the line orientation testing

22. Rey-Osterrieth Complex Figure Test

23. Judgment of Line Orientation Test

24. Methods of Neuropsychological Assessment
Language functioning
Word substitutions
Impaired naming
Luria-Nebraska Test Battery
Receptive Speech Scale

25. Methods of Neuropsychological Assessment
Memory
Wechsler Memory Scale (WMS)-IV
5 index scores
Auditory memory
Visual memory
Visual working memory
Immediate memory
Delayed memory
Contrast scoring
Benton Visual Retention test
Rey-Osterrieth Complex Figure Test

26. Methods of Neuropsychological Assessment
Test batteries
Halstead-Reitan Battery
Most widely used
Compromised of 12 sections
Information on probable localizations of lesions
Advantages
Probable localizations and gradual/ sudden onset
Validity and reliability
Disadvantages
Length and cumbersome
Neglect of some areas

27. Methods of Neuropsychological Assessment
Luria-Nebraska Battery
269 tasks in 11 subtests
Valid and reliable
Agreement with Halstead-Reitan results
Less than ½ the time of Halstead
Limited because of standardization and rationale

28. Methods of Neuropsychological Assessment
Variables that affect performance on tests
Use of appropriate norms
Handedness
Premorbid ability: before brain injury
Chronicity of condition
Non-neurological conditions
Motivational variables
malingering

29. Intervention and Rehabilitation
Nature of deterioration/ damage?
Permanence of damage
Rehabilitation
Thorough assessment
Maximum benefit of designed program
Spontaneous relearning vs. re-teaching

30. Intervention and Rehabilitation
Guides to re-learning
Include the impaired skill
Vary the difficulty of the task
Task should be quantifiable
Provide immediate feedback
Control number of patient errors

31. Training Training in Neuropsychology Requires specialty skills
Formally recognized by the APA
Requires
Generic psychological core
Generic clinical core
Neuroscience and neuropsychology
Special clinical neuropsychology
Real life training, clinicals, practicum