Neuropsychological Assessment - What is a Neuropsychologist?

A neuropsychologist is an individual who studies the brain’s structure and function as they relate to certain behaviors and psychological processes. It is a specialty in the realm of psychology and is seen as both a clinical field and an experimental field.

The goal of a neuropsychologist is to assess, understand, study and treat behaviors directly related to brain functioning. People who have sustained brain trauma  or tbi from car accidents or who have early dementia are good candidates for neuropsychological tests done by the neuropsychologists.   Most neuropsychologists work in research settings such as laboratories, universities and research institutions.

Others practice in clinical settings, involved in the treatment and assessment of patients with neuropsychological problems.

Some work in industrial or forensic settings as consultants where neuropsychological problems exist. A few work in pharmaceutical fields where the drugs being tested might have CNS effects.

Even though the title “neuropsychologist” is a relatively new one, its roots can be traced to ancient Egypt at least. People in ancient times were looking at the functions of the brain.

For many centuries, the brain was felt to be completely useless-not the center of bodily function as it now is. Only Imhotep, an Egyptian priest and physician seemed to understand the role of the brain in the body.

In the 18th through 20th centuries, increasing knowledge was learned by various anatomists, psychologist and physicists about the structure and function of the brain. Slowly a picture of the brain has been uncovered, including what parts of the brain are responsible for different functions in the body
 
In the latter half of the 20th century, the discipline of neuropsychology was born. Research was directed at how the brain affected both the body and personality. Then mental disorders and cognitive impairments were since identified.
 
Different treatment plans and tests have been developed over the years based on the dysfunctions identified by neuropsychological testing.
 
The field of neuropsychology is still evolving with much research being done to connect test findings with appropriate treatments.
 
Sometimes diagnoses overlap when it comes to the brain and this makes treatment complicated. The neuropsychologist must really use his or her skills to identify the most important diagnosis and recognize a proper treatment.

Other diagnoses can be ranked and treated in turn. Some diagnosis can effectively be treated together with the same goal in mind.

Doctorates who practice in the field of experimental neuropsychology are continuing to uncover the relationships between the physical brain and cognitive function

Usually, they work on healthy subjects while the minority of doctorates works on animal subjects. Specific features of the nervous system are isolated out and studied, such as the visual system. In clinical neuropsychology, the management and rehabilitation of people with neurocognitive problems is undertaken.

The parts of the brain are united with the aspect of the personality that has suffered. The brain deficits are practiced until they are improved on and until the psychological aspects of the illness have been similarly improved.

Neuropsychological Assessments are also called NPEs or neuropsychological evaluations are performed by a neuropsychologist, who can gain access to the patient’s motor, cognitive, behavioral, linguistic skills, and executive functioning.

This can tell whether or not a person is suffering from a cognitive deficit or other deficit in brain functioning. The information gathered can tell people if there is an effective treatment strategy in a patient’s rehabilitation.

The NPE provides a great deal of insight into the psychological functioning of the person, better than an imaging test can do.

The NPE  must be interpreted by a trained neuropsychologist and combined with clinical reports, physical examinations and premorbid/postmorbid relative reports.
Each test has strengths and weaknesses in being able be valid, reliable, sensitive and specific to the patient. The use of the NPE is increasing quite a bit.
 
It is a test that helps in many areas including evaluating the following:
  • Intellectual functioning
  • Language processing
  • Academic achievement
  • Attention and concentration
  • Visuospatial processing
  • Visual learning and memory
  • Verbal learning and memory
  • Speed of processing
  • Executive functioning
  • Sensory-perceptual functions
  • Motor speed and strength
  • Personality assessment
  • Motivation/symptom validity
There are various tests given that test for different things. For example:
  • Intellectual function.
  • Wechsler scales; Wechsler Adult Intelligence scale; Wechsler Intelligence scale for children; Stanford Binet intelligence test.
  • Academic Achievement.
  • Wechsler Individual Achievement Test; Woodcock Johnson Achievement test.
  • Language Processing.
  • Boston Naming Test; Multilingual Aphasia examination; Boston Diagnostic Aphasia Examination; Token test
  • Visuospatial Processing:
  • Ray Ostemieth Complex Figure-Copy condition; WAIS Block Design Subtest; Judgment of Line Orientation; Hooper Visual Organization Test.
  • Attention and Concentration:
  • Digit span forward and reversed; trail making tests; cancelation tasks; paced auditory serial addition; Vanderbilt Assessment Scale; Behavior Assessment System for children; serial sevens
  • Verbal Learning and Memory.
  • Wechsler Memory Scale; verbal paired-associates; Verbal Selective Reminding Test; WMS-III Verbal Memory Index; Ray Auditory Verbal Learning Test-Rote list learning; Logical Memory I and II-contextualized prose; California Verbal Learning Test-Rot list learning (related words); Hopkins Verbal Learning Test.
  • Visual Learning and Memory.
  • WMS, WMS III-Visual Memory Index; Ray Ostemieth Complex Figure-immediate and delayed recall; Visual reproduction I and II; Nonverbal Selective Reminding test; Continuous Recognition Memory Test; Visuo-motor Integration Test-Block design.
  • Executive Function.
  • Wisconsin card sorting test; category test; Stroop Test; Trail Making Test-B; WAIS Subsets of Similarities and Block Design; Porteus Maze Test; Multiple Errands Test; serial sevens; Mini-mental status exam.
  • Speed of Processing.
  • Simple and Choice Reaction Time; symbol digit modalities test-written and oral.
  • Sensory-Perceptual functions:
  • Halstead Reitan Neuropsychological Battery-Tactual Performance Test and Sensory Perception.
  • Motor speed and Strength.
  • Grooved Pegboard Task; Hand Grip Strength; Thurstone- Uni- and Bimanual Coordination test, Index finger tapping;
  • Motivation.
  • Ray 15 Item Test; Dot counting; Forced Choice Symptom Validity Testing.
  • Personality Testing.
  • Minnesota Multiphasic Personality Inventory; Millon Clinical Multiaxial Survey; Beck Depression Scale; Rorschach Test; Myers-Briggs Type Indicator; Thematic Apperception test for children or adults.
The idea behind the NPE is to quantitatively take measurements of the individual’s behavioral and cognitive capabilities. The data can be used to compare with others of the same age, gender, race and socioeconomic status and can include memory, attention, cognition, intelligence, and personality as well as the ability to problem solve, handle language, motor and perceptual skills. Learning abilities and academic skills are assessed.

Those who are appropriate for a referral to a neuropsychologist include the individuals with the following problems:
  • Head injury
  • Failed developmental milestones
  • Attention deficits or learning deficits
  • Exposure to alcohol or drugs in utero
  • Exposure to chemicals, heavy metals or toxins
  • Cerebral palsy
  • Neurodegenerative disorders
  • Parkinson’s disease
  • Seizure disorders
  • Substance abuse
  • Stroke
  • Dementia
  • Psychiatric disorders
 
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