Neurobehavioral Medicine Consultants
Clinical Neuropsychology

Neuropsychology is the subspecialty of psychology which relates behavior, cognitive function and other psychological processes to brain structure and function. Scientists have investigated the effects of brain injury and impairment on psychological and cognitive functioning for two centuries, studying patients who have specific documented brain defects or injuries and determining what deficits seem to result from the brain insults. The observations that specific functions such as language could be selectively affected by specific injuries have implied that some cognitive functions might be localized in specific areas of the brain and mediated by distinct neural pathways.

Brain Illustration

Brain Illustration
from 1920s Textbook

Such research has been greatly facilitated over the last several decades by the advent and continuing improvement of imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) brain scanning, which allow detailed noninvasive assessment of the morphology of brain injuries. In addition, other imaging techniques such as positron emission tomography (PET) and functional MRI (fMRI) provide data about the functioning of various portions of the brain under different circumstances. This information can also be correlated with electrophysiological techniques such as electroencephalography (EEG).

PET Scan Imange

Image from PET Scan

The clinical neuropsychologist brings extensive and detailed knowledge of neuroanatomy and neurobiology to the detection and diagnosis of cognitive deficits and the management, treatment and rehabilitation of brain injured and impaired patients. Neuropsychologists are likely to see patients who have learning disabilities or histories of traumatic brain injury (TBI), stroke and intracranial hemorrhage, brain tumor, dementia and other organic brain disorders. The specialty of clinical neuropsychology overlaps with a number of other specialties such as neurology, psychiatry and neuroscience.

A neuropsychological assessment focuses on arriving at a diagnosis of the underlying problem and obtaining a detailed understanding of the resulting cognitive or psychological difficulty and its impact on the patient's life. A series of assessments may also be used to measure the way a deficit changes over time, either to determine the course of an illness or to ascertain the effects of a treatment or rehabilitation program.

The assessment includes a detailed clinical interview and history. However, much of the objective data comes from administration of neuropsychological tests designed to measure specific neurocognitive processes, including orientation, learning and memory, intelligence, language skills, visual perception and executive functions. The patient's score on a test is typically compared to data from a large reference sample matched to parameters such as the patient's age, educational level and gender. The resulting statistically based scores provide a measure of the degree of impairment with respect to the reference population. The assessment will also examine other relevant circumstances such as the patient's personal and interpersonal relationships.

Missing Square Puzzle

The Missing Square Puzzle

Any patient who has an apparent cognitive deficit is a potential candidate for neuropsychological assessment. From information gathered during the clinical assessment and results obtained from the neuropsychological testing, the neuropsychologist will generally be able to determine whether a patient's cognitive or psychological problems are related to organic brain pathology or are secondary to an emotional or mood disorder which may be reversible.

The patient with cognitive deficits may be a candidate for cognitive rehabilitation, with the goal of improving functions such as attention, memory, executive functions and communications. Cognitive deficits are often accompanied by emotional and behavioral issues which may also respond to intervention. Effective rehabilitation depends on the involvement of both the patient and his or her family as well as the collaboration of all of the patient's health care providers. The neuropsychologist will formulate a set of recommendations designed to provide the patient with the most effective ways of treating the disorder and minimizing its impact on the patient's life.

Return to the Page Top.