NEUROPSYCHOLOGICAL

ASSESSMENT

NEUROLOGY

Neurology (from Greek: νεῦρον (neûron), "string, nerve" and the suffix -logia, "study of") is the
branch of medicine dealing with the diagnosis and treatment of all categories of conditions and
disease involving the nervous system, which comprises the brain, the spinal cord and the
peripheral nerves. A branch of medicine that deals with the nervous system in both healthy and
diseased states. The diagnosis and treatment of diseases of the nervous system is called clinical
neurology; neurologists diagnose and treat patients with stroke, dementia, headaches,
andbackpain, among other disorders.

PARTS OF THE BRAIN

Forebrain : The forebrain, situated at the anterior part of the brain, is the most prominent and
complex region in the central nervous system. Comprising the cerebrum, thalamus, and
hypothalamus, it plays a crucial role in higher-order cognitive functions, such as thinking,
reasoning, and memory. Additionally, the forebrain regulates sensory perception, motor
control, and emotional responses. Its intricate structure and diverse functions make it a
central hub for processing and integrating information, shaping our conscious experience and
behavior.

Midbrain : The midbrain, positioned between the hindbrain and the forebrain, is a vital
component of the central nervous system. It serves as a relay station for sensory and motor
pathways, facilitating the transmission of auditory and visual information. The midbrain also
plays a significant role in controlling basic motor functions like eye movement and reflexes,
contributing to our ability to respond rapidly to external stimuli. Furthermore, it contains
important structures, such as the substantia nigra, involved in the regulation of mood and
movement. In summary, the midbrain's anatomical location and functions make it an essential
bridge between lower and higher brain regions, contributing to our overall sensory perception
and motor coordination.

Hindbrain : The hindbrain, located at the posterior part of the brain, is a fundamental region
in the central nervous system. It consists of the cerebellum, pons, and medulla oblongata,
each with distinct roles. The cerebellum primarily coordinates fine motor movements,
balance, and posture, ensuring our physical movements are precise and coordinated. The pons
serves as a relay station connecting different regions of the brain and is involved in essential
functions like breathing, swallowing, and facial movements. The medulla oblongata controls
vital autonomic functions such as heart rate, blood pressure, and respiratory rate, making it
crucial for our survival. Overall, the hindbrain plays a critical role in maintaining basic bodily
functions and facilitating motor coordination.

Frontal lobe : The frontal lobes are in the front part of your brain, right behind your forehead.
This is the largest lobe and it controls voluntary movement, speech and intellect. The parts of
your frontal lobes that control movement are called the primary motor cortex or precentral
gyrus. The parts of your brain that play an important role in memory, intelligence and
personalityinclude your prefrontal cortex as well as many other regions of your brain.

Occipital lobe : These lobes in the back of your brain allow you to notice and interpret
visual information. Your occipital lobes control how you process shapes, colors and
movement.

Parietal lobe : The parietal lobes are near the center of your brain. They receive and interpret
signals from other parts of your brain. This part of your brain integrates many sensory inputs so
that you can understand your environment and the state of your body. This part of your
brainhelps give meaning to what's going on in your environment.

Temporal lobe : These parts of the brain are near your ears on each side of your brain. The
temporal lobes are important in being able to recall words or places that you've been. It
alsohelps you recognize people, understand language and interpret other people’s emotions.

DEFINITIONS OF NEUROPSYCHOLOGY

Neuropsychology is a specialty field that joins the medical fields of neurology, psychology and
psychiatry. Neuropsychology involves determining how well the brain is working when it is
disrupted by a brain injury or psychological disorder. Neuropsychology was defined as
concerning the relationships between “cerebral structures” and “higher mental functions”
(Hécaen, 1972), the “neural mechanisms underlying human behavior” (Hécaen and Albert,
1978), “the interrelations of the brain with mentation and behavior” (Benton, 1988), “the
relationships between brain, mind, and behavior” (Berlucchi, 2009). Neuropsychology is then
placed at the intersection between the neurosciences (neurology, neuroanatomy,
neurophysiology, neurochemistry, neuroimaging), and the behavioral sciences (psychology,
linguistics), including cognitive and emotional-motivational processes (Hécaen and Albert,
1978).
"Neuropsychology is the scientific discipline that examines the relationship between brain
and behavior, in particular how brain processes impact cognitive functions and emotional
responses."- Laura A. Flashman & Erin D. Bigler

"Neuropsychology is the study of the brain and how it affects behavior, cognition, and
emotions, providing insights into the underlying mechanisms of various mental functions." -
ElkhononGoldberg

"Neuropsychology is a subfield of psychology that seeks to understand how the brain and
nervous system influence a person's cognition and behaviors." - Michael S. Gazzaniga
&GeorgeR. Mangun .These definitions also capture the essence of neuropsychology and its
focus on exploring the connections between brain structure, function, and psychological
processes.

NEUROPSYCHOLOGICAL DISORDERS :

Neuropsychological disorders refer to a set of mental illnesses related to brain functioning and
behavior. These conditions can cause significant impairment in thinking, planning, and
memory, as well as emotional, social, and physical distress. Neuropsychological disorders are
often complex and difficult to diagnose and treat, so early detection and intervention are
essential for maintaining good mental health.

There are many nervous system disorders that require clinical care by a physician or other
healthcare professional.

Epilepsy:

Epilepsy is a neurological condition involving the brain that makes people more
susceptibletohaving recurrent seizures. It is one of the most common disorders of the
nervous systemandaffects people of all ages, races, and ethnic background. Almost
2.2 million Americans live withepilepsy. Anything that interrupts the normal
connections between nerve cells in the brain can cause aseizure. This includes a high
fever, low blood sugar, high blood sugar, alcohol or drug withdrawal, or a brain
concussion. Under these circumstances, anyone can have one or moreseizures.
However, when a person has two or more seizures, he or she is considered to
haveepilepsy. There are many possible causes of epilepsy, including an imbalance of
nerve-signalingchemicals called neurotransmitters, tumors, strokes, and brain
damage fromillness or injury, or some combination of these. In the majority of cases,
there may be no cause that can be discovered for epilepsy.

Parkinson's Disease:

More than one million people in the United States are living with the neurodegenerative
ravagesof Parkinson's disease. This disease, which typically hits people past the age of 65, is
progressive, gradually stripping away motor abilities, leaving people with a slow and awkward
gait, rigidlimbs, tremor, shuffling and a lack of balance. No one knows what causes
Parkinson's. Most cases arise spontaneously; some are hereditary. What is known is that brain
cells in the area of the brain called the "substantia nigra" die off. These are the cells which
manufacture the molecule dopamine, a chemical that helps control muscle movement.
Thanks to recent advances in the lab, including the pinpointing of several Parkinson's
genes, research is exploding. Scientists are now picking apart newly discovered
biochemical pathwaysinvolved in the disease and uncovering new targets for therapy.

Guillain-Barré syndrome (GBS)

It is also called acute inflammatory demyelinating polyradiculoneuropathy (AIDP). It is a

neurological disorder in which the body's immune system attacks the peripheral nervous
system, the part of the nervous system outside the brain and spinal cord. The onset of GBS can
be quitesudden and unexpected and requires immediate hospitalization. It can develop over a
fewdays, or it may take up to several weeks with the greatest weakness occurring within the
first coupleofweeks after symptoms appear. GBS is rare, affecting about 3,000 people in the
U.S. It can affect people at any age and bothmen and women equally. GBS often develops after
a respiratory or gastrointestinal viral infection.

NEUROPSYCHOLOGICAL ASSESSMENT

Neuropsychological Assessment can be defined in various ways -

"Neuropsychological assessment is a comprehensive evaluation of a person's cognitive

abilities, emotional functioning, and behavior, using standardized tests and tasks to provide
insights intobrain-related conditions." - Keith D. Cicerone & Dennis C. Choi, "Clinical
Neuropsychology: APocket Handbook for Assessment"

"Neuropsychological assessment is a process that involves the administration and

interpretationof a battery of tests to assess a person's cognitive, sensory, motor, and
emotional functions, providing valuable information about brain-behavior relationships."
- Erin D. Bigler, "Neuropsychology and Behavioral Neurology: Handbook of Clinical
Neurology"

"Neuropsychological assessment is a specialized method for understanding the relationships

between brain functioning and various cognitive, emotional, and behavioral processes in
individuals with brain injuries, disorders, or neurological conditions." - Arthur MacNeill
HortonJr. & Danny Wedding, "The Neuropsychology Handbook"

COMPONENTS OF NEUROPSYCHOLOGICAL ASSESSMENT

Neuropsychological assessments are composed of various components, including standardized

tests, interviews, observations, and the interpretation of results. These components work
together to provide a comprehensive understanding of an individual's cognitive functioning,
emotional state, and behavioral traits. Here are the key components of a neuropsychological
assessment:

● Clinical interview - information about the patient's medical history, presenting problems,
and current symptoms.

● Standardized tests - assess various cognitive functions, such as memory, attention,

language, and executive functioning.

● Cognitive testing - evaluate specific cognitive domains, such as intelligence, memory,

problem-solving, and spatial reasoning.

● Behavioral observations - patient's behavior, including their motor skills, emotional

reactions, and interactions with the environment.

● Self-report questionnaires - assess their emotional and psychological well-being.

Medical records review - Reviewing the patient's medical records, including past medical
conditions, treatments, and medications, can provide important context for the
assessment.

● Neuroimaging data - neuroimaging data from techniques like MRI (Magnetic Resonance
Imaging) or CT (Computed Tomography) scans may be integrated into the assessment to
visualize brain structures and identify abnormalities.

● Feedback and interpretation - After completing the assessment, the neuropsychologist

provides feedback to the patient and, if applicable, their family or caregivers.
 ● Diagnostic formulation - Based on the assessment results and clinical judgment, the
neuropsychologist formulates a diagnosis or differential diagnosis, if applicable.

● Treatment recommendations - treatment plan tailored to the patient's needs. This plan
may involve cognitive rehabilitation, psychotherapy, medication management, or other
interventions aimed at improving functioning and quality of life.

● Follow-up - patient may receive ongoing care and follow-up appointments to monitor
progress and adjust treatment as needed.

GOALS OF NEUROPSYCHOLOGICAL ASSESSMENT

The primary goals of neuropsychological assessment are :

i) The first goal is to identify the disrupted psychological components/ processes/domains
inanindividual patient and arrive at a profile of adequacies and deficits of psychological
functions.

ii) The second goal is to identify the brain structures/ functional networks, which are
dysfunctional or damaged using the neuropsychological profile that has previously been derived.
Finally, this information is used to lateralise and localize the brain lesion.

Neuropsychological assessment typically aims to achieve several goals, including:

● Diagnosis and Differential Diagnosis
● Characterization of Cognitive Profile
● Treatment Planning
● Monitoring Progress
● Research Purposes
● Legal and Forensic Contexts
● Educational Planning
TYPES OF NEUROPSYCHOLOGICAL ASSESSMENT

Practitioners generally break these exams into seven categories based on what skills they
test :

1. Memory
2. Intelligence
3. Language
4. Executive Function
5. Visuospatial
6. Dementia-Specific
7. Multiple Functions

Memory
Although many people think of memory as one brain function, it has five distinct
components”semantic, episodic, procedural, priming, and short-term. Memory-focused
neuropsychological tests can examine one or more of these types of memory at a time.

Intelligence
Some cognitive functions, such as language, are particularly sensitive to physical damage.
Intelligence neuropsychological tests focus on those that may be more resistant to TBIs. As
such, these exams can aid in the differential diagnosis process.

Language

Speaking, writing, and reading functions may diminish after patients experienceTBIs,
seizures, strokes, or other ailments. These tests determine which parts of language clientshave
lost and to what extent.

Executive Function
These exams evaluate a patient’s ability to complete complex tasks, including problem-solving,
planning, organization, and selective attention. The type of test a doctor recommends depends on
which of the cognitive functions the patient may have lost.

Visuospatial
Each of these tests covers three areas of cognition and the ways these functions
interact with one another:
Visual Perception
Visual Integration
Visual Construction
For example, the clock test requires patients to draw an analog clock from memory.
Professionals then evaluate the placement of the numbers, hands, and other elements.
Dementia-Specific
Dementia is a different disorder that requires equally unique diagnostic testing. Practitioners
may use the Clinical Dementia Rating and the Dementia Rating Scale to determine if a patient
has the disease.

Multiple Functions
Some neuropsychological exams assess functions from several of the above categories at
once. For example, the Cognistat (The Neurobehavioral Cognitive Status Examination)
examines all of the following five areas of neurological behavior: Language, Construction,
Memory, Calculations, Reasoning. Many tests exist to help professionals and patients look at
several cognitive functions at once. Neuropsychologists will use patient symptoms to decide
which tests can help.

NEUROPSYCHOLOGICAL TEST & BATTERIES

A neuropsychological battery refers to a comprehensive set of standardized tests and

assessments designed to evaluate various cognitive functions, emotional states, and
behavioral traits in individuals. These batteries are commonly used by neuropsychologists,
clinical psychologists, and other healthcare professionals to assess and diagnose cognitive
and neurological disorders, track changes in cognitive function over time, and develop
treatment plans.

NIMHANS Neuropsychological Battery

The National Institute of Mental Health and Neurosciences (NIMHANS) Neuropsychological

Battery is a comprehensive and standardized assessment tool designed to evaluate various
aspects of cognitive functioning in individuals. Developed by experts in the field of
neuropsychology, this battery includes a wide range of tests that assess memory, attention,
language, executive functions, and other cognitive domains. It is particularly valuable in
diagnosing and monitoring cognitive impairments related to neurological conditions,
psychiatric disorders, and brain injuries. The NIMHANS Neuropsychological Battery aids
clinicians in understanding an individual's cognitive strengths and weaknesses, facilitating
more accurate diagnoses and tailored treatment plans to improve their quality of life.

The Halstead-Reitan Neuropsychological Battery (HRNB)

The Halstead-Reitan Neuropsychological Battery (HRNB) is a renowned and widely used

battery of neuropsychological tests, initially developed by Ralph Reitan in collaboration with
Ward Halstead. This comprehensive assessment tool comprises a battery of tests that examine
various cognitive and motor functions, helping clinicians evaluate brain functioning and
identify potential impairments in individuals. The HRNB assesses a wide range of cognitive
domains, including attention, memory, sensory-perceptual abilities, and problem-solving
skills. Originally developed to diagnose brain injuries, it has since been applied to evaluate
various neurological and psychiatric conditions. With its rigorous testing procedures and
extensive normative data, the HRNB remains a valuable resource for clinicians in the field of
neuropsychology, aiding in the accurate assessment and understanding of individuals'
cognitive abilities and deficits.

Luria-Nebraska Neuropsychological Battery (LNNB)

The Luria-Nebraska Neuropsychological Battery (LNNB) is another comprehensive

neuropsychological assessment tool, similar to the Halstead-Reitan Battery, used to evaluate a
wide range of cognitive functions and identify deficits resulting from brain injuries,
neurological conditions, or cognitive disorders. The LNNB is based on the
neuropsychological theories of Russian neuropsychologist Alexander Luria, and it was
developed by Ralph M. Reitan and Deborah Wolfson in the 1970s as an alternative to the
Halstead- Reitan Battery. Here are some key features and components of the Luria-Nebraska
Neuropsychological Battery: Standardized Tests; Subtests; Qualitative Analysis; Validity
Scales; Profile Analysis; Individualized Assessment; Diagnostic Utility; Research and
Clinical Practice:

The Luria-Nebraska Neuropsychological Battery remains a historically significant and

influential tool in the field of neuropsychology, particularly for its emphasis on qualitative
analysis and its ability to assess a wide range of cognitive functions. However, contemporary
neuropsychological assessments may incorporate elements of both the LNNB and other more
recent

APPLICATIONS OF NEUROPSYCHOLOGICAL ASSESSMENT

Neuropsychological assessments have a broad range of applications across different

domains, including diagnosis, treatment, management, and research.

Diagnosis

● Neurological Disorders: Neuropsychological assessments aid in diagnosing conditions such

as Alzheimer's disease, Parkinson's disease, Huntington's disease, and other
neurodegenerative disorders. They help differentiate these conditions from other
cognitive and movement disorders.

● Neuropsychiatric Disorders: Assessments contribute to the diagnosis of conditions like

schizophrenia, bipolar disorder, and major depressive disorder, by assessing cognitive
deficits and emotional dysregulation.

Treatment

● Personalized Interventions: Neuropsychological assessments provide insights into

anindividual's cognitive strengths and weaknesses, allowing clinicians to tailor
 interventions and therapies to address specific deficits.

● Behavioral Interventions: For conditions like ADHD and autism, assessments guide the
development of behavioral interventions that target specific cognitive and social deficits.

Management

● Educational Accommodations: Neuropsychological assessments inform the creation of

individualized education plans (IEPs) for students with learning disabilities, ensuring they
receive appropriate accommodations and support.

● Vocational Planning: Assessments help determine an individual's cognitive and functional

abilities, assisting in vocational rehabilitation and return-to-work planning.

Research

● Clinical Trials: Neuropsychological assessments are used to measure cognitive changes and
disease progression in clinical trials for medications or interventions targeting
neurodegenerative disorders.

● Cognitive Neuroscience: Researchers use neuropsychological assessments to explore brain-

behavior relationships, contributing to our understanding of how different cognitive
processes are localized in the brain.

REFERENCES
Neurological Foundation. (n.d.). What is Neurology | Neurological
Foundation.http://www.neurological.org.nz/resources/what-neurologyhttps://www.neural.org.uk/

Neurological disorders.
(n.d.). https://dphhs.mt.gov/schoolhealth/chronichealth/neurologicaldisorders Georgia

Behavioral Health Professionals. (2019, April 1). Neuropsychological testing |

Types of neuropsychological tests |

services. https://www.mygbhp.com/services/neuropsychological-testing/

Batchelor, E., Jr., Sowles, G., Dean, R. S., & Fisher, W. (1991). Construct validity of the
Halstead-Reitan neuropsychological battery for children with learning disabilities. Journal of
Psychoeducational Assessment, 9(1), 16–31.

Article by Elkhonon Goldberg, "The New Executive Brain: Frontal Lobes in a Complex
World"2010

Michael S. Gazzaniga & George R. Mangun, "Cognitive Neuroscience" 2015

Arthur MacNeill Horton Jr. & Danny Wedding, "The Neuropsychology Handbook"
Springer Pub.,2008