CLINICAL NEUROPSYCHOLOGY

Seminario de actualización – Evaluación Neuropsicológica

Ana María Gómez Carvajal, Psi, MSc

Neuropsychology?

Neuropsychologist?

Where does a neuropsychologist work?

“The impact of brain injury or disease on the cognitive, sensorimotor, emotional,
and general adaptive capacities of the individual” (Vanderploeg, 2000)

“Clinical neuropsychology is an applied science that examines the

impact of both normal and abnormal brain functioning on a broad
range of cognitve, emotional, and behavioral functions” (AACN, 2007).
NEUROPSYCHOLOGY

 Relatively new field (1960s)

 The number of patients with disorders caused by brain damage or dysfunction has increased
exponentially.
 Diagnostic evaluation attempt either to identify the nature (pathology unknown) or extent of potential
injury or delineate the behavioral sequelae of brain injury when the pathology is known.
 Study the relationship between behavior and the brain (higher cognitive functions)
 Special attention to the consequences of brain injuries and altered cognitive processes.

Basic Clinical
neuropsychology neuropsychology
ETIOLOGÍA DE LAS LESIONES CEREBRALES

Vasculares Traumatismos

Neoplásicos Infecciones

Enfermedades
degenerativas
ASSESSING BRAIN FUNCTION

Interpretation
of the findings
 A neuropsychologist is ‘‘a professional psychologist trained
in the science of brain-behavior relationships’’.

Systematic
 The prefix ‘‘neuro’’ in neuropsychologist means that the
behavioral psychologist is a specialist who has had explicit training in
observations
neuroscience and neurological bases of behavior.
Neuropsychological
tests
A neuropsychologist possesses skills beyond simply administering and scoring a particular set of tests.
NEUROPSYCHOLOGICAL ASSESSMENT

 Using neuropsychological assessment, we will reveal the relationship between specific brain regions
and particular cognitive processes.
 Neuropsychological evaluation is a PROCESS.
 Neuroimaging tests enrich findings
 It uses standardized tests and procedures to systematically assess various areas

Theoretical Clinical
▪ Neuropsychological assessment is based upon the premise that specific brain regions underpin specific cognitive
processes
 ETHICAL AND CLINICA ISSUES

 Neuropsychologists are aware of, and sensitive to, ethical and legal issues of informed consent, confidentiality,
autonomy, and related human rights that arise in the context of evaluating children and adults.

Third party
assessments
Informed consent Forensic cases
(insurance,
judge,…)
 INTRUSIVE FACTORS
Cultural, linguistic, disability, and other demographic and socioeconomic factors influence individual’s participation in
the process of neuropsychological asssessment, and may alter the meaning of the information obtained from
testing.

Low levels of education

Group of individuals for whom there are insufficient or

limited test adaptations, normative data, or validity studies

Those whose first language is different from the orginal test

Distinctive cultural or sociodemographic groups

Those with physical or mental disabilities that limit the ability

to participate in the examination as orginally intended.
 Identify personal factors that can affect
Scores
performance in cognitive tests
 Motivation
 Cultural level
 Profession and educational level Neurofunctional Cognitive
(QoL, ADL) functions

Neuropsychology is not just a psychometric interpretation of the results obtained in the

tests.

The objective of neuropsychological evaluation is to understand the intensity and nature of

the deficit, to relate it to the SN and to the personal characteristics of each patient.
No se pueden estudiar las relaciones conducta - cerebro con los mismos criterios de la
neuropsicología de adultos.
SKILLS OF A NEUROPSYCHOLOGIST

Evaluation / Intervention /
Prevention Research
Assessment Rehabilitation
STRATEGY OF NEUROPSYCHOLOGICAL ASSESSMENT

 Look for dissociations on several aspects:

Between estimated pre-morbid

optimal level and current level of
functioning

Between different focal cognitive

domains (e.g. memory / language/ …)

Within specific cognitive domains (e.g.

episodic or semantic memory)
GOALS OF NEUROPSYCHOLOGICAL EVALUATION

Patient
evolution over
Specific time
therapeutic
and
Clinical rehabilitation
Know the diagnosis goals
impact of
brain damage

*Quality of Life (QoL)*

STEPS

Interview of
Decision to Review of Selection of
patients and
evaluate records tests
relatives

Test
Feedback Report Interpretation application
and scoring
 INTERVIEW

 Complete understanding of the patient’s history and current situation.

 Clinicians gain perspective on the patient’s experience (including self-perception of the problem)
 Integrate this information with data from other sources.

Primary symptoms
Impact on daily
Duration and changes over
functioning
time

Results of
Patient’s strenghts
previously
and interest
conducted tests

*Patients may not always be reliable informants*

 History of alcohol Current and past
Prenatal history
or substance abuse medication

Birth and Current and past

developmental medical and Legal history
background psychiatric history

Family medical,
psychiatric and
Educational history Work history substance abuse
history
 BEHAVIORAL OBSERVATIONS – MENTAL STATE EXAMINATION

• Age-appropriate, neat, clean

Apperance

• Alert, cooperative, able to concentrate, able to establish and maintain set, slow response rate,
General
behavior
impulsive, inconsistent, perseverative

• Adequate speech comprehension, expression, prosody

Language

• Exhibited sense of humor, able to establish rapport, anxious, tense body posture, sad, euphoric,
Affect irritable, restless, fatigued, aware and concerned about deficits

• Tremorous, slow, stiff, masked facial expression, speech abnormality

Motor