Distributed processing and brain damage The Wernicke-Geschwind model is useful for understanding symptoms of aphasia , which is a language impairment resulting from brain damage. Damage to different parts of the interconnected circuitry results in different, predictable language impairments. Other circuits have been identified in the brain too, such as circuits that play a vital role in learning, memory, and emotion. Knowledge of how these circuits function helps explain the symptoms resulting from brain damage. In aphasia, different symptoms will emerge if the brain damage is in the front versus the back of the brain. However, in other cases, damage to different regions of the brain can sometimes have Chapter summary This chapter provided an introduction and overview of brain cells, neuroanatomy, and brain circuitry. Clinical neuropsychologists rely on this information extensively. They are Introduction The duration of neuropsychological evaluations vary based on setting, patient capabilities, and referral question. A typical evaluation with an adult involves a review of the medical records, an intake interview with the patient and preferably also with a knowledgeable caregiver or family member, test administration, test scoring and interpretation, behavioral observations, report writing, and a feedback session with the patient and caregiver. For children, parents are included in the assessment process as sources of historical information and insight about current The referral question The neuropsychological evaluation begins with the referral question. Referral questions can come from physicians, nurse practitioners, parents, teachers, or other healthcare professionals, but they also can come from patients themselves. Below are some common referral questions: ● Does this 60-year-old patient have a depressive disorder or a neurocognitive disorder due to Alzheimer’s disease? ● Do I have a specific learning disability or ADHD? ● Is my child gifted? ● This patient suffered a left hemisphere stroke one year ago. What are the residual cognitive impairments, and how can functioning be maximized? ● Why is my child struggling in school? Before beginning the assessment process, neuropsychologists need to have a referral question that is capable of being answered. A good referral question is specific and direct. Referral questions usually pertain to a functional problem in daily life, a diagnostic issue (e.g., Are my memory problems a Review of records and the clinical interview The neuropsychologist begins by obtaining a thorough background and history about the patient. Information pertaining to current and past medical and neurologic conditions, current medications, strengths, sources of support, and levels of functioning and impairments is needed. All major sources of historical information are reviewed, such as medical records, previous testing reports, and/or school records. The clinical interview is another source of historical and background information and it represents the first contact between the patient and neuropsychologist. It is best to obtain information directly from the patient, if possible, and from a knowledgeable informant, like a family member or caregiver. Patients have unique insights into their experiences and history and thus their input is invaluable. Informants also have unique
similar effects on behavior, thinking, or emotion. For example, observational case studies and experimental animal research have demonstrated that damage to the thalamus can produce anterograde amnesia (e.g., a disorder of new learning) that is similar to the amnesia produced by damage to the hippocampus (Segobin & Pitel, 2021). Damage to the hippocampus can produce symptoms similar to those caused by damage to the thalamus, a distant anatomical structure, because they are interconnected by the fornix (Figures 2-1b, 2-2b) and both play a role in learning new information.
trained to understand and appreciate the organizing principles of brain function to help them diagnose and intervene in a vast array of neurologic, psychiatric, and medical disorders.
CHAPTER 3: THE NEUROPSYCHOLOGICAL EVALUATION
functioning; school records are reviewed and teacher input is sought. The tests that are administered vary based on the referral question. Test administration can occur in one session or in multiple sessions on different days. The feedback session is designed to be educational. It focuses equally on strengths and relative weaknesses and provides the patient and caregiver with recommendations to help address the referral question. The goal of this chapter is to provide an overview of the entire neuropsychological assessment process. sign of normal aging or a disease?), and/or treatment issue (e.g., How can I compensate for my memory problems?). Referrals also can be made for a baseline evaluation to determine a patient’s current profile of cognitive and emotional strengths and weaknesses, which will be used to track change over time. In these cases, the referral source may be interested in whether a particular condition is progressively getting worse over time, as might be the case for neurocognitive disorder due to Alzheimer’s disease, or improving, which might occur following a neurocognitive disorder due to traumatic brain injury. Neuropsychological evaluations also can be useful to determine whether a patient is responding favorably to a particular behavioral or medical intervention. Neuropsychologists are asked to evaluate candidates for some types of neurosurgery, to determine whether there are any contraindications for surgery, such as a neurocognitive disorder, and to track response to the intervention (Mitchell & Ostrem, 2020).
COMPONENTS OF A NEUROPSYCHOLOGICAL EVALUATION
information to provide because they observe the patient function and behave in different contexts. They also can provide information about interpersonal issues. If the patient lacks insight or the ability to provide reliable information about their history, the informant becomes an essential source for this information. The goal of the clinical interview is to obtain detailed information about the presenting problem and its history, as well as information about the patient’s educational, social, medical, psychiatric, developmental, and family background. During the interview and subsequent interactions, neuropsychologists need to be cognizant of patient identities and cultural values, as well as how family dynamics may vary by culture (Fujii, 2018).
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