Clinical Application of Neuropsychological Test Batteries Clinical Application of Neuropsychological Test Batteries

Clinical Application of Neuropsychological Test Batteries Clinical Application of Neuropsychological Test Batteries Edited by THERESA INCAGNOLI Veterans Administration Medical Center Northport, New York and School of Medicine State University of New York Stony Brook, New York GERALD GOLDSTEIN Veterans Administration Medical Center, Highland Drive and University of Pittsburgh Pittsburgh, Pennsylvania and CHARLES J. GOLDEN University of Nebraska Medical Center Omaha, Nebraska Plenum Press • New York and London Library of Congress Cataloging in Publication Data Main entry under title: Clinical application of neuropsychological test batteries. Includes bibliographies and index. 1. Neuropsychological tests. 2. Halstead-Reitan Neuropsychological Test Bat tery. 3. Luria-Nebraska Neuropsychological Test Battery. I. Incagnoli, Theresa. II. Goldstein, Gerald, 1931- . III. Golden, Charles J., 1949- [DNLM: 1. Neuropsychological Tests. 2. Neuropsychology. WL 103 C6413j RC386.6.N48C52 1985 152 85-25674 ISBN-13: 978-1-4684-4993-8 e-ISBN-13: 978-1-4684-4991-4 DOl: 10.1007/978-1-4684-4991-4 © 1986 Plenum Press, New York Softcover reprint of the hardcover 1st edition 1986 A Division of Plenum Publishing Corporation 233 Spring Street, New York, N.Y. 10013 All rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher Contributors Nelson Butters, San Diego Veterans Administration Medical Center and Department of Psychiatry, University of California School of Medi cine, San Diego, California Gordon J. Chelune, Veterans Administration Medical Center and De partment of Psychiatry, University of California, San Diego, California Kathleen L. Edwards, Department of Psychiatry, University of Pitts burgh School of Medicine, Pittsburgh, Pennsylvania William Ferguson, Behavioral Medicine Service, St. Joseph's Hospital, Lancaster, Pennsylvania Carol Gainer, Murfreesboro, Tennessee Charles J. Golden, University of Nebraska Medical Center, Omaha, Nebraska Gerald Goldstein, Veterans Administration Medical Center, Highland Drive, Pittsburgh, and Department of Psychiatry and Psychology, Uni versity of Pittsburgh, Pittshurgh, Pennsylvania Harold Goodglass, Boston Veterans Administration Medical Center, and Department of Neurology, Boston University School of Medicine, Boston, Massachusetts Theresa Incagnoli, Veterans Administration Medical Center, North port, New York, and School of Medicine, State University of New York, Stony Brook, New York Robert L. Kane, Veterans Administration Medical Center, East Orange, v vi CONTRIBUTORS New Jersey and Department of Neurosciences, University of Medicine and Dentistry of New Jersey, Newark, New Jersey Andrew Kertesz, Department of Clinical Neurological Sciences, st. Joseph's Hospital Research Institute, London, Ontario, Canada Mark Maruish, National Computer Systems, Minnetonka, Minnesota Kurt Moehle, Department of Psychology, Purdue University School of Science, Indianapolis, Indiana Oscar A. Parsons, Department of Psychiatry and Behavioral Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma Andrew Phay, Veterans Administration Medical Center, Murfreesboro, Tennessee Abigail Sivan, Child Development Clinic, Department of Pediatrics, University of Iowa, Iowa City, Iowa Ralph E. Tarter, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Nils R. Varney, Veterans Administration Medical Center, and Depart ment of Psychiatry, University of Iowa College of Medicine, Iowa City, Iowa Preface Clinical neuropsychology has become a field of major prominence dur ing the past several years, as well as a field of great complexity. As a result of the extensive amount of activity that neuropsychology has experienced recently, two major developments have emerged. First, several approaches have evolved regarding comprehensive neuro psychological assessment. There are presently several standard test bat teries in common use, as well as an approach to assessment that does not make use of standard batteries, but rather fits the evaluation accom plished to the particular diagnostic problems presented by the indi vidual patient. Second, a great deal of specialization has emerged, with assessment procedures developed for evaluation of specific types of neuropsychological deficit. The purpose of this volume is to review these developments, particularly with reference to their implications for application in clinical settings. The history of this book's development is of particular interest. Some years ago, the Veterans Administration became concerned with developing an optimal method of neuropsychological assessment for its many health-care related facilities. Initially, the problem was con ceptualized in terms of whether the VA should encourage wider use of the long-established Halstead-Reitan Neuropsychological Test Battery (HRB) or promote more extensive use of the recently developed Luria Nebraska Neuropsychological Test Battery (LNNB). A conference was funded to bring together authorities in clinical neuropsychology to dis cuss this matter and present a series of papers to invited psychologists from various VA facilities. However, the planners of the conference soon discovered that a simple comparison between these two pro cedures would not be the most productive route, and that a broader perspective needed to be taken. It was pointed out that many neuropsy chologists do not use standard batteries, but have adopted a more flexi ble approach representing the philosophies of such pioneers in the vii viii PREFACE field as Kurt Goldstein, Heinz Werner, and Alexander R. Luria. It was pointed out further that not all neuropsychological assessment is a matter of administering comprehensive screening batteries of the HRB or LNNB type. Some of it involves detailed assessment of specific areas, notably language, memory, and visual-spatial skills, that may only be briefly evaluated by the standard batteries. Additionally, it became clear that the administration of tests was not the only means of neuro psychological assessment, and that much can be learned from clinical interviews of the patient, from the medical and social history, and from interviews with informants. The conference that was held, therefore, consisted of a much broader array of topics than was originally contem plated, and went far beyond comparisons between the HRB and LNNB. There were also papers on memory evaluation, language testing, flexi ble and individualized approaches to evaluation, and the use of the interview and history in neuropsychological assessment. When this book was planned, the editors took note of these devel opments in the planning of the conference and of the issues and contro versies that were raised at the conference itself. They decided that the book should reflect a wide range of assessment strategies and philoso phies including contributions by advocates of the two major standard neuropsychological batteries, as well as by advocates of the indi vidualized, flexible battery approach. Furthermore, contributions were invited from individuals with expertise in the use of the interview and history, in the use of standard psychological tests as applied to clinical neuropsychological areas, and in various aspects of specialized testing. The book as a whole therefore reflects a comprehensive overview of the recent status of neuropsychological assessment and of the controver sies and issues in the field that are of great current interest. The editors are pleased to note, as students of clinical neuropsychology are no doubt aware, that the list of contributors contains individuals who are in distinct disagreement among themselves regarding major philosoph ical and practical matters. We would like to note the spirit of friendly controversy that characterized the development of the book, and to compliment the contributors not only on their scholarly work, but on their willingness to participate in a joint effort with others of persua sions different from their own. Drs. Incagnoli and Goldstein would like to acknowledge the sup port of the Veterans Administration with regard to preparation of the book and for support of the VA-sponsored research that it contains. We are indebted to Joseph 1. Mancusi, Associate Director of Psychology, Veterans Administration, for his encouragement of that conference. Vivian Avery, Nelson Butters, and Andrew Phay were instrumental in planning the conference. Special thanks are also due to Christopher PREFACE ix Carlson, Chief, Psychology Service, VA Medical Center, Northport, New York for his continued support of this project. We would like to acknowledge the assistance of Lorraine Hummel and Adelaide Goertler for assistance in preparation of the manuscript. THERESA INCAGNOLI GERALD GOLDSTEIN CHARLES J. GOLDEN Contents CHAPTER 1 Current Directions and Future Trends in Clinical Neuropsychology 1 Theresa Incagnoli The Evolving Role of the Clinical Neuropsychologist .......... 1 Framework Within Which to Conduct Neuropsychological Evaluation ................................................. 3 Approaches to Evaluation ................................... 7 Current Issues and Future Directions in Clinical Neuropsychology ........................................... 12 References ................................................. 32 CHAPTER 2 Clinical

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