REVIEW ARTICLE Neuropsychological assessment : An overview Neuropsychological assessment : An overview Bidita Bhattacharya Ph .D., M.Phil., M.Sc., Assistant Professor and Head Department of Clinical Psychology Institute of Psychiatry 7, D. L. Khan Road, Kolkata, West Bengal, India Email : [email protected], +91 9831095984, +91 33 25238099 ABSTRACT Man’s interest in the relationship between the brain and behaviour extends back at least 2500 years. The study of brain behaviour relationship evolved with the development of a science of human behaviour based on the function of human brain, known as neuropsychology. Clinical neuropsychology in the 20th century showed a steady accumulation of clinical reports and research investigations that have gradually refined the theoretical positions. However, assessment relies heavily on the use of specific tests to investigate brain-behaviour relationships. There has been several specific standerdized tests as well as test batteries developed across the globe. Current article has focused on different neuropsychological test batteries to evaluate individuals suspected of having brain dysfunction or damage. INTRODUCTION It was not until 15 centuries later that Galen’s views of the relationship between the cortex and Neuropsychology is the study of brain-behaviour intelligence were taken seriously, when Vesalius relationship with the development of a science of reported an anatomical relationship between the human behaviour based on the function of human brain and intellectual functioning. He argued that brain. Clinical Neuropsychology is the application humans are more intelligent than animals, because of empirically established facts concerning brain- humans have larger brains. Present views on brain– behaviour relationships to clinical problems and neurological assessment, which is sensitive to the behavior relationships began to take form since condition of the brain. Man’s interest in this area nineteenth century. During the last 20 years there has extends back at least 2500 years, when Pythagoras been a growing realization that the emotional and argued that the brain was the site of human reasoning. behavioural problems that accompany brain insults Approximately 100 years later, Hippocrates claimed are more disabling than the cognitive problems that that the brain was the organ of the intellect and are produced (Lezak, 1987; Sbordone, 1990). recognized that a depressed skull fracture on the right side of the head could produce motor paralysis Neuropsychology can be divided into two branches. on the (contra lateral) left side of the body. Galen, in The first, clinical neuropsychology includes approximately 170 a.d., was able to map out many of the major brain structures and argued that the behavioural neurology and deals with patients with frontal lobes were the seat of our mental abilities. cerebral lesions. The second branch is experimental Galen’s hypothesis, however, was later discarded in neuropsychology, which studies normal subjects in favour of the belief that reasoning and intelligence the laboratory by a range of techniques including was a product of the ventricles of the brain. specialized physiological techniques (Sbordone, Bidita Bhattacharya, Ph .D., M.Phil., M.Sc. Saul, & Purisch, 2007). Assistant Professor and Head Department of Clinical Psychology Institute of Psychiatry, 7, D. L. Khan Road, Kolkata West Bengal, India Email : [email protected] Phone : +91 9831095984, +91 33 25238099 20 Bengal Journal of Psychiatry, Vol. 19, No. 1, January-June 2013 Neuropsychological assessment : An overview NEUROPSYCHOLOGICAL 1970). She also found that bilateral removal of the ASSESSMENT : THE PAST hippocampi produced a severe and permanent impairment in the ability to learn new information. The use of psychological tests to investigate the On the basis of the research studies of Milner and behavioural consequences of brain damage was her colleagues, a number of neuropsychological tests first utilized approximately 70 years ago in the were developed that were particularly sensitive to United States. A number of publications appeared damage to specific areas of the brain. during the 1930s and 1940s that described the effects of frontal lobe lesions on intelligence Hans-Lukas Teuber, at the Massachusetts Institute and other functions, visual–spatial impairments of Technology, used neuropsychological tests to following right frontal lobe lesions and the effect study the effects of local brain damage on a variety of brain damage on abstract thinking, and memory of visual and spatial skills and identified the impairments following focal brain lesions (Jones & importance of the parietal lobes in spatial relations Butters, 1983). In the Soviet Union during this same and the role of the frontal lobes in problem solving. time, Luria utilized psychological tests to investigate These studies led to the development of several the effects of brain trauma and disease (Sbordone, psychological tests that were found to be highly Saul, &Purisch, 2007). sensitive to specific brain lesions and the functions served by these regions (Teuber, 1972). The first neuropsychological laboratory in the United States was set up by Ward C. Halstead in The Boston V.A. Medical Centre, under the 1935. He used neuropsychological tests to study leadership of Harold Goodglass, Edith Kaplan, the effects of brain damage on a wide range of and Nelson Butters, was responsible for the cognitive, perceptual, and sensory motor functions. development of a number of neuropsychological In 1951, Halstead collaborated with his former tests based upon numerous research studies, which student, Ralph M. Reitan, who had established a were conducted over a period of over 30 years. neuropsychology laboratory at Indiana University They assessed patients with aphasia, amnesia, and Medical Centre. Reitan (1955) modified Halstead’s dementia, and developed “qualitative” methods for neuropsychological battery and created what is now analyzing the various psychological and behavioural described as the “Halstead–Reitan Battery.” Reitan manifestations and damage to specific parts of administered this battery to a number of patients the brain. Their approach has provided clinical with documented focal and diffuse brain damage, neuropsychologists with a greater appreciation of as well as to a group of hospitalized control patients, the specific effects that brain damage can have on presumably free of brain disease, and developed a set the individual. Arthur Benton, at the University of of test norms. Indices developed by Reitan allowed Iowa, also developed several neuropsychological him to localize brain damaged areas, as well as to tests and made a number of important contributions infer the cause of the neurological injury (Wheeler, to clinical neuropsychology. Burke, & Reitan, 1963). Alexander Luria, who was initially trained as a Brenda Milner and her colleagues at the Montreal cognitive psychologist and then later as a physician Neurological Institute and at McGill University have and neurologist, spent over 40 years in studying utilized neuropsychological assessment techniques the behavioural and psychological impairments to evaluate behavioural changes. Those patients of head-injured war victims and neurological have undergone the surgical removal of portions and neurosurgical patients, and developed of their temporal lobes, which were believed to understanding about the relationship between a cause uncontrollable seizures. She described the specific area of the brain and its effect on complex relationships between verbal and nonverbal learning behaviours. He developed neuropsychological following temporal lobe lesions. She found that tests that could be administered at the patient’s patients whose surgery involved the left temporal bedside and formulated a theory of brain–behavior lobe had impaired verbal learning skills, while relationships. His theory emphasized that complex the patients who underwent right temporal lobe behavior could be broken down into their respective surgery had impaired visual learning skills (Milner, components and studied separately to determine Bengal Journal of Psychiatry, Vol. 19, No. 1, January-June 2013 21 Neuropsychological assessment : An overview which aspects of a “functional system” had been brain damage when the neurological examination compromised. His evaluation procedure heavily is normal, and the neuroimaging studies are emphasized qualitative methods based upon negative. This is likely to place more emphasis on observation of the types of errors made by the the development of innovative methods of assessing patient. how the brain injury or dysfunction effects the patient’s functioning in real-world situations. Through collaboration with Anna-Lise Christensen, a Danish psychologist, Luria’s tests and method of ASSESSMENT PROCESSES neuropsychological assessment were introduced in the United States in 1975 under the title of Luria’s Assessment process typically includes identifying Neuropsychological Investigation. Unfortunately, specific areas of the brain, that have been damaged it was generally not well received in the United and demonstrating the relative severity of the States since it required the neuropsychologist to patient’s cognitive and emotional impairments. have extensive training and a strong background Since, the issue of causation is often important, it is in behavioural neurology. In an attempt to rectify essential that a variety of confounding or extraneous