Abstract
Introduction
Neuropsychology, the subdiscipline of psychology, is primarily concerned with the study of relations of a person’s cognitions, behaviors, and the nervous system. It has roots in the parent disciplines of psychology, psychiatry, and neurology. Neuropsychological studies or research works developed many theories to explain the relationship between specific brain areas and behaviors. On the basis of these evidence-based studies, some neuropsychologists or other related professionals developed some tools to assess these associations. Psychological assessments involved in this subdiscipline are called neuropsychological testing or assessment. It is the most precious aspect of the field of neuropsychology because it utilizes and makes applicable its principles and theories in investigating cognitive and behavioral consequences of brain pathology or dysfunction.1,2
In the case of intellectual, cognitive, or behavioral decline or dysfunction, neuropsychological evaluation is much needed for the purpose of evaluation of severity and type of cognitive or behavioral deficit. With the advent of sophisticated radio-diagnostic procedures such as PET, MRI, CT scans neuropsychological assessment has emerged as an eminent discipline in diagnostic evaluations. 3
The importance of neuropsychological assessment lies in the fact that it often screens abnormality or dysfunction which is sometimes missed by much sophisticated diagnostic tools and techniques like CT scans or MRI. In this light, it becomes a more reliable and valid tool to detect brain pathology and its cognitive or behavioral outcomes. Though a standard mental status examination provides a good screening on mental abilities and functioning, a comprehensive neuropsychological assessment allows one to deep and comprehensive understanding or evaluation of various cognitive domains of persons undergoing the evaluation process.4–6
A person trained in neuropsychology with professional skills specifically related to brain–behavior relations is called a neuropsychologist. While making use of his professional knowledge he makes assessments that help in diagnostic clarification, treatment planning, and rehabilitation of patients with neurological conditions as well as other related psychiatric problems.
History and Development
Though the roots of neuropsychological investigation go back to the renaissance period, systematic investigations in this field started later in the mid of twentieth century with the works of Halstead, Reitan, and Goldstein in the United States, and on the other hand Rey was working on it in France and in the Soviet Union prominent figure was Alexander Luria. Ward Halstead developed a comprehensive battery of neuropsychological assessments along with his student Reitan, which was very popular in the United States as well as in some other English-speaking countries. It was thought to be very effective not only in screening but also in localization of brain damage. It has been considered to be a very popular and effective tool until other more sophisticated tools or techniques like CT scan, MRI, PET scan, etc., emerged later. 4 Similarly some other batteries also developed in other parts of the world synchronically or later in time. These test batteries follow the assumptions that the different parts or structures of the brain have different and specific functions. But the fact is that brains are not similar in size, shape, and function. The mechanisms of neuroplasticity, equipotentiality have been ignored in these test batteries. Another drawback with these batteries is the time-consuming process, usually it takes 3–4 hours to complete, which is inconvenient to the clinical population.
Need for assessment
It is a universally accepted phenomenon that scientific and technological advancements have made a huge change and development in all walks of life, which made some very significant inventions outdated and this is also true in this field of neuropsychological testing. In the past century not very far here was a time when psychological testing used to play a pivotal role in examining brain pathology but due to the undergoing advancements in technology psychological testing exclusively and primarily is no longer required for the evidence of brain pathology as the more efficient objective measures are available these days.8,9 Despite that neuropsychological testing has not now become an important ancillary procedure to neurological diagnostic evaluations, management and to provide rehabilitation measures. Neuropsychological assessment is currently being used for the following purposes:
To measure the extent and nature of cognitive dysfunction this is crucial for planning treatment.
For planning training and counseling for patients at home setting this may involve family members also.
It is useful in evaluating the severity of dysfunction for the purpose of disability certification.
To evaluate the effectiveness of treatment intervention processes.
It is very helpful in the proceedings of the judiciary to decide upon compensation after an accident or trauma.
Nowadays historical role of neuropsychological assessment through psychometric tests has been greatly reduced by modern and more advanced neuroimaging techniques. But neuropsychologists are continuously contributing to the evaluation process and patient care due to its clinical utility.10,11 There are some clinical questions and queries, that is, diagnostic clarification, nature of cognitive, behavioral, and emotional problems, treatment planning and evaluation, academic and clinical research and evaluation for forensic purposes, and generating a referral for a neuropsychological evaluation. 12
Conclusion
Neuropsychological assessment has particular importance because of its psychometric properties and its ability to describe the functional strengths and weaknesses of the individual. This allows crucial rehabilitation strategies to be devised and coordinated, with the aim of ameliorating the effects of brain injury and impaired cognitive processing. In all of its applications, the strength of neuropsychological assessment is its quantification of the cognitive correlates of structural alterations to the CNS, but one must always view such assessment as part of an integrated approach to diagnosis and treatment, incorporating all of the relevant neurological disciplines.
The advances in the functional neuroimaging techniques might lead to improvements in the cognitive assessment processes, which might result in strengthening our understanding of brain–behavior relationships. As the utility of the neuropsychological evaluation begins even before a disease becomes clinically manifest and continues throughout its trajectory, from estimation of risk to disease detection, differential diagnosis, monitoring changes throughout the course of the disease, and predicting functional abilities. The neuropsychological measure can also aid the design of interventions and clinical trials. In short, neuropsychological evaluation remains to play a pivotal role not only in brain insult or injury but also in functional disorders as well.