A Handbook of Neuropsychological Assessment

John R. Crawford, Denis M. Parker, William W. McKinlay

• Publisher: Routledge
• Year: 2018
• ISBN:
  9780429954528
• Edition: 1
• Topic: Psicología
• Subtopic: Historia y teoría en psicología

Originally published in 1992, this is a wide-ranging text concerned with the principles and practice of neuropsychological assessment in adults. It combines a flexible hypothesis testing approach to assessment with information on specialised test batteries. The book covers the major areas of memory, language, perception, attention, and executive dysfunctions, and includes chapters on dementia, alcohol, drug and toxic conditions, stroke and closed head injury. Assessment of dysfunction in cases involving claims for compensation and chapters on specialised assessment techniques, including automated test procedures, are provided. The book presents a sound introduction to this complex area and gives guidelines for the clinician who may need concise information on a specialised topic.

1 Introduction

John R. Crawford and Denis M. Parker

Department of Psychology, University of Aberdeen,
Kings College, Old Aberdeen AB9 2UB

Clinical neuropsychology is a demanding profession, requiring not only a high level of clinical skills but also a detailed and highly specialised knowledge base. In the U.K., acquisition of this knowledge base is not easy because, with one exception, there are no postclinical/postgraduate courses on offer. Furthermore, the opportunities for “on the job training” are limited as there are typically only one or two posts in neuropsychology in any one health district. This book is therefore primarily aimed at the clinical psychologist who is either specialising in neuropsychology or who is required to conduct neuropsychological assessments in the course of more general clinical duties. We hope that it will also serve as an introduction to the area for trainee clinical psychologists, as a detailed knowledge of the area is not assumed.

In many other countries the profession of clinical neuropsychology is considerably more developed than is the current situation in the U.K., although the formation of a Special Group in Clinical Neuropsychology within the British Psychological Society is an encouraging development. In the U.S., for example, there are a number of specialised training courses, a credentialling system, and a special division (Division 40) of the American Psychological Association. Despite this, our hope is that the expertise of the contributors and the broad coverage of topics will also make this book of interest and value to clinicians in such countries.

The material is organised into four sections, the first dealing with basic topics. In Chapter 2, Ed Miller provides an overview of the aims of neuropsychological assessment, its rationale and its problems. The WAIS-R and its predecessor the WAIS continue to occupy a prominent place in the assessment process. The uses and potential misuses of these scales in neuropsychological assessment are covered by John Crawford in Chapter 3. This chapter also provides a detailed evaluation of proposed methods of estimating a client’s premorbid level of ability. The assessment of handedness, footedness and eyedness can provide the clinician with some clues as to a client’s cerebral laterality. The assessment of handedness and other preferences is more complex than many might imagine. Marian Annett (Chapter 4) reviews the various methods and offers practical advice on their use.

The second section of the book is devoted to the assessment of the major cognitive functions. Andrew Mayes and Richard Warburg provide an extensive treatment of memory assessment (Chapter 5) in which the major patterns of memory dysfunction are outlined. The bulk of the chapter is devoted to a critical review of clinical memory tests and guidance on their use. In recent years there has been some concern over the ecological validity of clinical memory tests. Partly in response to this, there have been a number of attempts to make the collection of information on a client’s everyday memory problems more systematic through the use of memory failures questionnaires. The use of these with clients and their relatives provide different but complimentary information to formal memory testing. Anne Hickox and Alan Sunderland (Chapter 6) review the available questionnaires/checklists and offer guidance on their use.

Chapter 7 covers the wide range of dysfunctions subsumed under the term visuoperceptive dysfunction. The topics covered include: Colour perception, visuospatial, and visuoconstructive abilities. In common with the other contributors, Graham Beaumont and Jules Davidoff highlight the importance of a unifying conceptual structure as a prerequisite for a rational approach to assessment in their area.

Deficits in face processing can produce severe disruption in a client’s ability for social interaction/communication, and screening for their presence is an important part of the neuropsychological assessment process. Haydn Ellis describes the different forms of face processing deficits, and presents methods for their assessment. Unilateral neglect has also been allocated a separate chapter as it straddles the areas of attentional and visuoperceptive dysfunction and yet is clearly very distinct from other disorders that could be subsumed under either heading. Peter Halligan and Ian Robertson detail the various forms of neglect and provide a comprehensive review of methods of assessment.

Sandra Walker (Chapter 10) reviews the background to language dysfunction and presents a number of alternative, and clinically robust, assessment schemes. The model of language organisation which forms a background to this chapter is the classical neurological one. While this model has been criticised by the majority of those active in the area of cognitive neuropsychology, it is the conceptual framework within which most neurologists work. Consequently the practising clinical neuropsychologist has to be familiar with it. Both linguistic and cognitive neuropsychological approaches are discussed, but it is clear that at their current stage of development neither can provide a realistic set of assessment procedures that the practitioner would be happy to adopt. In a companion chapter to that on language dysfunction, Philip Seymour specifies the functional systems underlying reading ability, outlines how they can be disrupted, and offers guidance on methods for their assessment. The approach presented here is very much the cognitive neuropsychological one, and it reflects the fact that in this area both the model of the processes involved in reading, and appropriate techniques for assessing impairment are well developed.

Assessment of the various forms of attentional dysfunction is an important part of the neuropsychological assessment process, particularly in cases of closed head injury. Ed van Zomeren and Wiebo Brouwer (Chapter 12) provide an introduction to this topic and a guide to methods of assessment.

Assessment of cognitive dysfunction arising from frontal lobe injury is one of the most problematic areas in assessment. It is clear that there are very few well-standardised and well-validated tests available to the clinician. Chapter 13 (Denis Parker and John Crawford) evaluates the tests that are available and discusses the changes in behaviour and mood that can follow damage to anatomical areas within the frontal lobe.

The third section of the book is devoted to the major clinical conditions that the clinical neuropsychologist is liable to encounter. The chapters in this section provide a brief introduction to the pathology involved in these conditions and outline current theoretical issues. However, the main emphasis is on the pattern of neuropsychological deficits observed in the various conditions and on the provision of practical guidance on assessment. The topics covered are: closed head injury (Bill McKinlay and John Gray); stroke (Clive Skilbeck); toxic conditions and alcohol and drug abuse (Lindsay Wilson and Klaus Wiedmann); and the dementias (Mike Kopelman and Robin Moris). In these chapters cross-referencing with the section on assessment of cognitive functions is provided.

The final section of the book deals with three supplementary topics: Assessment for medico-legal purposes, computerised assessment, and the use of evoked potentials.

The importance of a detailed neuropsychological assessment as evidence in compensation cases is increasingly being recognised by the medical and legal professions. Bill McKinlay’s chapter deals with a number of topics in this area including the admissibility of neuropsychological evidence, report writing and the possibility of faking deficits. A good deal of very practical advice on dealing with court appearances/hostile cross-examination is also offered.

Most if not all clinical neuropsychologists now have access to a desktop computer. The chapter by Sarah Wilson and Tom McMillan assesses the advantages and disadvantages of using computers in assessment. It also details the available software, discusses its applications in various clinical conditions, and provides guidance on software development.

Finally, the chapter by Michael Rugg introduces the area of event-related potential recording. This type of investigation will only be available to a few clinical neuropsychologists since, regrettably, the combination of necessary facilities and expertise is present only at a restricted number of centres. However, it is likely that this non-invasive technique for investigating brain function will prove to be increasingly popular in the future. It does not involve injection of inhalation of radio-labelled pharmaceuticals, as both single photon emission computed tomography (SPECT), and positron emission tomography (PET) require, yet it can provide evidence about the functional state of populations of neurones involved in cognitive activities. This chapter provides a “tutorial” introduction to the area for the clinical neuropsychologist. It is not envisaged that any practitioner will embark on a programme of investigations using these techniques after this concise review, but it should provide them with the necessary background to make the available literature in this important area comprehensible.

Every effort has been made to direct the chapters in this volume towards the practitioner who has some experience with patient assessment but who wishes to gain a readily assimilable grounding in particular areas or issues. Even though we have aimed for a wide coverage of neuropsychological assessment in the book as a whole, each chapter should be capable of being accessed and read as a guide without working through others. Obviously Chapters 2, 3 and 4 discuss issues which are relevant to all areas of neuropsychological assessment; nevertheless we believe it is possible to read any of the chapters in sections B, C and D, and utilise the knowledge gained without having to refer back to these foundation chapters. This does not deny the importance of interdependencies and conceptual relations between areas, but recognises the reality of how practical demands may direct the search for a concise source of information on a topic.

SECTION A:
BASIC ISSUES

2 Some Basic Principles of Neuropsychological Assessment

Edgar Miller

Department of Clinical Psychology, Addenbrooke’s Hospital, Cambridge CB2 2QQ

INTRODUCTION

Assessment is a central issue in neuropsychology, and much more so than in most other branches of clinical psychology where assessment is often regarded as of little significance. There are doubtless several reasons for this. Amongst these is the fact that psychologists are rather more confident in the measurement of cognitive functioning than in the assessment of disordered personality and mood, which are the characteristic features of more psychiatrically related disorders. In addition, clinical neuropsychologists have not been actively drawn away by developments in psychological treatment as psychological methods for the management of those with neuropsychological impairment are still in an early stage of development (see Miller, 1984; Prigatano, 1986). Finally the question of diagnosis in those with neuropsychological impairments is of more obvious relevance to future management than is the case with psychiatrically related problems.

Despite having become unfashionable in some branches of clinical psychology, assessment is not an issue that will go away. For example, any therapeutic intervention, whether it be surgical, psychological, pharmacological, etc., is based on some form of assessment of the client’s problems. Similarly, the effectiveness of any intervention can only be judged in relation to some assessment of change in these problems. What follows from this is that assessment is an issue of critical importance which needs to be considered in a wide context. This book will consider many different aspects of neuro psychological assessment but it is the purpose of this particular chapter to set out the fundamental issues involved. In doing so it will be assumed that the reader has some familiarity with psychometrics and test theory as set out in the standard texts on the subject (e.g. Anastasi, 1982; Crocker & Algina, 1986; Cronbach, 1984).

In the first place, it is important to ask why an assessment is being carried out. Broadly speaking, assessment in neuropsychology can be carried out with a number of goals in mind.

1. Diagnosis, to determine the underlying nature of the problem. A simple example here is an assessment to determine whether someone with a complaint of memory impairment is suffering from an organic disease of the brain.

2. To delineate the nature of any neuropsychological impairment and its impact on the individual as a means of devising, say, a rehabilitation programme or offering advice as to an individual’s suitability to drive a vehicle or return to previous employment.

3. The measurement of change. For example, to determine the consequences of a surgical procedure or the impact of a cognitive training programme.

In addition, assessment may also be carried out for research purposes as when patients with a particular type of lesion are studied to determine the effects of that lesion on psychological functioning. In such circumstances the principles involved are very much those associated with the related clinical assessment as in the aforementioned goal 2.

An important consequence of these different goals of assessment is that the crucial features of the assessment process will vary with the goal. This point will be brought out in greater detail later, but it is fairly obvious that the sensitivity to detect small changes in level of functioning is a much more important characteristic of an instrument used to monitor change as a result of a rehabilitation programme, than is the case for a test used purely for diagnostic purposes.

DIAGNOSTIC ASSESSMENT

The literature on neuropsychological assessment is heavily dominated by discussions on the use of neuropsychological tests to diagnose brain lesions; both their presence and approximate location within the brain. The value of some of this diagnostically oriented assessment is open to fundamental questioning. The past two decades have seen very impressive developments in neuroradiological techniques and, in particular, sophisticated forms of brain scanning. In terms of detecting areas of infarction, the presence of tumours, etc., it would take neuropsychological instruments of extremely impressive validity to compete with radiological techniques in many diagnostic situations. In any case, even if neuropsychologists could locate tumours within the brain as efficiently as the radiologists, surgeons would still require the radiological pictures for other reasons. One of these is simply that when opening a head to operate on a tumour, it is so much easier for the surgeon to rely on films which can give a three dimensional impression of where the pathology is inside the head. In addition the surgeon may need to have some idea of localised blood flow and this can only be revealed by radiological techniques.

Whereas these arguments greatly limit the value of the diagnostic exercise as far as neuropsychology is concerned, some important diagnostic issues still remain. In the first place, sophisticated scanners are not always easily accessible and their use can be expensive, thus making other methods of investigation, including neuropsychology, useful as preliminary screening. It is also the case that not all lesions are readily demonstrated radiologically and that radiological evidence can be equivocal. For example, CT scanning is often unhelpful in the early diagnosis of dementia simply because the overlap between normal brain and mild atrophy is quite considerable. Therefore, neuropsychological assessment is certainly not redundant for diagnostic purposes, even though the range of situations in which it is of real value may have declined.

Requirements of diagnostic instruments

Diagnostic instruments have particular requirements. The most important is a high level of criterion (or discriminative) validity in that the test is able to distinguish the presence and type of lesion reliably enough to be of value in making decisions about individual cases. Construct validity, in the sense of the test embodying relatively pure measures of specific psychological functions, is not an essential feature. For example, the value of the Trail-making Test (see Lezak, 1983) as a diagnostic instrument depends on its ability to detect patients with certain types of brain lesion. Whether failure on this test is due to lowered motor speed in tracing the line, a difficulty in detecting where the next target is, or in planning movements ahead, is not of immediate significance (although knowing the answer to this question might enhance the value of the test for use in other ways).

The technical problems in dev...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Original Title Page
• Original Copyright Page
• Table of Contents
• List of Contributors
• 1. Introduction
• Section A: Basic Issues
• Section B: Assessment of Major Psychological Functions
• Section C: Major Clinical Disorders
• Section D: Specialised Assessment Techniques
• Author Index
• Subject Index