Psicologia

II

Chapter

34

Neuropsychology
Justin J.F. O’Rourke, Leigh Beglinger, Jane S. Paulsen CHAPTER OUTLINE
Goals of Neuropsychology 570 Neuropsychological Evaluation 571
Test Administration 571 Test Interpretation 572 Alzheimer Disease 579 Vascular Dementia 582 Mixed Dementia 582 Frontotemporal Dementia 582 Parkinson Disease with Dementia and Dementia with Lewy Bodies 583 Huntington Disease583 Multiple Sclerosis 584 Epilepsy 584 Traumatic Brain Injury 585

Brief Mental Status Examination

575

Mini-Mental State Examination 575 Modified Mini-Mental State Examination 576 Montreal Cognitive Assessment 576 Telephone Interview for Cognitive Status—Modified 576

Neuropsychological Characteristics of Neurological Disease 576
Mild Cognitive Impairment 578

Neuropsychology is thescientific study of neural correlates for cognition and behavior, with a specific clinical interest in patients presenting a range of medical, neurological, and psychiatric illnesses. Neuropsychologists are specialized clinicians who receive extended fellowship training (with available board certification) in functional neuroanatomy, neurobiology, psychopharmacology, neurological illness orinjury, neuroimaging, personality and mood testing, clinical psychology, and neuropsychological assessment. Neuropsychological evaluation refines neuroimaging and neurological examinations by determining the extent to which cognition is affected by brain dysfunction and by assisting the neurologist in objectively quantifying cognition and behavior. A complete clinical neurological examination would belacking if it did not consider the patient’s decision-making ability, judgment, attention, memory, language, and the effect changes in these domains can have on functional capacity. Detailed cognitive evaluation can contribute to diagnosis and prognosis, treatment planning, and the ability to monitor changes over time. In this chapter, we begin by explaining the utility of neuropsychology anddescribing the neuropsychological evaluation. Guidelines are then suggested for brief cognitive screening in clinical settings. Finally, the typical patterns of cognitive impairments associated with major neurological disorders are discussed.

Goals of Neuropsychology
When neural damage is present or cognitive changes are observed or reported during clinical evaluation, an extendedneuropsychological evaluation is appropriate. The prominent neuropsychologist, Arthur Benton (1975), best described 570

neuropsychology as “a refinement of clinical neurological observation [that] serves the function of enhancing clinical observation [and] is closely allied to clinical neurological evaluation and in fact can be considered to be a special form of it.” (p. 68) In clinical settings,neuropsychological assessment aims to extend the clinical neurological exam by: (1) providing important diagnostic information and predictions, even in conditions not detected via other procedures (e.g., anoxia), (2) attributing cognitive strengths and weaknesses to their appropriate factors (e.g., psychiatric symptoms, neurological disease, demographic factors), (3) predicting functional ability to enhancetreatment planning, and (4) monitoring cognitive changes and treatment effectiveness across time (Lezak et al., 2004). Neuropsychological assessment is also used in forensic settings and for research in neuroscience, but discussion on these topics is beyond the clinical focus of this chapter. Before the advent of neuroimaging in the 1970s and 1980s, one of the main goals of neuropsychology waslesion localization. Since current structural imaging techniques are capable of localizing lesions with remarkable accuracy, the focus of neuropsychology has shifted toward characterizing patients’ cognitive and behavioral profiles. Such profiles can be used to make differential diagnosis decisions, especially when lesions may not be evident. For example, some types of dementias present with a...