1. Adam Brickler, Psy.D. March 1, 2019
The Benefits of Neuropsychological Assessment in the Diagnosis and Treatment of Brain Injury
Adam Brickler, Psy.D.
March 1, 2019

2. Goals Define neuropsychological assessment
Identify advantages of neuropsych testing vs. neuroimaging
Discuss value of neuropsych assessment in differentiating and/or establishing severity of injury
Review various neuropsychological evaluation processes

3. Definition of Neuropsychological Assessment
A branch of clinical psychology that studies how the brain and nervous system affect how we function on a daily basis
Uses various assessment methods to ascertain function and dysfunction and applies this knowledge to evaluate, treat and rehabilitate individuals with suspected or demonstrated neurological or psychological problems.
In essence, goal is to identify cognitive strengths and weaknesses
Unlike the use of neuroimaging techniques such as MRI, CT scans and EEG where the focus is on nervous system structures, neuropsychology seeks to understand how various components of the brain are able to do their jobs (FUNCTIONING)
Entails a detailed knowledge of brain anatomy, the role that different brain areas serve and how these functions are likely to be impacted by various disorders 
AB include point about assessing across biopsychosocial domains

4. Purposes of Neuropsych Testing
Lesion Location
Diagnosis
Level of Functioning
Strengths
Weaknesses
Conditions
Rehab Recommendations
Prognosis

5. Brief History
Largely rooted in the need for screening and diagnosing brain injured and behaviorally disturbed servicemen during World War I
Continued to be driven by rehabilitation needs of veterans after combat
Evolution of field equally impacted by movement to measure the concept of intelligence and “educational evaluation”
Led to recognition of statistics-dependent testing, normative data

6. Normative-based Testing

7. Neuropsych Evaluation vs. Neuroimaging
MRI/CT
Examiner bases clinical opinion on visual representation of brain anatomy/metabolic processes
Neuropsych assess. based on functional status of patient and norm- based, providing more accurate depiction of patient’s abilities
While imaging typically more clearly observable for acute ABI, as brain heals, images change, but deficits remain
Neurologist's expertise is diagnosing and treating the structural and physiological consequences of brain injuries and neurological illnesses.
Neuropsychologists assess the effects of brain injuries and illnesses on cognition and behavior; they are experts in assessing functional capacities

8. Electroencephalogram (EEG)

9. Computed Tomography (CT)

10. CT Normal vs. Abnormal Atrophy
Normal CT
Severe bifrontotemporal atrophy

11. CT (Small Vessel Ischemia)

12. Magnetic Resonance Imaging (MRI)

13. Diffusion Tensor Imaging (DTI)

14. Positron Emission Tomography (PET)

15. Neuropsych vs. neuroimaging Case Example 1
Paula, 77
Family reported sig. STM problems, confusion when completing tasks, irritability, geographic confusion, and sig. problems completing functional activities
MRI reflected “age-appropriate” cortical atrophy
Neuropsych results suggested statistically sig. verbal and visual STM, executive, and visuospatial deficits
Pt was diagnosed with an Alzheimer’s Dementia

16. Neuropsych vs. Neuroimaging Case Example 2
Ruth, 81
Family reported sig. STM impairment and functional problems
CT scan reflected “minimal” small vessel ischemic changes
Neuropsych testing revealed moderate to severe verbal and visual STM deficits
Pt diagnosed with a Vascular Dementia

17. Value of Neuropsychological Testing
Specific profiles obtained on testing reveal more detailed data on location and severity of injury
Injury can cause inflammatory response affecting whole brain
Pressure-related affects on other areas
Coup-Contrecoup
Frontal- “everything” connection (i.e., frontal-cerebellar)
Helps differentiate co-morbid conditions

18. Types of Neuropsychological Assessments
Low-level evaluation
Glasgow Coma Scale
Brief Cognitive Examinations
Montreal Cognitive Assessment (MOCA)
Repeatable Battery for the Assessment of Neuropsychological Status (RBANS)
Neurobehavioral Cognitive Status Examination (Cognistat)

19. Comprehensive Neuropsychological Battery
Extensive battery involving assessment of multiple cognitive and biopsychosocial domains
Cognitive domains
Verbal/language abilities
Visuospatial skills
Executive functioning
Attention, planning/sequencing, working memory, mental flexibility
Verbal and Visual Memory
Processing Speed
Motor/sensory

20. Neuropsych subtest examples
Rey-O Complex Figure Copy
Alzheimer’s patient copy

21. Trailmaking B subtest

22. Stroop subtest

23. Picture Naming subtest

24. List Learning subtest

25. Processing Speed Measure

26. Comprehensive Neuropsychological Battery
Emotional Factors
Depression
Anxiety
Adjustment to medical condition
Lability
PTSD

27. Medical History Review
Medical Co-morbidities
i.e. cardiovascular disease, diabetes
Medications
Substance Abuse
Neuroimaging findings

28. Social/Environmental Factors
Family/Social Relationships
Financial Status
Academic History
Vocational History
Living Situation

29. Stroke Case Example 1
Include walk-through of interview, chart review, battery, and interpretation

30. Questions?

31. References
Neuropsychological Assessment, Fifth Edition; Lezak, Howieson, Bigler, & Tranel
Advanced Psychological Assessment, P.C. (
Signs of cerebral small vessel disease. From Inzitari et al, BMJ Jul 6;339:b2477. doi: /bmj.b2477
Inflammatory Response in Acute Traumatic Brain Injury. Current Opinion in Critical Care: Apr 2002