Clinical Neuropsychology - Lecture 1
Tuesday, January 11th, 2011
Chapter 1 - The Practice of Neuropsychological Assessment
About the quote by Lezak: As a clinical neuropsychologist, were interested in
understanding behaviour (more specifically cognitive function: memory
disorders, executive disorders, etc.). However, this definition is dated, there is
so much still to be learned and describing the limitations it presents. To
understand where its going, we need to see where it came from; therefore
history is necessary to cover.
Early demonology: why did this occur?, why would they drill a hole in peoples
skulls? There was a predominant view that demonology was responsible for
mental health deficits. However, when they did this, they caused brain
damage, increasing the abnormalities and mental deficits.
About witch hunts: looking for people they thought were possessed, who
displayed different symptoms from typical mental health disorders. People
who survived the dunking were considered witches and beheaded, people
who did not were dead anyway. This was one of the first ways of
administering tests to deduce the possession of impairments in mental
health. The same kind of algorithmic thinking occurs today.
Franz Joseph Gall - a direct bearing on where neuropsychology is going today.
His basic tenets (of the mind) based on his observations back in the day when
he was a teacher. 1: yes, we consider this; 2: yes, it has been determined that
different parts of the brain are used for different functions; 3: yes; 4: kind of,
there is conflicting evidence; 5: probably not, but what he was hinting to is
maybe there is something important in the area of the brain in relation to
someone who has a higher aptitude in some area; 6: no, he kind of fell apart
when he started to lean towards this tenet, leading to phrenology.
Phrenology: not so far from what Gall was doing with this, we have the
general idea of the modern day fMRI.
Video: Quack Gallery: Phrenology & Psycographs. 2 important things to take
from it, 1) modern brain mapping has some lineage back to Gall and his
tenets now true today and 2) its difficult to assess someone using a test like
this to be able to determine or extrapolate toward their real world behaviour.
www.notesolution.com Asylums: locked up like inmates or zoo cages, they were horrible experiences
for anyone with these disorders. There were some real keen neurologists
working in these hospitals, like Paul Broca.
Broca: He really was the first person to truly relate a cognitive disorder back
to the brain that still remains true today. He had a patient, Tan, who he
found to have a lesion in his left frontal lobe. He deduced that this led to the
unability to speak fluently but able to comprehend. He found more patients
with the same symptoms who, when they died, looking at their brains, also
had lesions in the same area. This area became known as Brocas area and
the disorder now more commonly known as Brocas aphasia.
Wernicke: After Paul Broca published his study, this neurologist came along.
He found a patient who had symptoms completely opposite of Brocas aphasia.
Where the person was fluent in their speech but could not comprehend.
Notice that these aphasic disorders are not so clear-cut, and so it is difficult to
assess patients with these symptoms. Some tests have been developed to
determine which one specifically they may suffer from.
This leads to executive disorders...
Phineas Gage: this was the first time that a brain disorder was related to a
change in personality. He became a classic study in terms of understanding of
how the brain could give rise to difficulties at a higher level of cognition,
beyond things like speech problems.
Psychoanalysts began to take over (ie., Freud, etc.) and these studies were
However, when the war came about, a lot of men came about with brain
injuries. a neurologist, Geshwind, in Boston, saw many patients with these
cognitive difficulties that we saw previously. He was the one to go back in
literature to see if these symptoms had ever described, and he came across
the studies of Broca, Wernicke, and Harlow.
His students included Lezak, Kaplan and Warrington. The fact that these
people are somewhat connected to us demonstrates how young this science
www.notesolution.com One of the first validated neuropsychological tests was the clock drawing,
displaying visual neglect. They recorded normative data (important term!
the science that neuropsychology is based on...) since they didnt have the
instruments we have today. They mapped the damaged areas and the
Tests were described to assess lateralization (motor tests: pegboard tests),
aphasia (Boston diagnostic aphasia test), Boston naming test: individual
ability of the patient to name pictures shown to them on cards. There are now
a plethora of tests used in neuropsychological assessment today.
Again, its a very young science. (2 main take home points!)
Things beyond brain injury, such as depression are also relevant, and so
clinical psychology plays a role, along with a few other fields. (Be familiar
The practice NPA:
- a clinical neuropsychologist is someone who earns a PhD in clinical
psychology who specializes in neuropsychology; also has to do a post-doctoral
residency in neuropsychological assessment
- they can diagnose psychological disorders as well as neuropsychological
disorders, but a clinical psychologist could not
- they could be involved with private practice, in a hospital setting, their
primary role is diagnostic
- there is a huge need for NPAs, because of what can be deduced from these,
and the science behind it, it also under weighs the majority of the treatment
that would be applied
This course will focus mostly on the diagnostic science of clinical
What precipitates a NPA?
1 - referral by a GP or neurologist (clarification of diagnosis, ie. does this
person have Alzheimers or is it just old age?)
2 - what is the breadth and severity of cognitive impairment and how does
that affect their ability to engage in activities in their daily living (do they
require supervision because of this?)
3 - ie., testing someone visual ability if their verbal is impaired, and
increasing their ability to compensate for the deficit
4 - ie., prescribing Ritalin to a child with ADHD
www.notesolution.com 5 - the neuropsychological signature that characterizes the disorder
6 - the most needed in recent days, neuropsychology has focused on issues
such as malingering, people emulating disorders, feigning a brain injury
Rey-Ostierieth Complex Figure: cognitive functioning, visuospatial ability,
which relates to the parietal lobe.
In this class, there are many levels of knowledge to learn! Ie., Anatomy,
cognitive functions, the tests that test it, and finally relating it to the
Predicitve/ecological ability, how well the NPA predicts future behaviour or
behavioural outcomes? One of what of the questions that arise in clinical
neuropsychology today... Can we assume something about someone based on
how they score on these tests? How do these tests lack this type of validity?
What well focus on in this class:
- refining tests: not everything comes from the brain in neuropsychology
- integration of computerized assessments: we learn that were not able to do
a NPA with people in front of us. Some of these patients cannot endure this
time or are in remote locations
- acquisition of normative data that are lacking: in order to compare
performances by the patients, more similar to the patient rather than what is
available today (only in the past couple decades did we start to notice that
differences in things like culture or education level affect what the data
Next week: basic concepts on what hes already led to!
Anything related to the exam, e-mail Sara, anything else, e-mail Eliyas.
Under demonstration (in the text), the tests used in the class demonstration
will be described...
Clinical Neuropsychology - Lecture 2
Tuesday, January 18th, 2011
Chapter 2 - Basic Concepts
Chapter 1 and 2 need to be read in their entirety, later chapters will be more