Neuropsychology

Application of cognitive neuropsychology in the clinical setting

Cognitive
Emotional
Behavioural

Patient has cognitive symptoms - is it neurological?
Patient has neurological diagnosis - what are the resulting cognitive symptoms?

Impaired episodic memory
Poor visuo-spatial functioning (poor navigation)
Progressive symptoms
Gross change of behaviour/personality
Impaired activities of daily living

Impaired attention
Recent stressful life events
Mental health problems
Other illness/pain
Intact episodic memory and other congition

External distractions
Internal distractions

Answer referral question
Develop hypothesis
Test hypothesis

Outpatient clinic
Remote
Inpatient
Private clinic

Symptoms
Premorbid ability
Neurological/psychological history
Recent stressors
Qualitative observations of speech, memory, behaviour

Standardised tests
Hypothesis driven personalised battery
Index of premorbid IQ
Mood questionnaire

How does patient perform relative to their peer group and to their premorbid level

Patient's cognitive ability in absence of any neurological injury
Provides a baseline for comparison

Memory
Language
Attention
Visuo-spatial function
Executive function

Cognitive overload
Extraneous factors impairing input
Attention deficit

Concentration
External distractions
Mood
Fatigue
Cognitive effort
Motivational issues
Malingering

+ Scientific method (hypothesis testing)
+ Evidence based
+ Standardised assessments, assess change over time, allows comparisons with peers
+ Assesses individual within context
+ Supported by quantitative and qualitative data
- Limited normative data
- Ceiling effects (pp reaches highest score, may not be measuring their full potential)
- Poor test validity (factor overlap)
- Test results can be skewed by poor motivation/fatigue/distraction
- Dependent on good quality info from patient/carer

Quantitative and qualitative data integrated
Provide opinion in answer to referral question
Provide feedback
Guide intervention