Neuropsychological diagnostics comprise a series of standardized paper-and-pencil as well as computer tests to clarify cognitive deficits after brain damage. The diagnostic procedure is a prerequisite for the assessment of the cognitive status as well as the planning of subsequent therapeutic measures. Testing is performed by neuropsychologists in facilities with a neurological focus.
What is neuropsychological diagnosis?
Neuropsychology focuses on damage to the brain as a result of accidents or disease and its effects on cognitive and psychological functions. These include memory, attention, concentration, perception, language comprehension, planning and problem solving, as well as motivation, mood and drive. In the treatment process, neuropsychologists cover diagnostic workup, implementation of various therapeutic measures, and counseling for affected individuals and their families. Neuropsychologists usually work in hospitals, therapy centers or rehabilitation clinics with a neurological focus. The diagnostic or test psychological examination covers the entire range of cognitive and emotional functions and their effects on the behavior of the affected person. The diagnostic procedure begins with a self-history, which is supplemented by an external history with relatives due to possible poor reliability of the affected person. Systematic behavioral observation in therapy and everyday situations supports and completes the data collected in the anamnesis. Standardized, partially computerized tests provide detailed information about various cognitive and psychological functions. Based on the test results, therapy is then planned and implemented. In many facilities, neuropsychological diagnosis is a standard procedure in the therapeutic process. Affected individuals with brain damage undergo extensive assessment, which is not necessarily followed by therapeutic treatment in the form of exercises and cognitive training, depending on the results.
Function, effect, and goals
For a comprehensive clarification, neuropsychologists perform several tests that may take quite a few hours. An essential part is the examination of short- and long-term memory. This may be due to acquired brain damage such as stroke or traumatic brain injury. In the long term, dementias also cause memory impairment, which progresses at different rates. The best-known means of determining dementia is the Mini Mental Status Test. Through various tasks on memory, orientation and the implementation of verbal and written instructions, cognitive performance is classified. If this test is conspicuous, further examinations are carried out to determine the form and progression of the dementia. An examination of local, temporal, personal and situational orientation already takes place in the anamnesis. In addition to personal information such as place of residence and date of birth, the patient answers questions about his or her current whereabouts, the current date or the course of the disease to date. Another large group from the field of neuropsychological examinations are tests of visual perception. If the visual center is damaged, complete or partial visual field loss in one or both eyes can result. The tests are increasingly computer-based. The patient is asked to try to see various objects on the screen without turning his or her head. A similar procedure is used for neglect tests. Neglect is an accompanying symptom of strokes, usually when the right hemisphere is damaged. For patients with neglect, one half of space does not exist visually, acoustically, and/or tactilely; stimuli from that half of space are not perceived. The easiest way to diagnose is line bisection tests, in which affected individuals miss lines on one side of the page and divide the lines not exactly in half, but at about a quarter. The clock test, in which the patient is asked to record a clock including the hands, also provides information about a neglect. Affected persons would draw all digits in only one half of the clock. Neuropsychologists also clarify linguistic aspects of brain damage. Reading and writing tests allow conclusions to be drawn about whether the speech center is affected. In addition to reading comprehension, memory is also examined when patients are asked to reproduce what they have read.Writing tests also reveal possible motor deficits in the dominant hand. Tests on action planning and problem solving provide information on how well affected individuals can cope in everyday or professional situations and overcome the challenges that arise there. Most neuropsychological tests also check attention and concentration in parallel. If abnormalities are present here, separate procedures such as smear tests can provide a more accurate picture.
Risks, side effects and dangers
Because neuropsychological testing is a noninvasive procedure, there is no physical risk to the individual. However, many individuals have difficulty fully accepting the testing and subsequent therapy. Physical deficits are often easier for the psyche to process than cognitive ones, which is why the affected person may not be compliant during the testing. A lack of insight into the illness complicates the diagnosis for the neuropsychologist. A further complication lies in patients with massive behavioral problems or aggression, which sometimes make testing impossible. In this case, neuropsychological diagnostics cannot be performed immediately after admission, but at a later time. Some neuropsychological tests, such as the Mini Mental Status Test, can only be used once. This test to determine dementia may show a better, and therefore falsified, result when administered a second time due to the learning effect. Neuropsychologists must consult with other professionals to avoid duplicate testing. Occupational therapists, for example, also perform testing in the cognitive domain to plan their therapy interventions. Consultation with other physicians and therapists is essential not only during the diagnostic process but also during the therapeutic process, since treatment of brain injury involves a multidisciplinary team.
