Thursday, August 16, 2012

Neuropsychology: Understanding Cognition

By DeLisa A. West, Ph.D., ABPP (CN), West Neuropsychology, LLC 205-453-9888

How often do you walk into a room and completely forget why you went into the room? Or do you struggle with remembering someone’s name a few seconds after they introduce themselves to you? It seems that these “senior moments” occur more frequently as we all get older. As a clinical neuropsychologist, I am often asked if this is normal aging or if it is a sign of a bigger problem such as Alzheimer’s disease.  The field of neuropsychology is uniquely skilled to answer this very question. Clinical neuropsychology is a sub-field of psychology which examines the relationship between the brain and behavior. It uses neuroscience, neuroanatomy, cognitive psychology, cognitive science and clinical psychology to understand the structure and function of the brain in relation to behavior and the information processing aspects of the mind. Neuropsychologists help to assess, diagnosis and treat individuals with neurological, medical, developmental or psychiatric conditions across the lifespan. Neuropsychological testing can aid in understanding how different areas of the brain are working. Neuropsychologists use various standardized tests to objectively examine a person’s strengths and weaknesses in all areas of thinking or cognition. Tests may be paper-and-pencil, answering questions, computer-based or task oriented. Areas of cognitive impairment or deficit can be identified and placed within the context of the individual’s medical and psychological history in order to determine what condition may be impacting a person’s functioning and thinking. 
Typically testing is requested if symptoms or complaints involving memory or thinking are noticed by individuals, their family members or healthcare professionals.  A person’s performance on each test is compared to those who are similar (e.g. same age, level of education, etc.) to decipher whether there are areas of thinking that are poorer than would be expected as compared to the person’s healthy peer group. The pattern of performance can show whether there has been a change in thinking in certain areas. A neuropsychological evaluation assesses all areas of our thinking including but not limited to:
·         General Intellect
·         Attention and Concentration
·         Language Skills (e.g. language comprehension, etc.)
·         Visual-spatial Abilities (e.g. perception)
·         Motor and Sensory Skills (e.g. fine motor skills, etc.)
·         Learning and Memory (e.g. ability to learn, retain and retrieve information)
·         Executive Functioning (e.g. reasoning, problem solving, organizing, etc.)
·         Mood and Personality (e.g. depression, anxiety, etc.)
Neuropsychological testing is sensitive to mild changes in thinking that might not be obvious in casual situations or conversations. Testing can identify whether changes are normal age-related changes or if they are related to a medical or psychiatric condition. Different conditions or illnesses can manifest themselves in different patterns of cognitive strengths and weaknesses on testing that can then aid in determining the most appropriate course of treatment. For example, testing can demonstrate different patterns among Alzheimer’s disease, stroke or depression. Once the cause of the deficit is identified then specific treatments can be chosen by the healthcare team. Neuropsychologists also assist with the management and rehabilitation of those who are suffering illness or brain injury which has caused cognitive difficulties. Additionally, they can provide helpful compensatory cognitive strategies as well as emotional support for adjustment to illness.
Current trends in the field involve neuropsychologists focusing on individuals with specific conditions. For example, neuropsychologists assist athletes with identifying whether they have experienced substantial cognitive problems secondary to sports-related concussions and whether they should return to sports given any cognitive difficulties identified. Attention difficulties can be examined to determine whether they are consistent with Attention Deficit/Hyperactivity Disorder (AD/HD) or other conditions such as depression, anxiety, etc. Neuropsychologists who work with older adults can answer whether cognitive problems are secondary to normal aging or various dementias such as Alzheimer’s disease. Approximately, one in eight older Americans has Alzheimer’s disease and memory and cognitive changes are the most prominent early symptoms. Neuropsychological testing can provide concrete data as to the severity and progression of cognitive impairment caused by Alzheimer’s disease. In addition, neuropsychologists provide recommendations to individuals and their families in regards to planning for future cognitive decline and the need for assistance with daily tasks. Neuropsychologists play a vital role on rehabilitation teams who work with individuals with traumatic brain injury (TBI) as questions as to the person’s cognitive ability to return to independent living or work are raised.  Different types of stroke or brain tumors can negatively impact a person’s thinking abilities and neuropsychological testing can aid in identifying any areas of cognitive impairment which may hinder a person’s ability to independently function (e.g. driving, manage finances, etc.). Psychiatric disorders such as Major Depression can cause changes in thinking which differ in pattern from other neurological conditions and neuropsychologists can help decipher what impact emotional conditions have had on a person’s thinking. They also can focus on working with children and adolescents to determine whether developmental disorders are affecting learning and thinking.
Often individuals are not sure what is causing their problems yet they know that something is not going well with their thinking.  Neuropsychological testing can help with determining:
·         Does cognitive impairment exist?
·         Does the pattern of impairment in the context of the person’s history suggest a diagnosis?
·         What are the real-life consequences of this impairment (e.g. need for assistance, medication, etc.)?
Neuropsychology: a specialty discipline that provides detailed cognitive data to guide healthcare treatment.  


  1. Let us assume that the aging is not a factor, but the concentration and mood are --- this is left to believe that if aging was a factor then there would be no way to diagnose the ailment, or disease because you would be unable to qualify and separate.

    I my studies with clients that have depression, or weight issues, sometime there is a premeditated block or purposeful lack of concentration for one reason or another.

  2. An excellent overview of the role neuropsychology plays in the diagnosis and management of dementia disease. Thank you, Dr. West!