Sunday, 4 December 2011

Neuropsychological Assessment: A Valuable Tool in the Diagnosis and Management of Neurological, Neurodevelopmental, Medical, and Psychiatric Disorders

Michelle Braun and colleagues have also published an article which should be helpful around the world for those wanting to advocate the benefits of neuropsychological assessment. It's certainly going to be useful for our cause in Australia, where neuropsychological work is not covered by Medicare, even though it is covered under the Department of Veterans Affairs, Workcover, and a number of motor vehicle accident insurance boards. Thanks again, Michelle et al, you've done great work!

reference details
Neuropsychological Assessment: A Valuable Tool in the Diagnosis and Management of Neurological, Neurodevelopmental, Medical, and Psychiatric Disorders
Braun, Michelle; Tupper, David; Kaufmann, Paul; McCrea, Michael; Postal, Karen; Westerveld, Michael; Wills, Karen; Deer, Teresa

Cognitive & Behavioral Neurology. 24(3):107-114, September 2011.

For both children and adults with neurological, neurodevelopmental, medical, or psychiatric disorders, neuropsychological assessment can be a valuable tool in determining diagnosis, prognosis, and functional abilities as well as informing clinical management. This review summarizes the contributions of neuropsychological assessment to clinical care across diagnostic categories, with the goal of helping clinicians determine its utility for individual patients.

The following quote from their section on non-CNS medical conditions shows how neuropsychologists can improve patient care outside of the traditional realms of neurology, rehabilitation, and psychiatry:

"Because cognitive dysfunction from a variety of
medical conditions is increasingly an issue in the elderly,
but is still poorly recognized, especially in primary care,
neuropsychological evaluation is critical to management.
124–128 There is a strong scientific basis for the use
of neuropsychological assessment to detect cognitive
impairment and guide treatment planning in many
noncentral nervous system conditions, including acute
respiratory distress syndrome, cancer, chronic kidney
disease, chronic obstructive pulmonary disease, cardiac
disorders, hypertension, obesity (for bariatric surgical
candidates), obstructive sleep apnea, and type II diabetes.
129 ... Neuropsychological
assessment sensitively detects the presence,
nature, and severity of brain dysfunction in these
conditions, and helps guide clinical management (eg, the
introduction of new medications or procedures such as
chronic transfusion in patients with sickle cell disease).
Neuropsychological assessment results also guide recommendations
for and implementation of rehabilitation
strategies such as speech therapy or training in activities
of daily living when functional disabilities interfere with
independent living or work productivity.137,140" (p.110)

I'd strongly recommend obtaining a copy of this article for your core reading list.

My next post will be the first in a series of classic papers in neuropsychology. This will be an entirely subjective series, based on writings that have had an ongoing impact on the way I aspire to practice clinical neuropsychology.

I'm interested to hear about other people's favourite references - email me at if you'd like to contribute.

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