Neuropsychology: A complete guide to all your questions

We clarify all the questions you may have about neuropsychology: What it is, what does it study, neuropsychologist’s role and patients, what cognitive tests are most used in this field, clinical cases, how it is applied, etc… Neuropsychology is a science that is booming, although it is not 100% known. Therefore, in the following article, we will solve all the doubts that may arise about this field.

Complete guide to Neuropsychology
Complete guide to Neuropsychology

What is Neuropsychology?- Concept and definition

Neuropsychology is a branch of psychology, with a more specific field of study. So what does neuropsychology study? Neuropsychology is the science that is concerned with how the brain and the rest of the nervous system influence a person’s cognition and behaviors. It studies the effects of a brain injury or brain damage in the structures of the central nervous system. These injuries cause changes in psychological, emotional and cognitive processes. These injuries may happen due to head trauma, stroke, tumors, neurodegenerative diseases or developmental disorders. What does Neuropsychology mean? It is the relationship between the executive functions and the cerebral structures. It is a scientific field that converges psychology and neurology.

History of Neuropsychology

Neuropsychology has its origin in the nineteenth and twentieth centuries, according to psychologists and physicians.Among the main studies that led to the creation of Neuropsychology is the study of aphasia (Pierre Paul Broca), which determined that the central location of language production was in what we know today as Broca area (left hemisphere).
Another important contribution of neuropsychology was the creation of the phrenology (Franz Joseph Gall), which considered that mental functions had different locations in the brain. Among his most important discoveries is how humans differ from animals due to the development of our frontal lobe
Nonetheless, the founding father of neuropsychology is Alexander Romanovich Luria. Luria perfected studying brain injury patients behavior and also created different psychological tests to establish what were the different cognitive processes affected.  
Currently, in addition to clinical observation, studies are based on different brain imaging studies (CT, PET, SPECT, MRI) and cognitive sciences that design functioning plans and rehabilitation of the altered functions based on preserved brain functions.

What Cognitive Functions does Neuropsychology study?

Within Neuropsychology, there are different areas that we will describe in the following sections. They are all within clinical neuropsychology but are divided into different subspecialties (attention, memory, language and executive functions).

  • Neuropsychology of Attention: this cognitive area besides being the commonly evaluated, it is the main subject of study in Neuropsychology. According to Luria, attention is a selective process of information needed to perform some specific activity. Neuropsychology explains attention as the result of the work from the Ascending Reticular Activating System next to the cerebral hemispheres synchronized in turn with the frontal lobes.
  • Neuropsychology of Perception: the French ophthalmologist L. Verry was among the first to affirm that visual perception had neural bases and specific brain areas. In neuropsychology, alteration of perception is known as agnosia.
  • Neuropsychology of Memory: probably one of the most studied cognitive areas. Ebbinghaus, one of the most important authors in this area, studied the memory processes from a psychological perspective and later studied the physiological processes. These studies were the starting point to know the organization and the functioning of memory. Alteration in memory can be called in different ways depending on the cause. Some examples are amnesia, cognitive impairment, or dementia. The main disorder that is directly related to memory failures is Alzheimer’s disease.
  • Neuropsychology of Language: this field studies verbal communication, from the formulation processes, coding, comprehension, and decoding when whichever paths are affected by a brain injury. Language alterations are known as aphasia.
  • Neuropsychology of Executive Functions: executive functions are composed of a wide range of cognitive skills and strategies. Within the executive functions, we find different processes (inhibition of responses, shifting, working memory, among others). An alteration in some of these functions can affect decision making, creating plans, solving problems or self-control, which in turn can make daily activities almost impossible.

Neuropsychology Evaluations-Tests

Neuropsychological tests are designed to perform cognitive assessments, that is, to measure the state of the different cognitive areas. The cognitive area measured has to be specified on the test. Some examples of different neuropsychological tests to evaluate each of the cognitive abilities are the following. 

  • Attention: d2, cancellation (WAIS-IV), TMT.
  • Perception (Gnosis): VOSP, Ishihara test, Gollin incomplete figures.
  • Memory: Pairs of words (WMS-III), Vocabulary, Similarities (WAIS-IV).
  • Language: FAS, Boston Denomination Test.
  • Executive Functions: Zoo Map, Search for the key.
  • Praxis abilities: Clock drawing, PIEN-B, Copy (Drawings – WAIS-III).

Nowadays, the number of computerized tests (applicable by computer) are increasing. These tests offer the option to asses from home cognitive abilities as well as train them. In this field, CogniFit is the world’s leading computerized cognitive training and assessment tool. It is available in 16 different languages and assesses up to 23 cognitive skills. 

Neuropsychology Patients

Neuropsychologists work with a wide range of age from infants, children or adolescents with learning disabilities to adults with brain damage and even seniors with dementia. The most common patients who go to the neuropsychologist are those who have suffered a traumatic brain injury, stroke or neurodegenerative disease.

People worried about their memory failures are an increasingly demanding group in neuropsychology. Currently, preventive workshops based on brain training, have cognitive stimulation exercises to work attention, memory and executive functions. In addition, recent studies have allowed an early diagnosis of Alzheimer’s disease through neuropsychological tests.

Neuropsychology goes hand in hand with clinical psychology. Many neuropsychological explorations have to be done on disorders such as schizophrenia, depression or obsessive-compulsive disorder since they interfere with different cognitive functions. Neuropsychologists also evaluate healthy people to compare their brain activity with those with brain damage.

Child Neuropsychology

It is a neuroscience that studies the relationships between behavior and the developing brain but as its name suggests, it is aimed at children. It may also be referred to as Neuropsychology of Child Development. The main cognitive areas that it evaluates and treats are developmental disorders, neuropsychology of language, and hyperactivity.

Neurorehabilitation in Neuropsychology

Neuropsychology is linked to neurorehabilitation. Neurorehabilitation is a process focused on recovering the damage caused to the nervous system by learning new strategies, such as compensation for functional disorders.

To do this, it is necessary to carry out an exhaustive neuropsychology evaluation to determine which cognitive areas are most affected by the damage. Then establish a rehabilitation program accordingly. The main intervention strategies in neuropsychology are restoration, substitution, and compensation.

Clinical Cases in Neuropsychology

There have been released numerous clinical cases that have allowed to discover how our brain works.

 It was through Broca’s patient that he was able to determine the brain area related to speech production. Thanks to this contribution, we now know Brodmann area 44 as Broca’s area (left frontal lobe) and production aphasia as Broca’s Aphasia.

As for language, another known case in Neuropsychology history is Wernicke’s case. Wernicke studied several patients with temporal lobe damage and concluded that an alteration in Brodmann area 22 (now known as Wernicke Area) produced an inability to understand and repeat language, maintaining language production intact. This helped to determine there are several brain areas in charge of language. This alteration is now known as Wernicke’s Aphasia.

When it comes to memory, the HM patient is the most famous case in neuropsychology. This patient had epilepsy, so the doctors determined that a surgical procedure had to be performed. The origin of epilepsy was in the left and right medial temporal lobes. The surgery had excellent results since the epileptic symptoms disappeared, however, it gave him anterograde amnesia. This case provided important information on brain pathologies and contributed to the development of theories on memory functioning.

Last but not least, the case of Phineas Gage, who, after losing the frontal lobes of the brain in a work accident, was able to recover most of his mental abilities. Nonetheless, his personality changed drastically, becoming an irritable and bad-tempered person. This case was important since it was discovered that the changes produced in the brain not only alter cognitive functions but also affect the personality.

The Role of the Neuropsychologist

Neuropsychologists can work in different fields (academic, clinical and research). In the clinical area, which is currently the most widespread, a neuropsychologist is responsible for the evaluation and diagnosis of the psychological and behavioral effects of brain damage, in order to create a personalized rehabilitation treatmentClinical neuropsychologists perform assessments to determine a person’s brain damage, detect preserved or altered anatomic zones and the cognitive functions related to them. 

The main functions of the neuropsychologist are: 

  • Evaluate and/or establish a clinical diagnosis (cognitive, behavioral and emotional) through standardized tests.
  • Rehabilitation and therapy.
  • Orientation to family members and health care staff.

Furthermore, a neuropsychologist also has an important academic and research role, in order to discover, deepen and transmit knowledge on the relationship between the brain, cognitive abilities, and behavior.

Neuropsychologists can be found in

  • Day centers and residences.
  • Memory units and dementias.
  • Pharmaceutical companies.
  • Multidisciplinary mental health teams.
  • Forensic psychology.
  • Child psychology.

Finally, I want to highlight the important role that neuropsychology plays today. It is a science that has specialized in studying the behavior and skill development in relation to the Nervous System and has allowed us to discover different neuro-rehabilitating treatments for different types of pathologies. It has also allowed us to create preventive treatments for neurodegenerative diseases, such as Alzheimer’s disease.

Hope you enjoyed this complete guide to neuropsychology and please feel free to leave a comment below!

This article is originally in Spanish by Sara Morales translated by Alejandra Salazar.

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