Assessment in Neuropsychology

This book quickly introduces the reader to the different philosophies that grossly characterize American and British approaches to neuropsychological assessment. The American approach, best exemplified by the Halstead-Reitan Neuropsychological Battery (1), espouses the quantitative, empirical, and psychometric aspects of assessment. Its tradition derives from efforts to construct tests that identify patients with underlying organic brain dysfunction. In this approach the distinction is made between tests that are differentially sensitive to specifically localized brain lesions. Thus, through testing, it is possible to formulate conclusions about the probability of brain dysfunction within specific brain regions. The American tradition has historically relied on comparing the individual with a normative reference group to assess the nature and extent of brain dysfunction.

In contrast, the British approach is rooted in a more theoretical foundation that relies on, and simultaneously informs, models of “normal” cognitive functioning derived from the field of experimental psychology. This brand of cognitive neuropsychology concerns itself with underlying brain variables only to the extent that the latter map onto or serve to validate the cognitive theories under consideration. Rather than exclusively fitting the individual patient to a particular normative or other reference group, the British approach emphasizes the theoretically driven and sometimes qualitative patient examination, geared toward delineating a patient's defective cognitive components relative to a particular (cognitive) model of normal functioning. By validating tests and techniques to a model of normal cognitive functioning rather than to a brain site, its proponents suggest that the British approach has more potential to link findings to specific functional deficits and thus to formulation of appropriate rehabilitation strategies.

The purpose of Assessment in Neuropsychology is not to provide a detailed contrast between the American and British styles but to delineate neuropsychological assessment techniques employed within the context of a theoretical approach to assessment. Indeed, the body of the book is devoted to solid discussions of neuropsychological assessment in the areas of visual function, sensorimotor deficits, visual perception, language, and memory (although conspicuously missing is a chapter on executive functions). With few exceptions, however, the descriptions are devoid of serious reference to the underlying cognitive models that led to development of the tests being presented. The exclusion of these theoretical underpinnings is conspicuous, given that the approach in question relies so heavily on theory to guide assessment. Perhaps the argument can be made that it is possible to provide a practical guide highlighting the tests that derive from cognitive neuropsychology. To the extent that this can be accomplished, the book meets its intended purpose. However, it is also clear that to gain the rich theoretical understanding necessary to practice this type of neuropsychological assessment, parallel reference to one of the classic texts in cognitive neuropsychology (2) will also be useful.