Assessment of cognitive functioning includes many complicated functions that we assume to be uniquely human: speech functions, memory, thinking and reasoning, ability to learn, and certainly intelligence itself. This area of clinical psychology, evaluation of neurological functioning, is one of the most complex and depends on basic neuroscience information. Our understanding of brain functions is advancing sharply. Certainly brain imaging technology (functional magnetic resonance imaging, or fMRI) is a promising technology.

Why assess for Neuropsychological functioning?

Even with these advanced methods for viewing the brain and its structures there isn't a one-to-one correspondence between brain structure and behavior. Perhaps here more than anywhere else the appearance of behavior changes, or even personality changes, cause alarm and the need to seek explainable causes. Something seems to be wrong: the individual is not functioning at a previously observed level. A person's memory or judgment seems different from what was normal for that person.  Typically persons are brought to the attention of professionals because of these changes; they do not seem to seek help on their own out of their felt concerns about changes.

There are a few general ways for describing these kinds of  problems and for explaining available assessment options. 

     Dementias

 For various reasons,  there are changes in brain cell that cause progressive losses in cognitive functioning. The best known among these is Alzheimer's disease (Alzheimer's Disease). Memory is progressively impaired, but as the course of the disorder continues, otherwise simple everyday functions are lost. There are also other forms of senility that go beyond the changes usually associated  with the aging process itself. Contrary to popular belief, "senility" is not a common course of normal aging! 

    Brain damage

 Brain damage can occur either because of physical head injury, tumors, or because of chemical changes (e.g., failure to supply sufficient oxygen to the brain cells), or genetically based diseases. 

A  traumatic head injury (e.g., from a car accident), or a closed head injury resulting from a blow to the head and causing a severe concussion, can produce brain damage. Tumors or growths actually change brain cells in surrounding areas that cause noticeable changes in behavior. Chemical changes include oxygen deprivation, such as associated with strokes when blood supplies are interrupted. This results in cells dying, which is of course what we mean by brain damage. 

 Although we know a great deal about how different areas of the brain relate to functions (e.g., speech, memory, senses, etc.), as already noted there is not a simple direct correspondence between behavior and area of the brain. The complex interconnections make some behaviors still possible even when faced with serious disruption of brain cell functioning.   The only certain statement is that the brain does not heal itself they way skin or bone might: once cells are damaged they are gone.

Most commonly, the questions to be answered by neuropsychological  assessment involve determining the current level of ability in areas of memory and intellectual functioning, We can also make inferences about ability to acquire new learning. Treatment for some neurological conditions (e.g., post stroke rehabilitation) is a separate area of expertise and one different from the assessment services I am discussing here. 

 The bottom line is that through neuropsychological testing we can aid substantially in treatment or custodial planning.  Neuropsychological evaluations can provide information about a patient when usual forms of observation are insufficient to explain behavior changes. 

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