Neuropsychological Test Batteries

Introduction

Given the progress in neuroimaging methodology, it is not the primary task of neuropsychological test batteries to detect brain injury. Today, neuropsychological testing has to meet more specific tasks, especially the evaluation of rehabilitation programmes and neuropsychological trainings. The first part of this contribution refers to impairment, disability, and handicap as three different levels of neuropsychological assessment. Following an explication of tasks and problems of neuropsychological assessment in the second part, relevant aspects of neuropsychological functioning are differentiated and diagnostic tools for the assessment of attention, memory, dementia, coping with illness, emotional status, and specific executive functions are presented.

Levels of Neuropsychological Assessment

Proceeding from the terminology proposed by the WHO (see Matthesius et al., 1995), possible long-term consequences of brain damage and effects of neuropsychological rehabilitation can be conceptualized according to the three levels of impairment (i.e. amount of the damage itself, e.g. damages in basic processes of memory, concentration, and perception), disability (i.e. resulting functional losses, e.g. decreases in working performance attributable to memory, concentration, or perceptual disorder), and handicap (i.e. disadvantage in social functioning, e.g. job discrimination). Corresponding to this differentiation, three aims in the treatment of neuropsychological problems can be distinguished: restitution (i.e. full recovery of functional status), compensation (i.e. enabling the person to compensate successfully for every-day consequences of impairment), and adaptation (i.e. adjusting environmental conditions so that the person is able to lead an independent life).

According to Wilson (1997), simply focusing on drill and exercise, most cognitive training programmes in neuropsychological rehabilitation proceed from the impairment level. This kind of training programme has been said to be useless for brain-damaged persons, since a restitution of cognitive abilities is often impossible. Instead, Wilson (1997) proposed neuropsychological rehabilitation to focus on the disability-level. Proceeding from neuropsychological knowledge, educational programmes should enable patients to compensate for individual problems attributable to neuropsychological impairment. Consequently, behavioural therapy is seen as a basis for developing individual training programmes, aimed to optimize patients' performance in everyday activities. From a practical perspective, training programmes should not be restricted to the improvement of basic processes (i.e. hoping for a generalization of regained skills and abilities) but should also consider the importance of environmental conditions for the relationship between competencies and actual performance. Focusing on the respective relevance in patients' everyday life, it can be argued that exactly those activities, that are usually expected to benefit by means of generalization, should be trained in rehabilitation programmes.

Nevertheless, all the three levels differentiated in the WHO-classification are of high relevance for neuropsychological assessment. First, none of these levels can be ignored since the development of individual intervention measures as well as the evaluation of effectiveness and usefulness of rehabilitation programmes must rely on information about the kind and severity of impairment, disability, and handicap. To give an example, proceeding from the impairment-level it might be obvious that a training aimed to improve memory performance should be offered. However, it is not enough to claim that patients' memory performance in a specific psychometric test could be improved due to the participation in a cognitive training. Additionally, to establish the effectiveness and usefulness of the respective intervention measure, it must be shown that patients do suffer from less memory problems or are more effective in managing memory tasks after their participation in the respective programme than before.

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