Reflections on clinical neuropsychology: a multifaceted approach

Abstract

Neuropsychology is a rapidly growing, independent discipline with a broad work field. Neuropsychologists are working in hospitals, rehabilitation centres, nursing homes, forensic organisations and research institutes. One of the most important instruments of a neuropsychologist in assessing the behavioural expression of brain functions is the neuropsychological examination. This examination can have different purposes: 1. Diagnosis 2. Patient care 3. Treatment 4. Research The aim of this thesis is to demonstrate the diversity of the purposes of a neuropsychological examination. I will do this by presenting a series of studies that reflect these different purposes. Chapter 2 and chapter 3 will describe the neuropsychological examination as a diagnostic tool in two case studies. Chapter 4 and chapter 5 discuss different aspects of the neuropsychological examination in patient care. Chapter 6 illustrates the neuropsychological examination as a manner to evaluate treatment. Chapter 7, 8 and 9 are examples of the neuropsychological examination in research. In Chapter 10, the General Discussion, we question whether the different purposes of a neuropsychological examination should be seen as isolated aspects. As neuropsychologists, we aim the most optimal use of our neuropsychological assessment. Should we therefore not continuously keep other purposes as the one defined in the referral question in mind as well? Combining different purposes in one neuropsychological examination can be described as a multipurpose examination. A multipurpose examination makes us aware of other possible purposes of the neuropsychological examination than originally determined. The multipurpose examination, or in other words a multifaceted approach, forces us to think outside the standard boundaries of our assessment and outside the original reason for referral. In daily practice, the combination between the different purposes, or in other words between research and clinical care, is not always made. This can be the result of limited time and financial resources, but also simply because we are not used to it. First of all, in the curriculum of neuropsychologists in the Netherlands, the integration of different purposes is not consistently made. Clinical care and research are artificially separated in different stages of the education system and only in a very late stadium reunited. By combining clinical and research topics consequently in all stages of the neuropsychological educational program, neuropsychologists will be automatically more willing to integrate aspects of clinical care and research. Furthermore, in the broad profession of neuropsychology, some neuropsychologists are still working in isolation. This may have several drawbacks. The diagnosis and treatment procedures are viewed as fragmented and the results of the neuropsychological examination are therefore not always optimally used. Furthermore, interesting cases for research will be missed because neuropsychologists working in clinical settings are not in contact with those who are participating in research. Short lines between hospitals, rehabilitation centres, nursing homes and research institutes will be helpful in combining the different purposes. Finally, standards of evidence-based methods can be illustrative in combining research and clinical care (and integrating the four purposes described by Lezak). This thesis makes neuropsychologists more aware of the different purposes of a neuropsychological examination. Being aware of these different purposes can be helpful in looking outside the standard boundaries of your profession. As a result neuropsychology will rise to a higher level.