Neuropsych Inability to Return to Task Without Beginning Again
Dialogues Clin Neurosci. 2012 Mar; 14(1): 91–99.
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Clinical applications of neuropsychological assessment
Aplicaciones clínicas de la evaluación neuropsicológica
Applications cliniques de l'évaluation neuropsychologique
Philip D. Harvey
Academy of Miami Miller School of Medicine, Research Service, Bruce W. Carter VA Medical Center, Miami, Florida, USA
Abstruse
Neuropsychological assessment is a performance-based method to assess cerebral performance. This method is used to examine the cognitive consequences of brain damage, encephalon disease, and severe mental disease. In that location are several specific uses of neuropsychological assessment, including collection of diagnostic information, differential diagnostic information, cess of treatment response, and prediction of functional potential and functional recovery. Nosotros conceptualize that clinical neuropsychological assessment will continue to be used, fifty-fifty in the face up of advances in imaging technology, because information technology is already well known that the presence of pregnant encephalon changes can be associated with nearly normal cerebral operation, while individuals with no lesions detectable on imaging can have substantial cognitive and functional limitations.
Keywords: neuropsychology, disability, schizophrenia, Alzheimer's affliction
Abstract
La evaluación neuropsicológica es un método basado en el rendimiento para evaluar el funcionamiento cognitivo. Este método se emplea para examinar las consecuencias cognitivas del daño cerebral, de enfermedades cerebrales y de enfermedades mentales graves. Hay varios usos específicos de la evaluación neuropsicológica, que incluyen elementos para información diagnóstica y para el diagnóstico diferencial, para la evaluación de la respuesta terapéutica y para la predicción del potencial funcional y de la recuperación funcional. Se anticipa que se continuará aplicando la evaluación neuropsicológica clínica, a pesar de los avances en la tecnología de imágenes, ya que es bien sabido que la presencia de importantes cambios cerebrales pueden estar asociados con un funcionamiento cognitivo cercano a lo normal y que individuos sin lesiones detectables en las imágenes pueden tener limitaciones significativas tanto cognitivas como funcionales.
Résumé
50'évaluation neuropsychologique est une méthode basée sur la operation permettant d'évaluer le fonctionnement cognitif. Cette méthode est utilisée pour analyser les conséquences cognitives des lésions cérébrales, de la pathologie cérébrale et des maladies mentales sévères. II existe plusieurs utilisations spécifiques de l'évaluation neuropsychologique, comprenant le recueil d'informations diagnostiques, d'informations diagnostiques différentielles, d'évaluation de la réponse au traitement et de la prévision du potentiel fonctionnel et de la récupération fonctionnelle. Nous prévoyons que l'évaluation clinique neuropsychologique continuera à être utilisée malgré les avancées technologiques de fifty'imagerie, car il est déjà bien connu que des modifications cérébrales significatives peuvent être associées à un fonctionnement cérébral presque normal tandis que certaines personnes sans lésion détectable à l'imagerie peuvent présenter des limitations fonctionnelles et cognitives importantes.
Introduction
Neuropsychological assessment is the normatively informed awarding of operation-based assessments of diverse cognitive skills. Typically, neuropsychological assessment is performed with a bombardment arroyo, which involves tests of a diversity of cognitive ability areas, with more than 1 test per ability area. These ability areas include skills such as retention, attention, processing speed, reasoning, judgment, and problem-solving, spatial, and language functions. These assessments are commonly performed in conjunction with assessments designed to examine lifelong academic and cognitive achievement and potential,1 for a variety of reasons described beneath. The cess battery can be standardized or targeted to the individual participant in the assessment. Assessment information may be collected either directly by a psychologist or by a trained examiner, who performs and scores assessments and delivers them to the neuropsychologist. While neuropsychological assessments were originally targeted at individuals who had experienced encephalon injuries in wartime,ii the populations for whom neuropsychological assessments are useful spans the whole range of neuropsychiatric conditions.iii
Neuropsychological tests are intrinsically performance-based. They are structured to crave individuals to practise their skills in the presence of an examiner/observer. Cocky-reports of operation, besides as observations of behavior while performing testing, are critically of import pieces of information, as described below. Cocky-reports of functioning are often affected past the presence of neuropsychiatric conditions,4 and exercise non accept the aforementioned value as performance under standard conditions, which is compared with normative standards. A critical concept in neuropsychological assessment is normative comparison.five This involves taking the functioning of an private at the time they are tested and comparing that performance to reference groups of the same age, sex, race, and educational attainment. All of these demographic factors impact performance on the tests in a neuropsychological cess battery, and interpreting the test functioning of people, regardless of the illness or injury that they take experienced, is based on comparisons with individuals who are similar to them. These normative comparisons allow for determination whether an individual is performing equally would exist expected, given their lifetime levels of achievements and their educational attainment, or if their performance is poorer than expected. Operation that is poorer than expectations can exist quantified and interpreted accordingly.
Definition of a meaningful cerebral deficit
Neuropsychological cess provides both general and specific information near current levels of cognitive functioning. An average or composite score beyond multiple ability areas provides an overall index of how well a person functions cognitively at the current fourth dimension. As noted below, these global scores are the well-nigh reliable results of a neuropsychological assessment. These global scores are the indices almost unremarkably used to predict real-earth functional milestones and to make judgments nearly functioning in conditions where multiple ability domains are affected (eg, serious mental illness or traumatic brain injury).6
However, it is also important to be able to make judgments about specific differential deficits across ability areas. For instance, an individual who experiences a focal stroke or brain injury may have limited cerebral deficits, with most abilities unchanged. Thus, when making a judgment about the presence of a single cognitive arrears such every bit amnesia or a broader condition such equally dementia information technology is critical to be able to identify exactly what a "differential arrears" would be. This judgment process is complicated by the fact that healthy individuals with no testify of, or risk factors for, neuropsychiatric conditions prove some variability across their abilities.7 As a issue, information technology is important to consider several dissimilar factors when identifying normal variation between ability areas from neuropsychological deficits.
There are several factors that impact on within-individual variation across cognitive ability areas. These include the reliability of the measures, the normative standards for the measures, and the level of performance of the private. Tests with less reliability produce more variable scores at both unmarried assessment and retest. The discrepancies between ability areas that tin be interpreted as truly different from each other also depend on whether the normative standards for the tests were developed in a single sample (ie, co-normed) or separately.8 For case, meaningful differences betwixt private subtests on intelligence tests such as the Wechsler Adult intelligence scales9 are smaller than differences between tests that were developed completely separately from each other, considering of their co-norming on a unmarried sample. Likewise, normative comprehensive standards for extended neuropsychological cess batteries have also been developed with the same purposes in heed.10 Finally, extremes in performance, both higher and lower, lead to greater credible discrepancies between power areas. This is because that, at the tails of the distribution, smaller absolute score differences lead to larger normative differences.
In terms of interpretation of meaningful differences betwixt abilities in neuropsychiatric conditions, a widely accepted rule of for a clinically meaningful departure betwixt two ability areas is almost one -half of a standard deviation.11 This translates into about vii IQ points and this level of difference has been shown to be detectable by observers. Specific, multiple studies have suggested that untrained observers tin detect differences in functioning that occur over time that reach this threshold. As a result, treatment studies for cognitive impairments would not need to induce treatment furnishings smaller than this, considering they might not be detectable.
It should be noted that the changes seen in many neuropsychiatric weather are much more substantial than this 0.5 SD threshold. As a clear case, data regarding immediate retentivity changes, peculiarly rapid forgetting, at the outset of Alzheimer's disease (AD) are considerably more substantial than 0.five SD. Data examining differences in performance across ability areas at the time of diagnosis has suggested memory performance about iii.0 SD below that of demographically similar healthy controls.12 Further, differential deficits between abilities at the time of diagnosis are also substantial. In that same, very big-calibration study, memory performance was about 2.0 SD below that of confrontation naming at the time of diagnosis.xiii Although subtle differences can be detected past observers every bit described in a higher place, many of the differences between abilities in neuropsychiatric conditions are not subtle.
Weather condition where neuropsychological assessment provides useful information
Situations where an illness or injury has the potential to adversely impact on cognitive functioning is one where neuropsychological assessment is indicated. These situations include illnesses or injuries that directly bear on on cognition (Degenerative dementias or traumatic encephalon injuries) or where the treatment for the illness impacts on cognitive functioning (chemotherapy for breast cancer). Finally, every bit neuropsychiatric conditions are complex, many of them accept the potential to induce changes in mood or motivational states that can have secondary impacts on cognitive operation. Every bit these secondary impacts tin crusade cognitive changes that are as just every bit existent as those caused past a encephalon injury, part of a comprehensive contemporary neuropsychological cess requires an assessment of other factors that may be contributing to impaired cognitive functioning.
Information obtained from neuropsychological assessment
In that location are several different uses for neuropsychological assessments. These include assessment for the purpose of diagnosis, differential diagnosis, prediction of functional potential, measuring handling response, and clinical correlation with imaging findings. Some of these uses are related to each other and some are impossible in certain circumstances, considering neuropsychological assessments do not provide information helpful for these tasks. These uses are presented in Table I.
Tabular array one.
Uses of neuropsychological assessment.
| • Diagnostic information for detection of dementias or other traumatic conditions |
| • Differential diagnosis of dementias vs less circuitous weather |
| • Measurement of functional potential |
| • Class of degenerative atmospheric condition |
| • Measurement of recovery of functioning |
| • Measurement of treatment response |
Diagnosis
Some weather condition are defined past the presence of cognitive damage. A prototypical example is dementia as divers past the DSM-TV-TR. xiv Dementia requires the presence of functional deficits and cognitive impairments. These impairments must be in two domains: retentivity, and one other cognitive deficit. In contrast to dementia, amnesia, also divers in DSM-TV-TR, requires merely the presence of memory deficits for its diagnosis.
For these weather condition, therefore, neuropsychological assessment would serve to provide diagnostic information, because the presence of specific or multiple cognitive deficits, including retentivity, would provide data for a diagnosis. Similarly at that place are other weather condition, such equally postconcussion syndrome where the presence of cognitive impairments of various types is required equally a role of the diagnosis. Further, mental retardation requires the presence of a certain level of current intellectual functioning that can only exist obtained psychometrically.
The way the DSM-Telly-TR is structured, however, there is no diagnosis that is confirmed simply as a part of the data obtained in a neuropsychological assessment. In the case of dementia, for instance, there are multiple additional criteria that must be met as well, and many of these pieces of information are obtained from other sources. These include history (eg, prior better levels of functioning), assessment of current adaptive deficits, and identification of a potential crusade of the condition. Every bit a result, neuropsychological assessments are only function of the diagnostic procedure.
Due to the mode the DSM-Goggle box-TR is gear up up, neuropsychological assessment does not provide information relevant to the diagnosis of most conditions where cognitive impairments are present. For example, many serious mental illnesses are marked by the presence of substantial cognitive impairments. Schizophrenia,15 bipolar disorder,16 and major low17 have substantial cognitive deficits as a common feature of their presentation, even in patients with electric current minimal levels of symptoms. Since these impairments are non function of the diagnostic criteria, neuropsychological assessment does non provide diagnostically relevant information. As noted below, however, at that place is considerable information that can be obtained from neuropsychological assessments in these conditions, particularly in functional and prognostic domains.
Differential diagnosis
There are some conditions where neuropsychological assessment can be important for differential diagnosis. As noted higher up, dementia requires memory deficits in the presence of other cognitive impairments, while amnesia is diagnosed by the presence of only deficits in memory. Detection of multiple cognitive impairments would therefore rule out the presence of amnesia and debate for a diagnosis of dementia in this case.
Differential diagnosis is much more challenging for most conditions, however. For example, studies attempting to differentiate between dementing conditions of dissimilar etiologies, such as vascular dementia as compared with Advertizing, accept establish little evidence of differential diagnostic utility from neuropsychological assessment.18 In fact, a fascinating book by Zakzanis et alnineteen that broadly approached this topic has suggested that for many atmospheric condition at that place is very little differential diagnostic information contained in a neuropsychological assessment that even allows for differentiation between healthy populations and patients with a variety of neuropsychiatric weather condition. Their meta-analysis includes all of the research published on neuropsychological test differences between healthy controls and several neuropsychiatric target populations during the years 1980-1997. As a result, there is a wealth of detail on how much information each of these neuropsychological tests provides for test-based differential diagnosis of the target populations compared with salubrious comparison subjects.
It is important in this surface area to consider the differences betwixt differential diagnosis and statistically significant differences in performance beyond different conditions. An effect size of .6 SD in the difference of two means, by convention a large effect and easy to detect in samples equally minor every bit 20 individuals per group, is associated with 62% overlap betwixt the 2 samples. In order to be able to tell with 90% certainty that an individual's test score is consistent with a psychiatric or neurological diagnosis and non part of the lower end of the distribution of salubrious, an average difference of about ii.5 SD between populations is required.
Many statistically meaning differences between samples would fare poorly as candidates for differential diagnosis. For instance, people with schizophrenia routinely accept more than significant cognitive deficits than people with bipolar disorder, regardless of the mood state of the bipolar patients.20 However, since bipolar patients themselves are more impaired in their cerebral performance than healthy people, in that location is substantial overlap in the distributions of cognitive operation between people with schizophrenia and bipolar disorder and minimal differential diagnostic information available. In contrast to the differences between people with AD and healthy populations on delayed recall memory, there is fiddling discrimination between bipolar and schizophrenia populations. The distributions of patients with severe mental illness and healthy people take substantial overlap. As can be seen in Figure 1, there is considerable overlap in the distributions of scores on neuropsychological assessments of people with schizophrenia and good for you people, even if the means of the distributions are 2 total standard deviations apart. The r-BANS21 is an abbreviated neuropsychological assessment that examines multiple ability domains in a repeatable format. It is scaled like an IQ examination, with a mean of 100 and standard difference of fifteen in healthy populations. As tin can be seen in Figure i,22 people with schizophrenia accept a mean level of performance that is 2.0 SD below that of healthy people (70 vs 100). Even so, one-half of the salubrious population is performing within ii SD of the mean of people with schizophrenia, and 35% of the people with schizophrenia perform within ii.0 SD of the hateful of the good for you population. While a score of 115 would be much more rare for someone with schizophrenia than a salubrious individual, a score of 85 would be at the 67th percentile for someone with schizophrenia and at the 17th for the healthy population; both of these are clearly within not outlying scores.
Normative information compared with a schizophrenia sample on the RBANS neuropsychological examination. RBANS, Repeatable Battery for Assessments of Neuropsychological Status
An additional intriguing result of the Zakzanis et al analyses is that many of the tests that are ofttimes described as capturing fundamental characteristics of illnesses such as schizophrenia fare relatively poorly when evaluated with differential diagnostic standards. For example, the Wisconsin Card Sorting exam/23 a multidimensional exam of executive functioning, is associated with forty% overlap betwixt the performance of patients and healthy controls. In schizophrenia, in fact, the top v discriminators, all associated with xx% or less overlap, are in the domains of verbal and visuospatial retentiveness. In the domain of chronic multiple sclerosis merely 1 test is associated with less than 25% overlap between healthy individuals and MS patients, while many of the tests are associated with about l% overlap between MS patients and good for you controls. These tests would provide substantially no data useful for differential diagnosis. There are some areas where there a number of excellent differential diagnostic candidates. In the domain of Ad in that location are xv dissimilar tests, all of retentiveness, that are associated with less than 5% overlap between salubrious controls and Advertizing samples. Similarly, the difference between schizophrenia patients and Advertizing patients on delayed remember retentiveness was found to be similar to differences between healthy controls and Ad patients.
Assessment of functional potential and the course of degenerative weather
Ane of the more robust correlations in enquiry in mental wellness is the association between cognitive operation and achievements in everyday functioning. This relationship has been appreciated for over 30 years and has been replicated across multiple neuropsychiatric atmospheric condition. Table II shows multiple examples of exactly this type of relationship. There are too several additional important points nigh these findings. These findings tend to exist near robust for global aspects of cognitive operation, every bit indexed by performance on composite measures. In fact, in i recent report in severe mental illness the predictive power of a blended score for correlation with functional deficits was 2 to three times equally great as whatsoever individual neuropsychological measure.xxx Similarly, functional deficits in AD are more severe and debilitating subsequently the affliction has progressed, and there are multiple cognitive processes affected. Although information technology is quite possible to take functional deficits originating from a unmarried residuum cognitive deficit, on average more than broad-ranging cognitive deficits, even if moderate in nature, leader to broader functional deficits. There will e'er be individual cases where a unmarried, patently delineated, cognitive deficit leads to gross impairment in functioning.
Tabular array II.
Neuropsychiatric conditions where cognitive performance predicts everyday performance.
| • Reduced cerebral impairment post TBI predicts greater potential for functional recovery25 |
| • Progression of cerebral impairment leads to functional pass up in Alzheimer's disease26 |
| • Cognitive impairments predict everyday functional deficits in people with schizophrenia27 |
| • Cognitive impairments in schizophrenia and bipolar disorders accept most identical relationships with everyday functioning28 |
| • Cerebral impairments in Parkinson's disease are associated with functional deficits consistent with dementia29 |
The most of import clinical implication of what we know about cognition and functioning is this: when individuals affected by a neuropsychiatric condition are institute to have electric current cerebral abilities congruent with pre-illness functioning they are to the lowest degree likely to have functional deficits. This is particularly true in conditions such equally HIV neuropathology31 or traumatic brain injury (TBI)32 where changes tin occur in the context of unimpaired previous functioning. Multiple studies of TBI have also accept shown that recovery of cerebral functioning predicts recovery of everyday functioning much more than efficiently than measures of the "severity" of the injury and some studies of TBI have had some success in the identification of the most efficient predictors of recovery of operation. They tend to exist from the domains of executive functioning and processing speed, only some studies as well propose that memory measures may exist important (see ref 33, p 12).
Information technology has proven hard to establish accented standards for how much damage in cognitive operation will definitely pb to functional changes. In addition, the search for specific cerebral to functional relationships has also proven challenging in conditions other than TBI. The group average information do propose some general guidance, merely clinical prediction will require analyses of specific cases. What is clear, even so, is that neuropsychological assessment is an splendid tool for the prediction of recovery.
Assessment of changes in cognition in progressive degenerative atmospheric condition requires a dissimilar approach than required for the initial diagnosis of dementia or the assessment of improvement following TBI. If delayed recall operation is at a level that is close to 0 at the time that dementia is detected, this power will not be a feature of the illness with the potential to change over time. In fact, research comparison individuals with Advertisement at different levels of illness duration (and progressive course) have suggested that there is a pattern of progression in the worsening of cognitive impairments, with delayed think nearly completely absent at the fourth dimension of diagnosis, with other changes occurring in close temporal proximity, including reductions in rate of learning, executive operation, and processing speed. Later in the course, changes in longterm retentiveness such as confrontation naming are detected and spatial and perceptual deficits become more than severe.12-13 These changes are not necessarily compatible or anticipated for individual cases and many individuals volition manifest impairments in one ability area that are more severe than expected by their electric current stage of illness. What is clear from research, however, is that in individuals with Advert and considerable cognitive impairments, functional performance tends to worsen quite markedly.
Measurement of recovery of functioning and treatment response
There is major interest in treatment of cognitive deficits in degenerative weather, attention-arrears disorder, and severe mental illness. These approaches have ranged from in person and computerized cerebral remediation efforts to multiple pharmacological interventions. Information technology makes sense that the aforementioned measures of cerebral functioning used to place functionally relevant deficits across unlike neuropsychiatric weather condition would be used to measure handling outcomes. This arroyo has been used in multiple dissimilar studies, although at that place are some issues that require attention in interpreting the results of the studies. These include changes in functioning that are due to random variation and practice furnishings and the fact that certain cognitive measures are more than vulnerable to these effects than others, limiting their utility every bit outcome measures. I of the things that will render neuropsychological assessment consistently important is the new evolution of rehabilitation therapies. Development and marketing of computerized cognitive remediation interventions has not always been accompanied by the systematic assessment of their efficacy and long-term usefulness. It seems likely the operation on structured neuropsychological measures will continue to be the gilt standard for choice of patients for these interventions and evaluation of their efficacy.
One of the strategies that has been developed to understand "existent" cognitive improvements vs psychometric artifacts is the "reliable change index (RCI)" method.34 The RCI adjusts for expected practise effects and unreliability of measures in society to develop an index of change on an private basis that would be definitely non-random. Substantially, a statistic is calculated that takes test scores at two unlike times and examines the difference between them, establishing a range of scores that could be attributed to practice furnishings or unreliability of measures. Differences that exceed this range are and so considered to be reliable. Thus, measures with greater test-retest reliability and smaller exercise effects in good for you controls would be ameliorate candidates for detection of small amounts of change that would still be clinically meaningful. Previous results in severe mental affliction have suggested that changes in typically administered cognitive cess batteries would need to exist in the vicinity of one.035-36 standard deviations on the part of an private patient to be nonrandom, suggesting that quite substantial improvements may exist required with electric current instrumentation.
Reduction, or at to the lowest degree the clear recognition, of practice furnishings is an important goal, because big do effects in treatment studies on the part of the patients in the inactive treatment group can brand it incommunicable to detect modify in the treatment group.37 Certain measures are especially vulnerable to such effects, and some of them may really modify in their characteristics upon repeated administration. Episodic memory tests are specially vulnerable to practice effects, because of the possibility of learning of the content. However, information technology is critical to have alternating forms of such measures be closely equivalent, because if the alternating forms are different in their difficulty, an apparently improvement effect can be spuriously detected. Problem-solving tests are quite vulnerable to changes with retesting, considering if there is simply 1 problem, like in the widely used Wisconsin Card Sorting Examination, once it is solved the test is no longer a problem-solving examination. As a event, systematic efforts to develop problem-solving tests with similarly problems (like mazes) merely with culling stimuli take been conducted.
One of the major issues in using neuropsychological assessment as a sole result mensurate to measure either spontaneous recovery or treatment response is the lack of definitive information as to how much change is required to be important. In a sense, this is the converse of how much worsening due to disease or injury is pregnant, because both are equally difficult to define without additional reference points. For an adequately powered randomized trial, separation of active treatment from inactive treatment is certainly one standard; one that volition be applied by regulatory agencies. Another perspective is the empirically derived standard described higher up a ½ standard deviation improvement every bit having clinical meaning. A third strategy, which is optimal in certain circumstances where information technology tin can exist practical, is that of using concurrent assessment of functional outcomes. Every bit improvement in performance is the goal of treatment of knowledge, whenever possible improvements in functioning occur, accompanying cognitive improvements should be measured.
For instance, in a study of cognitive remediation in schizophrenia published a few years agone, the level of comeback in neuropsychological test functioning on the part of patients was less than 0.5 SD compared with the inactive handling group.38 However, the patients who received cognitive remediation were able to work much more finer and earned more 10 times as much money in the ensuing three-year follow-upward period compared with patients randomized to the inactive treatment.39 Thus, the cerebral improvement seen must accept been adequate for some patients, in gild for them to achieve such substantial functional gains.
The above study is dissimilar from many other studies because of its duration and because of the fact that patients who entered were all receiving a psychosocial intervention: supported employment. Such concurrent interventions have been shown to be a prerequisite for functional gains in cognitive remediation studies in severe mental affliction.40 In studies where treatments are offered for briefer periods, such as pharmacological efficacy studies, or in cases where patients are not receiving concurrent psychosocial interventions, such outcome measures would not be practical. A suggested arroyo has been to use functioning-based measures of functional capacity,41 which accept shown considerable validity in terms of prediction of everyday outcomes and sensitivity to functional decline in very elderly patients with astringent mental affliction. These measures, because they capture ability and not everyday outcomes, do not require environmental opportunities to perform skills and have been shown to be sensitive to the furnishings of short-term behavioral interventions.
Clinical correlation
Amidst the exciting developments in medical technology has been the appearance of high-resolution structural and functioning imaging of the brain. These techniques permit for highly precise examination of lesions associated with TBI and stroke, They also tin can identify potentially dangerous vascular abnormalities which may be repaired earlier catastrophic ruptures. Also possible is the visualization of previous "silent" ischemic changes, strokes, and other potential lesions. With the appearance of ligands that can label amyloid;42 information technology will as well probable exist the case that many individuals will be informed that they take substantial potential to experience degenerative changes. A major question that arises after detection of any such a brain change is whether at that place is whatever functional importance of these changes. Given the consistent findings that cortical degenerative changes are oft institute at postmortem in individuals who had no observational bear witness of deteriorated cognitive functioning during life,43 in that location volition be considerable need to perform cerebral assessments post-obit such scans. Similarly, serial neuropsychological cess will likely provide ameliorate (and cheaper) information about changes in cognitive operation than repeated scans.
Conclusions
Neuropsychological assessment has multiple clinical applications, ranging from collecting diagnostic data for dementia to predicting functionality and recovery from TBI. These assessments are non likely to be replaced by technology, because of the issues, reviewed immediately in a higher place, regarding the lack of articulate prediction of noesis and performance from cortical changes in late life. Neuropsychological testing does not provide differential diagnostic information for neuropsychiatric disorders, but it provides information that cannot be obtained anywhere else on abilities, motivation, and potential for future outcomes. There are probable to be new advances in assessment technology, but non assessment philosophy, over time, These improvements may include validly deliverable remote assessments and increased ease of administration of cess tools. At this time, neuropsychological cess has many uses and adds critical information to psychological, neurological, and neuroimaging assessments.
Acknowledgments
Dr Harvey has received consulting fees from Abbott Labs, Bristol Myers Squibb, En Vivo, Genentech, Johnson and Johnson, Merck and Visitor, Pharma Neuro Boost, Sunovion Pharma, and Takeda Pharma during the past year.
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3341654/
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