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Neuropsychology is the subspecialty of psychology that studies brain-behavior relationships. Neuropsychology is a diverse field that includes experimental neuropsychology, the study of brain-behavior relationships in nonhumans; cognitive neuropsychology, the study of normal cognition in humans; behavioral neuropsychology, which is the blending of behavioral theory and neuropsychological principles; and clinical neuropsychology, the study of brain-behavior relationships in humans. When physicians request neuropsychological testing for a patient, a clinical neuropsychologist will likely provide the assessment.

In most states, clinical neuropsychologists are licensed as clinical psychologists and have specialized training (both pre- and postdoctoral) in neuropsychology. The major role of clinical neuropsychologists is the assessment of cognitive function in individuals with known or suspected brain damage. Cognitive functions may be conceptualized as those processes by which an individual perceives both external and internal stimuli; selects pertinent stimuli and inhibits nonpertinent stimuli; records, retains, and recalls information; forms associations between stimuli and manipulates information in the pursuit of a goal; and outputs information through the expression of overt behavior. Clinical neuropsychology is based on the premise that assessments of these overt behaviors provide information about the functional integrity of the central nervous system.

The development of the science of neuropsychology is found in the works of Gall, [1 Broca,y James,y Watson,[4 Lashley,y Goldstein,y Halstead,y and Luria.y Early theories of the relationship between neurologic functioning and cognition proposed independent modules of function, demonstrated most clearly by the phrenologist Gall. According to this theory, specific brain regions, reflected by bumps on the skull, were associated with specific behavior. Watson's contributions to psychology in general, and neuropsychology specifically, led to an increased sensitivity to the need for empirical data to support theories of cognitive function, and the application of the scientific method to psychological studies. The work of Lashley and Goldstein led to a better understanding of the relationship between brain localization and behavior in neurologically healthy and neurologically damaged individuals. Halstead and Luria, through differing methods, clearly demonstrated that the assessment of overt behaviors could be used to identify brain damage with accuracy.

Although current understanding of the relationship between neuroanatomical structures and behavior rejects the skull-based tenets of phrenology, discovery of the neuroanatomical substrates of cognitive function remains a major goal of neuropsychology. It is hypothesized that cognitive function depends on both localized areas of specific functions as well as recursive connections between multiple brain areas that contribute, in toto, to cognition. In order to understand such a complex system, neuropsychology is a composite field of study integrating various disciplines including psychology, neurology, clinical neurosciences, psychiatry, statistics, and physiology.

The role of clinical neuropsychology is to elucidate the effects of brain damage on behavior, and to be able to account for the influences of other factors such as genetic, developmental, emotional, and experiential contributions on cognitive functioning. In order to accomplish this goal, neuropsychologists assess patients' cognitive function using behavioral tests. Two main approaches to neuropsychological assessment are typically used by clinicians: the quantitative approach, typified by standardized assessment techniques and comparison of individual performance measures against normative expectations, and the qualitative approach typified by in-depth analysis of individual performance characteristics using relatively standardized measures to elicit pathognomonic signs. Although these two approaches developed semi-independently, current practices

in clinical neuropsychology incorporate aspects of both. y Not only do neuropsychologists use both quantitative and qualitative approaches to testing, they also test cognitive function in a multidimensional manner. For example, the assessment of verbal memory, a form of cognition, may be assessed by simply asking patients to remember a list of words. This approach to testing is inadequate by itself, however, since verbal memory is more complex than simply remembering lists of words. Therefore, assessment of verbal memory entails testing memory for lists of words, pairs of words, sentences, and short stories, using both immediate recall, delayed recall, and recognition paradigms. Such an assessment strategy provides enough data to fully analyze specific deficits in cognitive abilities that may be shared by multiple processes and allows for a finer discrimination of abilities and impairments.

The complexity and depth of knowledge about brain- behavior relationships are reflected in the vast number of volumes devoted to their description. This chapter provides an overview of adult clinical neuropsychology with the aim of assisting practitioners with the use and interpretation of neuropsychological data.

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