Clinical neuropsychology deals with cognitive dysfunctions (involving memory, language, attention, perception…) and behavioral issues resulting from Central Nervous System (CNS) disorders, whether innate or acquired.
It utilizes specific psychometric tests calibrated and standardized on a reference population to reveal an individual’s mental functioning profile, both in terms of potential deficits and intact cognitive abilities. The aim is to provide a quantitative measure of different cognitive capacities and to verify the possible presence of behavioral disorders associated with neurological damage.
The objective and quantitative nature of the data obtained allows for:
- determining the actual extent of mental deficit with greater precision
- predicting its impact on the individual’s daily life and their family and social network.
Neuropsychological assessment also holds value in expert evaluations for certifying cognitive damages resulting from situations such as burnout, road accidents, and for driver’s license renewal when specifically requested by the appointed Commission.
The neuropsychologist is also responsible for drafting and implementing a specific cognitive rehabilitation/reactivation program for each individual.
Who it is for
Neuropsychological assessment is conducted on a wide range of neurological disorders. The main areas of intervention relate to:
- dementia-causing disorders
- demyelinating diseases
- epilepsy
- neoplasms
- head traumas
- cerebrovascular diseases
Dementia-causing disorders are CNS alterations that progressively worsen over time. Dementia is the loss of intellectual functions (thinking, remembering, reasoning) severe enough to interfere with an individual’s daily life activities. It is not a disease, but rather a set of symptoms that may accompany certain illnesses or physical conditions. The cause and degree of progression of dementias can vary.
Among the main forms are:
- Vascular dementias (any form of dementia resulting from cerebral vascular damage on an ischemic and/or hemorrhagic and/or hypoxic basis), whose clinical manifestation initially depends strictly on the specific cerebral districts involved. Subsequently, following multiple cerebral infarctions, it can globally involve all brain functions, becoming indistinguishable from Alzheimer’s Disease;
- Alzheimer’s Disease, which is currently the most common cause of dementia, affecting between 50 and 70% of people with cognitive decline. It is a cerebral degenerative process that causes a progressive and global decline in intellectual functions, associated with a deterioration of personality and relational life. Progressively, the patient loses autonomy in performing daily life activities and becomes completely dependent on others;
- Mild Cognitive Impairment, a more recently introduced diagnostic category, which indicates the intermediate phase between full mental efficiency and Alzheimer’s disease, essentially comprising those subjects who manifest an isolated memory disorder in the presence of an otherwise intact cognitive-behavioral framework;
- Frontotemporal Dementias, a very varied group of forms of cognitive decline that occur at an earlier age than Alzheimer’s and involve areas responsible for behavior regulation, in some cases causing severe and marked changes in personality, thought, and language;
- Parkinson’s Disease, a disorder often characterized by tremors, stiffness in limbs and joints, difficulty in speech and initiating physical movements. During the course of the disease, some patients develop dementia and sometimes Alzheimer’s disease.
Demyelinating diseases are characterized by a process in which the myelin (the sheath covering the fibers that conduct nerve signals) of the central or peripheral nervous system undergoes destruction (or “demyelination”), resulting in slowing of nerve impulses and thus the appearance of numerous neurological symptoms. These diseases can be acquired or hereditary.
Multiple sclerosis (MS) represents the most frequent acquired demyelinating disease of the CNS, with onset age mainly between 20 and 40 years, although numerous cases of onset in early childhood are now known.
It is called “sclerosis” because scars form in the damaged areas and “multiple” because the process affects the CNS in different parts and at different times; it is also called Demyelinating Disease, Plaque Sclerosis, or Neurasthenia. From a cognitive point of view, adults affected by MS present alterations in attentive competencies, with difficulties in rapid information processing, inattention and early mental exhaustibility, rigidity in unusual thought processes, slowness in learning with the need for more time to obtain good performance.
Epilepsy is a neurological syndrome characterized by sudden seizures. These are caused by hyperactivity of brain nerve cells (neurons), followed by a period of complete inactivity. Paradoxically, there is excessive functional activity of the nervous system where some or all neurons of the cerebral cortex begin to activate at a much higher rate than normal, producing a discharge. Epilepsy affects between 0.6 and 1% of the population (it is estimated that in Italy there are between 350,000 and 500,000 people affected by epilepsy) and can manifest at any age and in very different forms.
Given its variety, we generally speak of epilepsies, and it is therefore important, in classifying them, to take into account their cause and distinguish between symptomatic ones, which manifest during other morbid states, and idiopathic forms, whose origin is unknown. In a good number of cases, the cause of epilepsy cannot be found, and it is therefore defined as cryptogenic.
The cognitive profiles of epileptic patients are very heterogeneous, as are the epileptic syndromes themselves: the causes, topography of epileptogenic areas, pathogenetic mechanisms, and natural history determine specific cognitive functioning profiles.
Similarly, the major effects on the cognitive side are generally associated with early onset, long duration, and low pharmacological control. In particular, chronic forms generally have a greater impact on cognition, but at the same time induce processes of functional reorganization and compensatory behavioral mechanisms. In most idiopathic epilepsies, cognitive functioning is only slightly affected or even normal.
Symptomatic or cryptogenic epilepsies of focal genesis generally produce focal deficits that reflect the functioning of the respective affected areas.
Neoplasms are tumor pathologies in which some cells grow and multiply in an uncontrolled manner and apparently independently of physiological cell control mechanisms. The resulting mass occupies space and can thus interfere with normal brain activity. The brain tumor can increase intracranial pressure, invade or damage healthy nerves and tissues.
The anatomical location of the tumor influences the symptomatology, and this is due to the fact that different brain areas control different functions: it will be the neuropsychologist’s task, therefore, to perform a battery of tests aimed at studying both the affected and healthy areas, with the aim of drawing up a psychometric functioning profile that is as articulated as possible.
Head traumas (for example, after a road accident) are the most common cause of brain damage in younger subjects. Hence, the importance of assessing the severity of cognitive disorders arising as a consequence of such a traumatic event: cognitive and behavioral disorders, in fact, influence psychosocial adaptation and can have a serious impact on the patient’s daily life, much more than physical ones.
Usually, the abilities most involved are behavioral ones (since in some cases there are also severe and serious mutations of the pre-morbid character), as well as those of an attentive type and affecting abstract thinking and reasoning abilities (which are located in frontal areas particularly stressed in the physical dynamics of the trauma itself). Similarly, there may be alterations in memory for recent events, often secondary to attention and concentration disorders. Patients with head trauma, given their often young age and the non-assumed worsening of the underlying neurological picture, lend themselves to being the best candidates for cognitive rehabilitation paths.
Patients affected by cerebrovascular diseases (ischemic or hemorrhagic strokes) may present, depending on the CNS district involved and the hemisphere affected, peculiar linguistic alterations of various types (production, comprehension, repetition, or all of the above) or deterioration in the representation of space and one’s own body (neglect).
How a neuropsychological assessment is conducted
The neuropsychological assessment takes place in one or more meetings, depending on the specific needs of the subject, and is articulated in:
an initial moment of collecting anamnestic information, with a family member and/or with the user themselves, relating both to the type of difficulties that have arisen in daily life (e.g., memory, attention, language…) and to pre-morbid mental functioning.
testing with the individual user, which involves the administration of a battery of psychometric tests, both first and second level, with the aim of describing and objectifying the individual’s current cognitive functioning profile. Through this approach, the possible impairment of cognitive functionality present in acute/chronic brain lesions is evaluated and useful data are collected to formulate a differential diagnosis, such as between depressive pseudo-dementia and chronic-progressive cognitive decline.
Once the psychometric evaluation is concluded, after a few days there follows a subsequent phase of clinical feedback aimed both at providing the user and family member with a picture of intact and dysfunctional cognitive skills, and at proposing a possible rehabilitation intervention plan.
It should be emphasized that cognitive rehabilitation does not aim to restore the patient’s full mental efficiency that existed in the past, but rather aims to optimize residual cognitive potential, provide compensation strategies, strengthen weaker mental processes through specific stimulation, or, in cases of subjects with chronic-progressive dementia-causing pathologies, it is aimed at soliciting and enhancing residual memory skills.
Cognitive rehabilitation/reactivation meetings have a weekly or bi-weekly frequency, depending on the work plan drawn up with the user and family members, the severity of the condition, and the shared objectives.
Who it is for
- Adults
- Elderly
- Family members
