missing the proper reconstruction of a block design
task or for pushing the blocks off the examiner’s
table in anger is likely to be significant for the
patient’s ultimate diagnosis. Although the point
value obtained (zero) is the same in both cases, con-
sideration and analysis of the quality or nature of
the patient’s response help the neuropsychologist
in her or his case conceptualization.
Neurodiagnostic ProceduresBy now, it may have occurred to the reader that the
medical field already has a variety ofneurodiagnostic
procedures. They include the traditional neurological
examination performed by the neurologist, spinal
taps, X-rays, electroencephalograms (EEGs), com-
puterized axial tomography (CAT) scans, positron
emission tomography (PET) scans, and the more
recent nuclear magnetic resonance imaging (NMR
or MRI) technique. These are indeed valuable
means for locating the presence of damage and dis-
ease. But not all of these procedures work equally
well in diagnosing impairment. Likewise, these tech-
niques sometimes produce evidence of abnormalities
in the absence of actual brain damage. Finally, some
of these procedures pose risks for the patient. Spinal
taps can be painful and sometimes harmful; we all
know about the dangers of too many X-rays.
Still, the neurologist’s diagnostic procedures
search directly for evidence of brain damage. In addi-
tion to these standard forms of neurodiagnostic pro-
cedure, several other imaging methods are available
that provide a better sense of the“working”brain
(Zillmer et al., 2008). Single photon emission com-
puted tomography (SPECT) imaging is based on
cerebral blood flow, and this provides a“picture”
of how the brain is working. As another example,
functional MR imaging (fMRI) also assesses blood
flow changes in the brain. Both of these newer alter-
native neurodiagnostic procedures hold some prom-
ise in clinical neuropsychology because they are
perhaps more likely to provide information on
how different areas of the brain are working.
Many of these neurodiagnostic procedures are
quite expensive, and some are invasive. Therefore,
it may be helpful to use neuropsychological tests as
screening measures, the results of which may indicate
whether more expensive neurodiagnostic tests are
indicated. Next, we consider some specific neuro-
psychological assessment devices and batteries.Testing Areas of Cognitive
Functioning
Many tests are available for assessing a wide range of
cognitive and behavioral functioning. In this sec-
tion, we discuss only a handful of the areas of func-
tioning assessed by neuropsychologists. Further,
because of space constraints (entire books on neuro-
psychological assessment are available), we only
give a few tests as examples.Intellectual Functioning. A number of tech-
niques have been used over the years to assess levels
of intellectual functioning. To estimate level of
intellectual ability, many neuropsychologists use the
WAIS-IV (see Chapter 7) and subtests from a mod-
ified version of the WAIS-R, called the WAIS-
R-NI (Kaplan, Fine, Morris, & Delis, 1991). The
modifications include, for example, changes in
administration (e.g., allowing the patient to con-
tinue on a subtest despite consecutive incorrect
answers) and additional subtest items. Because of
these modifications, it is believed that the WAIS-
R-NI provides more information regarding the
patient’s cognitive strategies (Anderson, 1994).
If it is not possible to administer the entire
WAIS-IV, certain individual subtests may be used—
most commonly, the Information subtest, Compre-
hension subtest, and Vocabulary subtest. These
subtests are believed to be least affected by brain
trauma or injury and thus can also provide estimates
of premorbid intelligence. This is important
because often no preinjury test data are available to
serve as a baseline against which to compare present
functioning.Abstract Reasoning. For many years, clinicians
observed that patients diagnosed with schizophrenia
or those deemed cognitively impaired seemed to
find it difficult to think in an abstract or conceptual
fashion. Such patients seemed to approach tasks in a524 CHAPTER 18