Neuropsychological Assessment

2389 Pages·2012·24.89 MB·English

by  Muriel Deutsch Lezak

Neuropsychological Assessment
NEUROPSYCHOLOGICAL
ASSESSMENT
Fifth Edition
Muriel Deutsch Lezak
Diane B. Howieson
Erin D. Bigler
Daniel Tranel
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Library of Congress Cataloging-in-Publication Data
Neuropsychological assessment / Muriel D. Lezak … [et al.]. — 5th ed.
p. cm.
Includes bibliographical references and index.
ISBN 978–0–19–539552–5
1. Neuropsychological tests. I. Lezak, Muriel Deutsch.
RC386.6.N48L49 2012
616.8’0475—dc23
2011022190
Dedicated in gratitude for the loving support from our spouses, John Howieson,
Jan Bigler, and Natalie Denburg; and in memory of Sidney Lezak whose love
and encouragement made this work possible.
Preface
Direct observation of the fully integrated functioning of living human brains will probably always
be impossible.
M.D. Lezak, 1983, p. 15
What did we know of possibilities, just a little more than a quarter of a century
ago? The “black box” of
classical psychology is no longer impenetrable as creative neuroscientists
with ever more revealing neuroimaging techniques are devising new and
powerful ways of finding windows into the black box. In neuroimaging we can
now trace neural pathways, relate cortical areas to aspects of thinking and
feeling—even “see” free association in the “default” state—and are discovering
how all this is activated and integrated in complex, reactive, and interactive
neural systems. We may yet uncover the nature of (self-and other-)
consciousness and how synaptic interconnections, the juices that flow from
them, and the myriad other ongoing interactive neural processes get translated
into the experience of experiencing. We can never again say “never” in
neuroscience.
Yet, as entrancing and even astonishing as are the findings the new
technologies bring to neuroscience, it is important to be mindful of their roots in
human observations. As these technologically enhanced observations of the
brain at work open the way for new insights about brain function and its
behavioral correlates they also confirm, over and over again, the foundational
hypotheses of neuropsychology—hypotheses generated from direct observations
by neuropsychologists and neurologists who studied and compared the behavior
of both normal and brain impaired persons. These foundational hypotheses guide
practitioners in the clinical neurosciences today, whether observations come
from a clinician’s eyes and ears or a machine. In the clinic, observations of brain
function by technological devices enhance understanding of behavioral data and
sometimes aid in prediction, but cannot substitute for clinical observations.
When the earliest neuroimaging techniques became available, some thought
that neuropsychologists would no longer be needed as it had become
unnecessary to improve the odds of guessing a lesion site, a once important task
for neuropsychologists. Today’s advanced neuroimaging techniques make it
possible to predict with a reasonable degree of accuracy remarkably subtle
manifestations, such as the differences between socially isolated brain injured
patients who will have difficulty in social interactions although actively seeking
them, versus those who may be socially skilled but lack incentive to socialize.
Yet this new level of prediction, rather than substituting for human observation
and human intervention, only raises more questions for experienced clinical
neuroscientists: e.g., what circumstances exacerbate or alleviate the problem?
what compensatory abilities are available to the patient? is the patient aware of
the problem and, if so, can this awareness be used constructively? is this a
problem that affects employability and, if so, how? and so on. Data generated by
new neurotechnologies may help identify potential problem areas:
neuropsychologists can find out how these problems may play out in real life, in
human terms, and what can be done about them.
Thus, in the fifth incarnation of Neuropsychological Assessment, we have
tried to provide a wide-ranging report on neuropsychology as science and as a
clinical specialty that is as relevant today as it was when it first appeared 35
years ago. Certainly what is relevant in 2012 is somewhat different from 1976 as
the scope of activities and responsibilities of neuropsychologists has enlarged
and the knowledge base necessary for clinical practice as well as for research has
expanded exponentially.
Three major additions distinguish the first and the fifth editions of
Neuropsychological Assessment. Most obvious to the experienced
neuropsychologist is the proliferation of tests and the wealth of readily available
substantiating data. Second, a book such as this must provide practically useful
information for neuropsychologists about the generations—yes, generations—of
neuroimaging techniques that have evolved in the past 30 years. Further,
especially exciting and satisfying is confirmation of what once was suspected
about the neural organization underlying brain functions thanks to the marriage
of sensitive, focused, clinical observations with sensitive, focused, neuroimaging
data. In this edition we convey what is known about the enormity of interwoven,
interactive, and interdependent complexities of neuronal processing as the brain
goes about its business and how this relates to our human strengths and frailties.
What remains the same in 2012 as it was in 1976 is the responsibility of
clinicians to treat their patients as individuals, to value their individuality, and to
respect them. Ultimately, our understandings about human behavior and its
neural underpinnings come from thoughtful and respectful observations of our
patients, knowledge of their histories, and information about how they are living
their lives.
Muriel Deutsch Lezak
Diane B. Howieson
Erin D. Bigler
Daniel Tranel
Acknowledgments
Once again we want to honor our neuropsychologist friends, colleagues, and
mentors who have died in the past few years. Most of what is written in this text
and much of contemporary neuropsychology as science or clinical profession,
relies on their contributions to neuropsychology, whether directly, or indirectly
through their students and colleagues. We are deeply grateful for the insightful,
innovative, integrative, and helpfully practical work of William W. Beatty, Edith
F. Kaplan, John C. Marshall, Paul Satz, Esther Strauss, and Tom Tombaugh. The
authors gratefully acknowledge Tracy Abildskov in creating the various
neuroimaging illustrations, Jo Ann Petrie’s editing, and Aubrey Scott’s artwork.
Many of David W Loring’s important contributions to the fourth edition of
Neuropsychological Assessment enrich this edition as well. We miss his hand in
this edition but are grateful to have what he gave us. And thanks, too, to Julia
Hannay for some invaluable chapter sections retained from the fourth edition.
Special thanks go to Kenneth Manzell for his aid in preparing the manuscript
and illustrations. We are fortunate to have many colleagues and friends in
neuropsychology who—at work or in meetings—have stimulated our thinking
and made available their work, their knowledge, and their expertise. The
ongoing 2nd Wedns. Neuropsychology Case Conference in Portland continues to
be an open-door free-for-all and you are invited.
It has been a pleasure to work with our new editor, Joan Bossert, who has not
only been encouraging and supportive, but has helped us through some technical
hoops and taught us about e-publishing. Tracy O’Hara, Development Editor, has
done the heroic task of organizing the production idiosyncrasies of four writers
into a cohesive manuscript while helping with some much needed data
acquisition. Book production has been carefully timed and managed by Sr.
Production Editor Susan Lee who makes house calls. Thanks, OUP team, for
making this book possible. Last to get involved but far from least, our gratitude
goes out to Eugenia Cooper Potter, best known as Genia, whose thorough
scouring and polishing of text and references greatly helped bring this book to
life.
Contents
List of Figures
List of Tables
I THEORY AND PRACTICE OF
NEUROPSYCHOLOGICAL ASSESSMENT
1. The Practice of Neuropsychological Assessment
Examination purposes
The multipurpose examination
The Validity of Neuropsychological Assessment
What Can We Expect of Neuropsychological Assessment in the
21st Century?
2. Basic Concepts
Examining the Brain
Laboratory Techniques for Assessing Brain Function
Neuropsychology’s Conceptual Evolution
Concerning Terminology
Dimensions of Behavior
Cognitive Functions
Neuropsychology and the Concept of Intelligence: Brain Function Is Too
Complex To Be Communicated in a Single Score
Classes of Cognitive Functions
Receptive Functions
Memory
Expressive Functions
Thinking
Mental Activity Variables
Executive Functions