Clinical neuropsychology

Clinical Neuropsychology:

A Practical Guide to

Assessment and Management

for Clinicians

Edited by

Laura H. Goldstein

Department of Psychology, Institute of Psychiatry and

The Lishman Unit, Maudsley Hospital, London, UK

and

Jane E. McNeil

Department of Psychology, Institute of Psychiatry and

Regional Neurological Rehabilitation Unit, Homerton Hospital, London, UK

Clinical Neuropsychology

Clinical Neuropsychology:

A Practical Guide to

Assessment and Management

for Clinicians

Edited by

Laura H. Goldstein

Department of Psychology, Institute of Psychiatry and

The Lishman Unit, Maudsley Hospital, London, UK

and

Jane E. McNeil

Department of Psychology, Institute of Psychiatry and

Regional Neurological Rehabilitation Unit, Homerton Hospital, London, UK

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Library of Congress Cataloging-in-Publication Data

Clinical neuropsychology : a practical guide to assessment and

management for clinicians / edited by Laura H. Goldstein and Jane E. McNeil.

p. cm.

Includes bibliographical references and index.

ISBN 0-470-85401-4 (Cloth) – ISBN 0-470-84391-8 (Paper : alk. paper)

1. Clinical neuropsychology. I. Goldstein, Laura H. (Laura Hilary), 1960–

II. McNeil, Jane

RC386.6.N48C52725 2003

616.89 – dc21 2003007939

British Library Cataloguing in Publication Data

A catalogue record for this book is available from the British Library

ISBN 0-470-85401-4 (hbk)

ISBN 0-470-84391-8 (pbk)

Project management by Originator, Gt Yarmouth, Norfolk (typeset in 10/12pt Times)

Printed and bound in Great Britain by TJ International Ltd, Padstow, Cornwall

This book is printed on acid-free paper responsibly manufactured from sustainable forestry

in which at least two trees are planted for each one used for paper production.

Contents

About the Editors vii

List of Contributors ix

Preface xi

Part I General Introduction 1

Chapter 1 General Introduction: What Is the Relevance of

Neuropsychology for Clinical Psychology Practice?

Laura H. Goldstein and Jane E. McNeil

3

Part II Neuroscience Background 21

Chapter 2 Neuroanatomy and Neuropathology

Nigel J. Cairns

23

Chapter 3 Neurological Investigations

John D. C. Mellers

57

Part III Neuropsychological Assessment—General Issues 79

Chapter 4 Psychological and Psychiatric Aspects of Brain Disorder:

Nature, Assessment and Implications for Clinical

Neuropsychology

Richard Brown

81

Chapter 5 The Effects of Medication and Other Substances on Cognitive

Functioning

Jane Powell

99

Chapter 6 Psychometric Foundations of Neuropsychological Assessment

John R. Crawford

121

vi CONTENTS

Part IV Adult Neuropsychology 141

Chapter 7 Disorders of Memory 143

Jonathan J. Evans

Chapter 8 Disorders of Language and Communication 165

Pat McKenna

Chapter 9 Executive Dysfunction 185

Paul W. Burgess and Nick Alderman

Chapter 10 Disorders of Voluntary Movement 211

Laura H. Goldstein

Chapter 11 Visuospatial and Attentional Disorders 229

Tom Manly and Jason B. Mattingley

Chapter 12 Disorders of Number Processing and Calculation 253

Jane E. McNeil

Part V Neuropsychology: Specialist Areas of Work 273

Chapter 13 Clinical Neuropsychological Assessment of Children 275

Judith A. Middleton

Chapter 14 Neuropsychology of Older Adults 301

Robin G. Morris

Chapter 15 Neuropsychology and the Law 319

Graham E. Powell

Part VI Rehabilitation 343

Chapter 16 Theoretical Approaches to Cognitive Rehabilitation 345

Barbara A. Wilson

Chapter 17 Planning, Delivering and Evaluating Services 367

Camilla Herbert

Chapter 18 Interventions for Psychological Problems after Brain Injury 385

Andy Tyerman and Nigel S. King

Chapter 19 Neurorehabilitation Strategies for People with 405

Neurodegenerative Conditions

Esme Moniz-Cook and Jennifer Rusted

Index 421

About the Editors

Dr Laura H. Goldstein is Reader in Neuropsychology at the Institute of Psychiatry

and Honorary Consultant Clinical Psychologist at the Maudsley Hospital. Here she

has provided the clinical neuropsychology service to the Neuropsychiatry Unit at the

Lishman Unit for over 15 years. For some of that time she also either worked in the

epilepsy surgery programme at the Maudsley Hospital, or was attached to a regional

neurology service. She is actively involved in pre- and post-qualification training of

clinical psychologists. She devised and still runs the PG Diploma in Clinical

Neuropsychology at the Institute of Psychiatry and has been involved in the devel￾opments in post-qualification training in clinical neuropsychology being planned by

the British Psychological Society. She is actively involved in neuropsychological and

other clinical research and has published widely, in areas including motor neurone

disease, epilepsy and dissociative seizures, synaesthesia, bipolar disorder and

dyspraxia, holding a number of research grants including from the Medical

Research Council and Motor Neurone Disease Association.

After gaining clinical experience with a wide range of psychiatric conditions and

receiving a clinical qualification from the Institute of Psychiatry, Dr Jane E.

McNeil took up a position at the National Hospital for Neurology and Neurosur￾gery in London, where she specialized in the neuropsychological assessment of a

wide range of neurological disorders. Subsequently, Dr McNeil became interested in

the practical and treatment applications of theoretical Neuropsychology and moved

first to Queen Elizabeth’s Military Hospital, during this time publishing studies of

confabulation and acquired disorders of calculation, and then to the Homerton

University Hospital in London, where she has worked for the last eight years

providing a specialist neuropsychological rehabilitation service to patients with

single incident neurological disorders. She studied for her PhD on dyscalculia at

the University of London under Professors E. K. Warrington and Robin Morris.

She also currently works as a clinical lecturer in neuropsychological rehabilitation at

the Institute of Psychiatry and teaches on the PG Diploma in Clinical Neuropsy￾chology and the Doctorate in Clinical Psychology. Most recently Dr McNeil has

been investigating the efficiency of outcome measures after brain injury and continu￾ing investigations into dyscalculia.

List of Contributors

Dr Nick Alderman, Consultant Clinical Psychologist, Kemsley National Brain Injury

Rehabilitation Centre, St Andrew’s Hospital, Northampton NN1 5DG, UK

Dr Richard Brown, Reader in Cognitive Neuroscience, Department of Psychology,

PO77, The Henry Wellcome Building, Institute of Psychiatry, De Crespigny Park,

London SE5 8AF, UK

Dr Paul W. Burgess, Reader in Cognitive Neuroscience, UCL Institute of Cognitive

Neuroscience, Alexandra House, 17 Queen Square, London WC1N 3AR, UK

Dr Nigel J. Cairns, Center for Neurodegenerative Disease Research, University of

Pennsylvania School of Medicine, 3600 Spruce Street, Philadelphia, PA 19104-4283,

USA

Professor John R. Crawford, Department of Psychology, King’s College, University of

Aberdeen, Aberdeen AB24 2UB, UK

Dr Jonathan J. Evans, Associate Director of Research and Consultant Clinical

Psychologist, Oliver Zangwill Centre for Neuropsychological Rehabilitation, Princess

of Wales Hospital, Lynn Road, Ely, Cambs CB6 1DN, UK

Dr Laura H. Goldstein, Reader in Neuropsychology, Department of Psychology,

PO77, The Henry Wellcome Building, Institute of Psychiatry, De Crespigny Park,

London SE5 8AF, UK

Dr Camilla Herbert, Consultant Clinical Psychologist, Brain Injury Rehabilitation

Trust, Market Place, Burgess Hill, West Sussex RH15 9NP, UK

Dr Nigel S. King, Consultant Clinical Psychologist, Community Head Injury Service,

Bedgrove Health Centre, Jansel Square, Aylesbury, Bucks HP21 7ET, UK

Dr Pat McKenna, Consultant Neuropsychologist, Department of Clinical Psychology,

Rookwood Hospital, Llandaff, Cardiff CF5 2YN

Dr Jane E. McNeil, Lecturer in Neuropsychology, Department of Psychology, PO77,

The Henry Wellcome Building, Institute of Psychiatry, De Crespigny Park, London

SE5 8AF and Regional Neurological Rehabilitation Unit, Homerton Hospital,

Homerton Row, London E9 6SR, UK

x LIST OF CONTRIBUTORS

Dr Tom Manly, Clinical Psychologist and Scientist, MRC Cognition and Brain

Sciences Unit, Box 58, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 2QQ,

UK

Dr Jason B. Mattingley, Senior Research Fellow, Department of Psychology,

School of Behavioural Sciences, University of Melbourne, Victoria 3010, Australia

Dr John D. C. Mellers, Consultant Neuropsychiatrist, Department of

Neuropsychiatry, Room 32, Outpatients Department, Maudsley Hospital, Denmark

Hill, London SE5 8AZ, UK

Dr Judith A. Middleton, Consultant Clinical Neuropsychologist, Radcliffe Infirmary,

Woodstock Road, Oxford OX2 6HE, UK

Dr Esme Moniz-Cook, Clinical Director and Reader in Clinical Psychology,

Hull & Holderness Community Health NHS Trust, Coltman Street Day Hospital,

Coltman Street, Kingston-upon-Hull HU3 2SG, UK

Professor Robin G. Morris, Department of Psychology, PO78, Institute of Psychiatry,

De Crespigny Park, London SE5 8AF, UK

Dr Graham E. Powell, Consultant Clinical Psychologist, Psychology Service,

9 Devonshire Place, London W1N 1PB, UK

Professor Jane Powell, Department of Psychology, Goldsmiths College, Lewisham

Way, New Cross, London SE14 6NW, UK

Dr Jennifer M. Rusted, Reader in Experimental Psychology,

Laboratory of Experimental Psychology, School of Biological Sciences,

University of Sussex, Brighton, Sussex BN1 9QG, UK

Dr Andy D. Tyerman, Consultant Clinical Neuropsychologist, Community Head

Injury Service, Bedgrove Health Centre, Jansel Square, Aylesbury, Bucks HP21 7ET,

UK

Professor Barbara A. Wilson OBE, Senior Scientist, MRC Cognition and Brain

Sciences Unit, Box 58, Addenbrooke’s Hospital, Cambridge CB2 2QQ, UK

Preface

Although often viewed as a specialty within Clinical Psychology, it should be im￾mediately apparent that knowledge of neuropsychology (and its applications) is

relevant to all areas of clinical work where people (across the age span) might be

showing some change in their cognitive functioning. Thus a working knowledge of

neuropsychology and the assessment and management of cognitive impairment may

be necessary for the delivery of a competent clinical service by even those practi￾tioners who do not wish to see themselves as experts in the field of clinical neuro￾psychology and who may well have had little or no experience of clinical

neuropsychology during their training as clinical psychologists. While we would

argue that neuropsychological assessment should form part of the core skills

acquired by all trainee clinical psychologists, our compilation of this volume is

based on the more realistic appreciation of the training opportunities available to

those who are both pre- and post-qualification, an appreciation gained through

many years of being actively involved in both pre- and post-qualification training

of clinical psychologists at the Institute of Psychiatry.

There are of course different ways in which to present information on clinical

neuropsychological knowledge and practice. One is to focus on specific neuro￾logical disorders, and their assessment and management. Within the scope of a

relatively short book, however, we feel that this may limit the apparent relevance

and generalisability of the skills that we feel it is important for clinicians to

possess. Thus for the current volume we have chosen to focus on broad areas of

cognitive function (including those such as praxis and number processing and

calculation, which are perhaps less well-developed areas of clinical neuropsychol￾ogy in the UK), which may be relevant to assess across a wide range of neuro￾logical and psychiatric disorders. We have also chosen to include chapters that deal

with important background information relevant to those being assessed (such as

the effects of medication and the interaction between neurological and psychiatric

presentations) and, because so much of clinical neuropsychologists’ work does

involve test interpretation, an overview of key psychometric concepts underpinning

neuropsychological assessment.

In addition to addressing specific cognitive functions, it is of course obvious that

clinical neuropsychology may be somewhat differently applied at different ends of

the age spectrum, where different factors may assume particular importance. For

this reason we have chosen to include specific chapters that address the issue of

neuropsychological practice with children and older adults. At any point in the age

xii PREFACE

range, neuropsychologists may be required to have an input into the medico-legal

system, and for this reason we have included a very practical chapter dealing with

the way in which such work should be undertaken.

Clinical neuropsychology is by no means all about assessment, as the chapters

on specific cognitive functions will indicate, and the delivery of good rehabilitation

services requires every bit as much the generic skills acquired during clinical

psychology training as well as neuropsychology-specific ones. However, given the

considerable development of neuropsychological rehabilitation, it is important to

review the theoretical basis for effective cognitive rehabilitation, in an attempt to

maintain an evidence-based approach to clinical practice, as well as to consider

how psychotherapeutic interventions designed for use with non-brain-damaged

people might be modified and applied to those with acquired brain injury.

While most attempts at cognitive rehabilitation have been developed for patients

with acquired but non-progressive brain injury, the growing literature on such

approaches for adults with dementia, possibly supplemented by the so-called

‘anti-dementia’ drugs, opens up further areas of work for clinical psychologists.

Finally, psychologists should increasingly see themselves as being in a position to

inform the process of service planning and should have a good understanding of

the service delivery models that may bring about effective care of their patients

with neurological impairments.

We believe, however, that clinical neuropsychological practice is most effective

when set in the context of more general neuroscientific knowledge and thus feel

strongly that clinical neuropsychologists should have at least a basic understanding

of neuropathology and the neurological investigations that their patients may well

undergo. It is for this reason that two of the early chapters in this book present a

relatively concise overview of the central nervous system and some of its common

disorders and how these are investigated. While psychologists should never work

outside their own area of clinical expertise, an understanding of how medical

investigations can inform the design and interpretation of neuropsychological

assessments and interventions can only benefit the service psychologists provide

to their patients.

We are grateful to the contributors to this volume, many of whom have been

actively involved over many years in different aspects of our training of clinical

psychologists, for the importance that they, like us, attach to such training and

dissemination of good practice. In practical terms we are very grateful to Gail

Millard who has, good-humouredly, enabled us to convert very differently

prepared manuscripts into a more consistent style and coped with our many

revisions. Alex Dionysiou has helped us with the preparation of many of the

figures. Finally we express our appreciation to our many colleagues, psychologists

and non-psychologists alike, who over the years have set us good examples of how

to work effectively as clinicians in our respective clinical settings.

Laura H. Goldstein

Jane E. McNeil