NEUROPSYCHOLOGICAL TESTING

INTRODUCTION
o Neuropsychology is the branch of psychology concerned with the relationship between the brain, behavior
and thinking. The twin observations that perturbations to the brain may lead to predictable effects on its
output and that the path from disturbed cognition and behavior leads back to the brain and its functions form
the cornerstone of neuropsychology.
o Certain psychological manifestations deserves particular attention because they are sometimes found in
association with relatively circumscribed brain lesions.
o In every case they can also be seen with pathology which involves the brain diffusely or disturbs its
functions widely, so their presence is by no means a certain indication of a single localized lesion.
o Nevertheless, when they emerge as isolated defects or stand out prominently against a background of
mild impairment of other cerebral functions, they command especial care in the search for focal pathology
wherein lies the role of neuropsychological assessments.
HISTORICAL BACKGROUND
Mental processes are variously located in the soul, heart believed in the soul of which the brain
constituted a rational part
o believed that the heart was the source of mental processes while the brain functioned to cool the blood
o Modern thinking about the mind began with who believed in a unitary mind which is the reasoning or rational
entity.
o The argument for localization of function began with
o presented evidence fom his clinical studies that speech functions are localized in the frontal lobes
o described a syndrome consisting of inability to speak despite intact vocal mechanism in lesion of left frontal
lobe
o Wernicke (1874) proposed that there is more than one language area in the brain
o It was only after World War II neuropsychology received recognition as a distinct discipline.
o A number of laboratories were established in Europe and North America which were responsible for the
development of neuropsychological assessment as a tool in clinical neurology and psychiatry.
o first used the term Neuropsychology in the beginning of 20th Century.
o defined the double dissociation, which is regarded as the strongest evidence of localization of particular
function.
o Alkezandre Luria, also developed the notion of functional localization, and also associate the cognitive process
with the neuroanatomical correlates.
o Currently neuropsychology is defined as the “study of the relation between brain function and behavior”.
o It is the clinical assessment of adult, which examines the relationship between behavior and brain functioning
in the realms of cognitive, motor, sensory, and emotional functioning.
o Neuropsychology deals with the study of the mechanisms of human thinking, learning, and how this
mechanisms operate.
o Clinical Neuropsychology deals with the patients who have structural lesions of brain, and employs
a variety of testing procedure to assess functional changes and brain damage.
o Experimental Neuropsychology deals with both normal subjects with intact brains, and patients
with brain lesions.

PRINCIPLES OF NEUROPSYCHOLOGY
CEREBRAL ASYMMETRY and
CEREBRAL LOCALIZATION
GOALS OF NEUROPSYCHOLOGICAL ASSESSMENT
o Most of the referrals are made for the diagnostic issue.
Other important uses of testing includes:
o To diagnose the presence of cortical damage or dysfunction, and localize it where possible.
o Provide accurate estimate of an individual’s functional cognitive capacity
o To detect early dementia – condition such as 3rd ventricle related cognitive impairment and normal
pressure hydrocephalus.
o Detect changes even before structural changes are evident
o Post stroke syndromes – difficulty in memory, language, spatial skill and reasoning.
o Level of functioning – documentation of level of functioning for variety of reasons.
o Age or stress related cognitive change – middle aged and older adult may have concern about
concentration and memory impairment.
o To monitor course and outcome of treatment.
o To facilitate patient care and rehabilitation – serial assessment can provide significant information
about the rate of recovery and planning of treatment strategies.
o To evaluate the changes in functioning as a result of neurosurgery. To re-examine the patient with
follow-up neurological assessment after 6 months to 1 years.

STEPS INVOLVED IN NPA

o Clinical or diagnostic review of the history of present illness.
o Detailed interview of the patient and significant others to elicit details of onset, course, degree and
nature of cognitive and personality changes and profile of pre-morbid function.
o Selection and administration of appropriate neuro-psychological tests.
TECHNICAL ISSUES IN NPA
All patients should be compared with population based norms, as well as local normal and subgroup
normal to examine strength of weakness.
Issues, such as reliability, validity, sensitivity, and specificity need to be considered.
Results of an neuropsychological assessment must be considered in the context of the patient’s age,
education, sex and cultural background.
 Tests of perception/attention
Attention is the ability to focus on the matter and concentration is the ability to maintain that focus. Both
attention and concentration should always be considered as a potential contributor to impaired performances
on any test that require vigilance or rapid integration of information by the following neurological tests.
o Bender–Gestalt Test (Bender Visual Motor Gestalt Test)
o Visual Object and Space Perception Battery (VOSP)
o Behavioural Inattention Test (line bisection, star cancellation)
o Tests of Everyday Attention (TEA)
o Digit Span Test: It is a subset of WAIS.
Digit Forward: Reproduction of increasingly longer (3—9) digits.
Digit Backward: Reproduction of longer (3—8) digits.
Test should be stopped when there is 2 successive failures.
1 second for 1 digit
o A’ Random Letter Test:
o Omission Error
o Commission Error
o Perseveration Error
 Procedure: Letters are presented by ‘A’ on a revolving drum at 1 second interval for a period of 10
minutes. The person is to be asked to press a button whenever the letter ‘X’ appeared, or in a complex
version whenever X is preceded by ‘A’.
o Trail Making Test
This test is a measure of visual searching, visual sequencing, perceptuomotor speed and ability to make
alternating conceptual shifts efficiently.
It is administered in two parts:
Part A requires the patient to draw a line connecting 25 pseudo-randomly numbered circles on a
standard sheet of paper
Part B requires the patient to alternate between numbers and letters (i.e 1-A-2-B-C…) to connect the
same number of circles.
o Paced Auditory Serial Addition Test (PASAT)
This is a test of active verbal attention, information processing and basic ability to calculate. It consists of
a taped presentation of 60 pairs of randomized digits with the requirement that each digit is added to
the previously presented digit.
For example, for the presented numbers ‘’3-6-2-9-8” the correct response would be “9-8-11-17
The digits are presented at four different rates of speed ranging from one digit every 1.2 second to one
every 2.4 seconds
Derived scores include the percentage of correct responses at each rate or the mean score.
It is used to asses recovery from mild to moderate closed head injury
o Behavioral Inattention Test (line bisection, star cancellation)
Line bisection task and star cancellation is used to detect “neglect” following right-hemisphere brain
damage
For example, when searching through a visual scene patients with left neglect tend to look at elements
on the right only
o Bender–Gestalt Test (Bender Visual Motor Gestalt Test)
The Bender Visual Motor Gestalt Test (1946) is a widely-used test to assess visual motor processing.
VISUOSPATIAL TEST.
It is often referred to as the Bender Gestalt.
‘Bender’ is the person who designed it.
‘Gestalt’ comes from a German word meaning ‘form’.
Here nine sample designs are projected, one at a time and subject is asked to copy them. The type and
frequency of errors are noted and serve as the basis for identifying neurotic, psychotic, and brain damaged
subjects. There is no time limit in copying.
The Bender Gestalt test is sensitive at identifying organic brain damage, distinguishing it from purely psychiatric
diagnoses.
Visuo-graphic productive abilities are associated with the parietal lobe, especially in the right hemisphere and
the test detects abnormalities of such abilities
A good result cannot rule out brain damage in other regions of the brain.
Use of Bender Visual Motor Ability Gestalt Test:
As a test of motor ability
As a test of organic brain damage
As a test of visuo–motor coordinator
As a test of memory
As a test of spatial orientation

MEMORY
Memory is a complex, cognitive, or mental process involving the perception and encoding of the to-be-
remembered in formation, storage of what is to-be-remembered and retrieval of stored information.
Memory problem is one of the most common reasons for the referral to neuropsychology.
Types of Memory:
(A) Immediate Memory
(B) (i) Recent Memory
(ii) Recent Past Memory
(C) Remote Memory

FEW TESTS FOR MEMORY

o Paired associate learning tests
o Object Learning Test
o List learning tests
o Rey Auditory Verbal Learning Test
o California Verbal Learning Test
o Recognition memory tests
o Camden Memory Test
o Benton Visual Retention Test
o Rey–Osterrieth Test
o Adult Memory and Information Processing Battery
o Rivermead Behavioural Memory Test
o Autobiographical Memory Interview (AMI)
o Graham-Kendall Memory for Designs Test
(A) Immediate Memory (Recall with in 30 sec.)

Auditory –Verbal Visual -Non-verbal

Patient is asked to recall words, sentences or digits Patient is asked to recall memory
for designs, objects, faces

For patients with right hemispheric lesions the visual non verbal deficit > auditory-verbal deficit. But for
patients with left hemispheric lesion it is just opposite
B)(i) Recent Memory: (Recall within hours or days; 24—48
hours). Can be tested by asking the patient about his breakfast or who visited him.
(ii) Recent Past Memory: (Recall of perceived materials within past few months). Patient is asked
about current events.
(C) Remote Memory: (Recall of perceived material or events of distant past). Patient is asked about personal
events, e.g. the day he married, his first child was born, he joined the job.

Wechsler Memory Scale: Developed by David Wechsler in 1945 and adapted by Elert Russell to include the
immediate and delayed recall comparison. It is the most widely used memory test battery for adult. It is a
composite of verbal paired, associate, paragraph, retention, visual memory for design, digit span, counting
backward.
Consists of 7 subtests:
Personal & current information: Age, date of birth, current head of state etc.
Orientation: Time and place
Mental control: Automatisms such as alphabet recitation; Conceptual tracking: "Count by 4 from 1
to 53"
Logical Memory: Immediate recall of two paragraphs
Digit Span:
Visual Reproduction: An immediate visual memory drawing task
Associate learning: 10 words pairs; 6 easy associations (eg. baby-cries) and 4 hard associations

Scoring: It gives memory quotient for corrected score ranging from 50 to 118.

Benton Visual Retention Test

It consists of several series of simple and complex line drawings that are presented to the patient for
varying periods (5 to 10 seconds)
The patient reproduces the designs directly or does so after a variable delay.
This test assesses visual perception, short-term memory and constructional ability

Test for Mental Control: It includes counting backward from 20 to 1, used for detection of minor brain
damage.
Logical Memory: Immediate recall of two short stories each containing 25 scores unit.
Rey–Osterrieth Test
Developed by Rey and Osterreith (1944)
This is visual and non verbal memory test.
Investigates both perceptual organization & visual memory
A figure pattern is asked to be copied. The subject is first asked to copy the design as accurately as
he can with the original before him. Forty minutes later and without previous warning he is asked to
drawn the figure again, but this time from memory. The initial copying reflects any drawing disability or
disorder of spatial perception, but the recall score reflects in addition any visual memory impairment.
Patient with temporal lobe damage in the hemisphere, dominant for speech tend to show little impairment
Frontal lobe patients perseverate in copies
Left Hemisphere damage patients tend to break drawing into smaller units than the normals and simplify
(eg. by rounding angles such as those on the diamond; drawing dashes instead of each dot; turning the
cross into a T)
Right Hemisphere patients tend to make more omissions
Parietal lobe lesion patients have difficulty with spatial organization
 Visual Reproduction: Here the subject is shown four cards having geometrical figures. Subject must draw
what he remember after 10 seconds of seeing the cards.

This figures are exposed for 10 seconds and then asked to draw the figures immediately after taken away.
The subject is again asked to draw all the figures from his memory after 30 minutes.
Maximum Score : 14
For
A 3
B 3
C 5
D 3

Visual Memory Span: It is assessed by asking the subject to touch a series of coloured square in predominant
order, which is first demonstrated by the examiner.
Verbal Paired Associates: The subject requires to learn 8 pairs of words, four being easy and four having no
obvious semantic connection. Easy Paired Words : Penny/Quarter
Difficult Paired Words : Page/Yield
Subject is asked to read out the pairs and then read one word of a pair and recall the others and examiner
will say right or wrong.
For easy association = 2 mark; for difficult association = 1 mark
Digit Span: Digit forward and backward.
California Verbal Learning Test:
By this test verbal learning and memory can be assessed. It includes 16 words which belong to four defined
categories, e.g. fruits, clothing, tools, etc.
WMS III:
It is the latest revision of widely used battery of subsets with several measures of attention, memory, and
new learning.

LANGUAGE TESTS
Boston Naming Test
Graded Naming Test
Token Test
Speed and Capacity of Language Processing Test
Speed of Comprehension Test
Spot-the-Word Test
Psycholinguistic Assessments of Language Processing in Aphasia
(PALPA)

Language is the basic tool of human communication and the basic building block of most cognitive abilities.
The N.P.T. of Language examines:
Expressive Ability -Verbal Fluency
Boston Naming Test
Comprehension -Token Test
Pointing Commands & Questions

Verbal Fluency Test: Subject is asked to give all the words they can think of beginning with a given letter of
alphabet. Aphagic patient with ANTERIOR left hemisphere disease fails this task.
Two most effective verbal fluency test are the:
o Controlled Oral Word Association Test
o Animal Naming Test
Both objectively measure the patients’ ability to produce spontaneously words under the restrictions of a
limited category
e.g. “Name as many animals in farm”
“Name as many words starting with the letter F”
Reading and Writing: Also associate with the dominant hemisphere and are tested asking the patient to read
aloud and write names or brief passage.
Animal Naming Test: Subject is asked to recall the names of animals as many as possible within 60 sec.
Scoring: It is the number of correctly produced animal names during the 60 seconds.
18-22 animal names: Normal individual Age <= 69 years
17 animal names : Age 70 years
<13 animal names : Impaired verbal fluency
<10 animal names : Word finding problem

FAS Test: Subject is instructed to name as many as words possible, beginning with the stipulated letter ( F, A,
S, )within a 60 seconds trial.
Scoring:36–60 words/60 sec : Normal Individual
12–more words : Reduced Verbal Fluency

Boston Naming Test

It is a measure of visual confrontation naming.
It is a informative measure of the word retrieval ability of the brain damaged individual.
This consists of 60 line drawings of objects. The items range in difficulty from common objects such as a tree
or pencil or more difficult ones like a sphinx or trellis. When the subject cannot name the picture, then a
phonemic cue is given. These help to identify whether the subject knew word at all.

Token Test:
De Renzi and Vignolo (1962) introduced the test, which is sensitive to minor degree of impairment of
language comprehension.
It is a test of language comprehension which assesses an ability to respond to various sentence types,
semantic relations and linguistic elements.
It uses colored plastic tokens that are manipulated by the patient in response to a series of heirarchically
ordered verbal commands.
e.g. “Show me a circle”
“After touching the yellow circle pick up the white square”

In the first part of the test, large circles and rectangles are displayed and the subject is asked to pick up each
in turn by telling him to “pick up the yellow rectangle”, “pick up the red circle”, etc.
Subsequent proceed in graded stages by introducing small as well as the large tokens by asking subject to
pick up two at a time.
In the final part of the test, prepositions, conjunctions and adverbs are introduced, so as to radically change
the meaning of action, which the subject is required to perform. Thus the subject is asked to put the circle on
the green rectangle, pick up all rectangles except the yellow one, etc.

Tests for Temporal lobe Dysfunction

Block design test
Verbal and visual memory test
Benton visual retention test
Test for aphasia

Tests for Parietal lobe Dysfunction

Test for visuospatial perception
Bender Gestalt Test
Block design test
Visual object agnosia
Left Right Disorientation

Vigilance tests
Paced Auditory Serial Addition Test (PASAT)
Continuous Performance Test

Batteries
Halstead–Reitan Battery
Cambridge Neuropsychological Test Automated Battery (CANTAB)
Luria’s Neuropsychological Investigation
Luria Nebraska Neuropsychological Battery

MMSE

Although formal evaluation of cognitive impairment require time consuming, one practical and clinical
useful test is the MMSE. It is also a practical test to track the changes in a patient’s cognitive state.

The MMSE was elaborated by Folstein et al in 1975It is a simplified routine test to assess cognitive
function.It takes 5-10mins to be administered

MMSE consists of:

General DescriptioN
Language and Speech
Thought
Mood and Affect
Insight and Judgment
Cognition
It encompasses the following domains:
o ORIENTATION
o REGISTRATION
o ATTENTION AND CALCULATION
o RECALL
o LANGUAGE
o COPYING
SCORE:
19-26:mild
10-19:moderate
<10:severe

VISUOSPATIAL TEST
Bender Visual Motor Gestalt Test (Lauretta Bender, 1938)
Draw a clock test
Visual retention test
Visual object and space perception test
W.A .I.S–R – Picture completion test
Rey–Osterrieth complex figure test
Visual retention test
Facial recognition test

EXECUTIVE FUNCTIONING-
Executive function plays an important role in the planning and initiation of independent activities, self
monitoring of performance and inhibition of important responses.

Wisconsin Card Sorting Test:

It is used to test an individual’s ability to repeatedly form, maintain and switch categories.
The material consist of 64 cards and each containing from one to four geometrical figures. These consist of
any one of four shapes (triangles, stars, crosses and circles) in any one four colors. Four stimulus cards are
set out before the subject who must short the remainder beneath them.
His task is to discover by trial and error whether he is required to sort according to colour, form or number,
the clue being the examiner’s remark of right or wrong after each response is made. In administering the
test the subject is required to sort first of all by colours, all other responses being called wrong, then when
he has achieved 10 consecutive correct responses to colour the required sorting principle shifts without
warning to form. Later it shift to number, then back again to colour and so on.
The test measures the capacity for Abstract thinking and flexibility in problem solving. Sensitive to effects of
frontal lobe lesions
The patient must sort a series of printed cards according to color, form or number with the corrected
category shifting without notice each time the criterion of 10 consecutive correct responses is reached.
The patient is told whether a response is right or wrong but is not informed that the category will shift or
what the correct category is.
The test tasks approx. 12–20 min carryout and generates the following results:
Number of Trial
Number of Categories
Number of Errors
Number of Preservative Errors
Percentage of Preservative Errors

Halstead Category Test: It is a subset of Halstead Reiten battery test. It consist of group of pictures,
displayed on a screen, in response to which subject must press one of four levers.

Stroop tests
It is a test of cognitive flexibility of the patient.

Tower of London Test

The Tower of London test is used to detect deficits in planning
The test consists of two boards with pegs and several beads with different colors. The examiner uses the
beads and the boards to present the examinee with problem-solving tasks.
The performance of the examinee is compared to representative samples of individuals of the same age to
derive hypotheses about the person's executive cognitive ability.
 Halstead-Reitan Neuropsychological Test Battery
This battery is composed of a series of tests devised by Ward Halstead and his student Ralph Reitan in 1940
This battery is used to determine the location and the effects of specific brain lesions.
The test comprises of ten different subtests.

1. Abstraction, visual acquity

2. Spatial memory, tactual discrimination
3. Attention and concentration
4. Motor speed
5. Auditory discrimination, phonetic skills
6. Visuomotor perception, motor speed
7. Visual perception
8. Memory and spatial perception
9. Verbal and non-verbal brain functions
10. Sensory perception

Luria-Nebraska Test: The test based on the work of Russian Neuropsychologist, “Alexander Luria”. The test
assess a wide range of cognitive function like – memory, motor functions, tactile, auditory, visual function,
writing, spelling, reading and arithmatics
Consists of 269 discrete items and has high reliability
The test assess a wide range of cognitive functions.
Some Scales:
o Motor
o Rhythm
o Receptive Speech
o Expressive speech
 o Reading
o Writing
o Memory
o Visual functions
o Tactile functions
o Arithmetic
o Intellectual functions
Test is extremely sensitive for identifying specific type of problems ( dyslexia, dyscalculia etc) and locate
cortical zones
Designed for persons at-least 15 yrs old.
Children’s version can be used for 8-12 yrs old.

Frontal Assessment Battery

The FAB is a brief tool that can be used at the bedside or in a clinic setting to assist in discriminating
between dementias with a frontal dysexecutive phenotype and Dementia of Alzheimer’s Type (DAT).The
FAB has validity in distinguishing Fronto-temporal type dementia from DAT in mildly demented patients
(MMSE > 24). Total score is from a maximum of 18, higher scores indicating better performance.

1.Similarities (conceptualization)
“In what way are they alike?”
A banana and an orange
2. Lexical fluency (mental flexibility)
“Say as many words as you can beginning with the letter ‘S,’ any words except surnames or proper nouns.”
3. Motor series “Luria” test (programming)
“Look carefully at what I’m doing.”
The examiner, seated in front of the patient, performs alone three times with his left hand the series of
“fist–edge–palm.”
“Now, with your right hand do the same series, first with me, then alone.”
The examiner performs the series three times with the patient
4.Conflicting instructions (sensitivity to interference)
“Tap twice when I tap once.”
5. Go–No Go (inhibitory control)
“Tap once when I tap once.”
6. Prehension behaviour (environmental autonomy)
“Do not take my hands.”
The examiner is seated in front of the patient. Place the patient’s hands palm up on his knees. Without
saying anything or looking at the patient, the examiner brings his own hands close to the patient’s hands
and touches the palms of both the patient’s hands, to see if he will spontaneously take them. If the patient
takes the examiner’s hands, try again after asking the patient: “Now, do not take my hands.”
Interpreting results
A cut off score of 12 on the FAB has a sensitivity of 77% and specificity of 87% in differentiating between
frontal dysexecutive type dementias and DAT

KOH’S BLOCK DESIGN TEST

The ability to assemble complex object puzzles or reconstruct from a model standard geometrical pattern
of Koh’s block design test, which is better performed with left hand than the right.
B1 to B5 : Need 4 cubes, 2 mts
B6 to B7 : Need 9 cubes, 3 mts
B8 to B10 : Need 16 cubes, 3 mts

16 blocks printed alike – blue, red, yellow and white – full size, half red and half white, half yellow-half blue.
10 cards with printed designs of increasing order of difficulty both in term of number of blocks used and
diagonal relationship.
Time : Design : 1—5 : 2 mts for each
” 7—10 : 3 mts for each
Scoring : Maximum Score : 25
Design 1—5 : 2 marks within 1 mts.;
1 mark between 1—2 mts.
0 mark after 2 mts.
Design 7—10 : 3 marks within 1 mts.
2 marks between 1—2 mts.
1 mark between 2—3 mts.
0 mark after 3 mts.

MOTOR FUNCTION TEST

Grip Strength Test: This test is done to assess grip strength over several trials with the right and left hands.
Reduction in strength bilaterally when compared with the expected level of age and sex, may indicate brain
dysfunction.
Finger Taping Test: Subject is asked to tap the index finger of each hand. A number of reports suggest an
average of approximately 55 5 tapes with the dominant hand. During a 10 seconds period approx 50 4
tapes with the non dominant hand. This test is done assess motor speed and inferences may be given
regarding possible lateral brain damage.

SENSORY PERCEPTUAL TEST:

The subject performs a number of task with eyes closed-like identifying where he has touched, hand or
face, which finger touch, what coins are placed in his hand and what numbers are written on the skin.

INTELLIGENCE TEST
Bhatia’s Battery of Performance Test
Stanford-Binet Test
Wechler Adult Intelligence Performance Scale
Advance Progressive Matrices

PGI BATTERY OF BRAIN DYSFUNCTION

Developed in PGI Chandigarh
The Battery consists of the following materials:
5 cards of retention subtest of memory
2 cards of picture naming ( one with 10 objects and other with 20 objects
Kohs’ Block Design test
Passalong test
8 cards of Nahor-Benson test
9 cards of Bender Visual Motor Gestalt test
Verbal Adult Intelligence Scale
NEUROPSYCHOLOGICAL TESTS IN CHILDREN

Psychological approaches for the assessment of Brain pathology

MULTIFACTORIAL---- Based on the assumption of functional autonomy of the structures(localization)---
Assessed by comprehensive batteries of tests
UNITARY--- Based on the assumption of functional unity of the brain as a whole-- Assessed by unitary
function test such as intelligence, memory etc.

NEUROPSYCHIATRIC DEFICITS IN PSYCHIATRIC DISORDER

SCHIZOPHRENIA
Neuropsychological deficits in:
Attention and information processing
Learning and memory
Language
Conceptual and executive functions
Dysfunction in several interconnected brain regions
MOOD DISORDERS
Neuropsychological deficits in:
Memory
Perceptual discrimination
Verbal fluency
Deficits more in non-dominant hemisphere
OCD
Neuropsychological deficits in:
Attention
nonverbal auditory perception
spatial learning
Frontal lobe, basal ganglia and interconnection with limbic system

Alcohol Dependence
Neuropsychological deficits in:
Location learning
memory
Spatial and visuo-perceptual analysis
Problem solving
Cortical atrophy, frontal lobe involvement Rt>Lft
Dementia
Neuropsychological deficits in:
Attention
Comprehension and language
Learning and memory
Visuospatial functions
Sensorimotor function
Widespread cortical and subcortical involvement

LIMITATIONS OF NEUROPSYCHOLOGICAL TESTS

Function and region do not have a one-to-one mapping
Many functions can be affected by lesions at many multiple disparate locations
Many brain regions subserve multiple functions
The brain's functions do not map cleanly onto easily-definable functional categories
Neither attention, nor memory etc. are really unitary functions: each can be decomposed into many
(sometimes non-intuitive) subfunctions

CONCLUSION
There are many types of tests that examine brain functioning. Some tests are very sensitive and can
be highly accurate in assessing damage. These can be used to help detect brain damage before other
techniques are used.

With the advent of sophisticated radio-diagnostic techniques the neuropsychological tests may seem
ancillary in diagnostic evaluation but their role has increased in the understanding of the patients for total
management and to provide rehabilitatory measures.