Philosophy

Even the most minimal neuropsychological assessment must evaluate each of the basic functions known to be sensitive to brain dysfunction. The abilities assessed in Cognistat--attention, language, constructional abilities, calculations, memory and reasoning--represent the most essential functional areas. A more thorough neuropsychological assessment would need to additionally evaluate mental tracking or sequencing, spelling, spatial memory, story paragraph memory, executive functioning, processing speed, and reading.

There is no "gold standard" for how much testing must be carried out within each functional area. The decision of how much testing is enough depends upon the judgment of the clinician and the confidence he or she has in the adequacy of the results. In some cases even minimal testing using the screen item from Cognistat is sufficient to assure the clinician about the functional integrity of certain ability areas. For example, an 80 year old man of average intelligence who passes the 3-step command can usually be considered intact in language comprehension. At other times, even the passing of the Cognistat metric test may not be sufficient. For example, a 40 year old woman of superior intelligence who reports memory problems can't be considered intact in this area even if she recalls all four words spontaneously on the memory section.

Each screen item should be thought of as a test that is more or less adequate for our evaluation depending on the entire context of the individual case. Each metric test represents a further level of assessment that may or may not be adequate for a particular evaluation. Additional testing can be carried out that extends the evaluation process to the next level of detail. At each point, the metric serves as the screen for the next level of assessment. The clinician continues this process until she/he feels confident about the assessment in each functional area.

The assessment process can be compared to the exploration of an unknown house. We only enter the house when we have something specific we are searching for. Each room is like a specific functional area. We can look in the room from the door and be satisfied that nothing is there. If our cursory inspection raises new questions, however, we need to enter the room and look further. We may be able to reassure ourselves quickly by walking through the room and looking around. If we discover anything out of order, however, we may need to investigate more closely. Even this search may not satisfy us, and we may begin to take things apart in order to obtain the most thorough search possible. We direct this process through our questioning and investigating. This is the way in which a neuropsychological assessment takes place. We have designed Cognistat to provide clinicians with a sound first step toward the assessment process.