Beyond the Numbers: Expanding the Boundaries of Neuropsychology
Neuropsychology brings many things to science such as a history replete with creativity, a true understanding of basic psychological principles, an appreciation for individual differences, a sophisticated understanding of psychometrics, a comprehensive knowledge of brain functioning, and an appreciation of the application of our work to understanding the human condition. Let me provide an example from the work of Andy Saykin and colleagues (2006) at Dartmouth. They studied three groups of people, one group with minor cognitive impairment (MCI), one group of healthy individuals who had normal neuropsychological profiles, but who had a high number of cognitive complaints and, a third group of neuropsychologically normal people without cognitive complaints. They found a similar pattern of decreased gray matter (GM) changes in frontal and medial temporal lobes in the MCI patients and healthy individuals with cognitive complaints. When they combined all the groups they also found that the degree of GM loss was associated with not only the memory complaints, but also with verbal memory performance deficits. These findings imply that there may be a pre-mild cognitive impairment state that can be identified by neuropsychologists in which early therapeutic opportunities exist for what otherwise would appear to the neurologist as a normal aging person. Taken alone, none of these assessment paradigms, be it clinical assessment, neuropsychological assessment, or imaging would have revealed a complete story about the relationship between cognitive complaints and neuropathological changes among the elderly. Combined together however, our colleagues' work illustrates what can be learned when a discipline expands beyond its comfort zone and expands its boundaries.