Sunday, January 5, 2014

Toward a Modern Neuropsychology

Are neuropsychology’s current syndromes and assessment measures out-dated?  Ardila (2013) argues that this may be the case in his commentary in the journal Archives of Clinical Neuropsychology.  Ardila contends that some classic neuropsychological syndromes (e.g., aphasia, alexia, prosopagnosia) may need updated, considering the changes in technological and social conditions that have taken place over the last 100 years.  Because of these changes, tasks are often performed in different ways then they used to be, thus potentially requiring the use of different brain areas.  The author specifically refers to cognitive abilities including spoken language, written language, numerical abilities, spatial orientation, people recognition, memory, and executive functions.

Written language is one of the more interesting areas addressed in this article.  Much writing is now done using a keyboard and word processor rather than pen-and-pencil.  Although an understanding of language is necessary for both, typing and handwriting require differing demands from the individual.  For example, handwriting requires individuals to construct letters using fine motor skills, while also keeping the letters spaced properly.  Typing, on the other hand, merely requires the press of buttons rather than construction of letters; however, typists must use both hands to type letters in the correct order.  To do this quickly and accurately, a well-functioning corpus callosum is needed to facilitate communication between the two cerebral hemispheres.  The argument is that because modern written language involves much typing, we need to learn more about the brain structures involved (as opposed to those involved in handwriting) and develop new ways to assess for impairment in typing ability that is due to brain dysfunction.  This same concept applies to the other functional domains addressed in the article.  For example, societal changes over time may affect how our brain is organized for the recognition of people, as we are now compelled to remember more faces than we were when neuropsychology was a new field due to exposure to television, the internet, and other media. 

The author concludes that our century-old neuropsychological syndromes (and measures used to test for them) need re-assessed.  In any field, it is important to take time to examine practices to see if they are out-dated or could be improved upon, and neuropsychology is no different.  On the other hand, is it necessary to declare the existence of new syndromes based on modern tasks that did not exist previously?  Ardila suggests one such new syndrome could be “acomputeria” – an inability to use computers.  He goes on to list potential specific subtypes of acomputeria.  I wonder if a better solution would be to classify problems based on their underlying causes, rather than inventing a new syndrome for each new modern task.  For example, one’s inability to use a computer may not be a syndrome in and of itself, but the result of memory problems (the individual is unable to learn new information), executive dysfunction (the individual may be unable to problem solve and continue to perform unsuccessful actions), or something else.  In this case, traditional neuropsychological measures may be effective in determining the underlying problem.  Either way, the issues addressed in the commentary are certainly worth thinking about further, and, most importantly, testing empirically.

Here is a link to the abstract: Ardila 2013

Ardila, A. (2013). A new neuropsychology for the XXI century. Archives of Clinical Neuropsychology, 28, 751-762.

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