Neuropsychology

A neuroscientific discipline

Discipline crossroads born mainly interaction between Neurologie and Psychologie, the neuropsychology benefits from the current passion for the Neurosciences and is today in full rise. However it is not a new discipline: its roots plunge in the old Egypt where Imhotep establishes the bond between brain and physical Sémiologie, and at some Médecin S of the ancient Greece like Alcméon of Crotona or Érasistrate which defends, against the hippocratic school that the brain is regarded as control committee of the body and the seat of the heart. However, during the eras Roman and Christian, the model of Galien, centered on the cerebral ventricles, will remain dominating until the knowledge of the cerebral Anatomie develops at the 16th century (Vésale) then at the 17th century (Willis, Vieussens). It is also the time when the Philosophe S, in particular Descartes or Spinoza again are interested in the seat of intellectual faculties and nelles emotion and where the Anatomiste S and Médecin S take little by little conscience of the determining role of the brain in the mental activities. However, one of the major difficulty remains to include/understand how this relatively homogeneous nervous fabric mass can generate the multitudes of faculties of the spirit.

At the 18th century, develops a vision localisationnist cerebral functions, on speculative relativements bases. One of the first attempts to bind the mental functions with cerebral surfaces comes with Gall and the Phrénologie, discipline which claimed to determine the character traits and the intellectual abilities of the individuals by palpating the bumps of the cranium. Phrenology presented methodological gaps which strongly limited the scientific value of it: it with final led to no knowledge on the spirit. Its historical importance comes owing to the fact that it is the first theory localisationnist, i.e. supporting a bond between cerebral localizations and cognitive functions. However this localisationnism, discussed very a long time since the controversy between Gall and Flourens, is undoubtedly the most essential base of the neuropsychology, even if it is moderated today by the stress laid on the concept of distributed cerebral network. It will have had an important influence on experimental work which will constitute the scientific and theoretical bases of the neuropsychology. On the one hand, the clinical observations are done more precise and one starts to put in bond the sites of the cerebral lesions with the associated disorders. Paul Broca, French neurologist, is one of the first to establish a correspondence anatomo-private clinic between the Langage and a precise cerebral zone by studying patients Aphasiques, i.e. become unable to communicate by the word. The major observation of Broca is that, among these patients, the brain is injured at the same place of the frontal Lobe left. He concludes from it that this area (with the foot of the third left frontal convolution), since called Aire of Broca, plays a crucial role in the linguistic roduction. In addition, on the experimental level, the appearance of new tools (like the Stimulation électrocérébrale by Fritsch and Hitzig) or the improvement of the existing techniques (possibility of carrying out precise surgical lesions in the animal) also took part in the development of knowledge on the bonds between brain and cognitive functions.

However, in parallel then in reaction to the localisationnism, a holistic theory develops brain. A major figure of this current of thought is Pierre Flourens (1794-1867) which, in Physiologiste rigorous, criticizes the methods of the phrenologists severely. However if he manages to identify the role of the Cervelet in the Motricité and of the Medulla in the vegetative regulation , he considers, in particular on the basis of observation on the Oiseau X which the brain is an undifferentiated body which functions like a whole in the production of the thought. In the field of the language, against Broca and Wernicke, Pierre Marie will support after examination of the brains of their patients that the " the third left frontal convolution does not play any special part in the function of the langage". Even if work pioneers of the localisationnists were criticizable, the refinement of the theories psychologiaues and the accumulation of observations precise anatomo-private clinics result in giving up the most radical versions of the holism as well it becomes indubitable as the brain obeys a certain functional organization.

Parallel to that, at the end of the 19th century, the scientific Psychologie takes its take-off and attempts to study functions such as the memory or the Perception. At the beginning of the 20th century, with the crossroads of clinical neurology and experimental psychology, the term of neuropsychology is thus introduced by Sir William Osler.

A discipline cognitivist

During first half of the 20th century the idea emerges that the case studies individual (of patients presenting a cerebral Lésion quite localized to the quite precise consequences on their Comportement) do not make it possible any more to sufficient gather data on the relation between the cerebral surfaces and the mental functions. In particular it would miss with this type of observations a quantitative aspect. The psychologists behaviorists, forts of their methodology, provide a means of investigation much more reliable and more powerful by developing certain numbers of precise tests allowing the studies of groups. This development in particular benefitted from the consecutive inflation of the number of patients cérébro-injured with the First World War and of the expansion of psychometry. The study based on the simple clinical observation for a time is thus relegated to the second plan.

In the second part of the 20th century, the birth of the model of data processing in cognitive Psychologie will allow the opening of the " box noire" behaviorist to study the stages, the processes and the modules of treatment of the Perception and the Cognition. These theories find their applications in the modern neuropsychology and a return to the case study is carried out, while remaining with a view to standardization of the tests, making it possible to quantify the disorders and to compare pathological performances with normal performances. The cognitive neuropsychology thus sticks to the comprehension of the mechanisms of the disorders more than to their simple description. Among the great cognitive functions one finds for example, the memory of which the explorationa largely profited from the study of the cases of patients Amnésique S, in particular through work of Brenda Milner on the case HM .

For these last years, under the impulse of researchers like Antonio Damasio, Joseph LeDoux or, in France, Roland Jouvent, the study of the emotion has started to be really taken into account in operation Neurocognitif, thus the neuropsychology is also interested it in the study of the emotional disorders resulting from a cerebral attack. That led the researchers and clinicians to be interested in certain aspects of the behavior hitherto neglected like the modifications of the sexual Behavior or deteriorations of the moral judgment consecutive to a cerebral lesion. The taking into account of the paradigm cognitivist in the discipline neuropsychology gave place to an important change of prospect, towards the end of the year 1970. The cognitive Neuropsychologie moved away from the simple search for correlation anatomo-private clinics, characteristic of the neuropsychology. Its own objective is the comprehension of the normal cognitive system, by the means of the study of its dysfunctions. The ultra-cognitiviste position goes sometimes until excluding from its research field the anatomical considerations, with the pretext that " the facts concerning the brain do not force the nature of the systems of treatment of the information" (Coltheart, 2004, cité by Manning, 2006).

An experimental discipline

Like disciplines scientific, the neuropsychology thus sticks to discover the cerebral seat of the mental functions such as the Attention, the memory, etc, but also to observe the relations between these functions, from a cerebral point of view (study of the loops of operation, studies of neural networks) and cognitive. It is a question of including/understanding the brain like support of intellect and of including/understanding intellect as integrated into the Cerveau.

Like disciplines cognitive, its role is also to provide experimental arguments to the models cognitivists, and in other words, to check or revoke, by the practice, of the theories on human and animal mental operation. Thus if a cognitive map postulates the strict interdependence between two mental processes has and B, but that the neuropsychology observes a double dissociation of the disorders (process preserved when overdrawn process B, and conversely at other patients) on the level of these processes, a critical solid could be brought to the model since the clinical data provide elements in favor of an independence of the processes has and B.

Research in neuropsychology also makes it possible to develop neuropsychological tests making it possible to appreciate and quantify a cognitive disorder after a cerebral affection.

Means of investigation

The neuropsychological tests are the first tool of the neuropsychologists, who they are clinicians or researchers. It is a question of measuring, using standardized and standardized tests, the capacities mnemic, linguistic, motor, gnostic… of a patient and of comparing it, possibly, with those of a healthy subject (or of a group of healthy subjects).

Its means of investigations are varied but the cerebral Imagerie (IRM, Mtoe, EEG, MEG…) constitute a tool from now on impossible to circumvent in current research. In fact the contemporary neuropsychology is thus integrated in the current of the cognitive Neurosciences.

The researcher in neuropsychology

If there very exists a Doctorat of neuropsychology bringing to a formation of high level in the field of the neuropsychology, a doctorate in Psychologie, in cognitive Psychologie, cognitive Sciences or Neurosciences can constitute very well a ticket of entry in research in neuropsychology since the topics of the young researcher coincide with those of the neuropsychology. It acts as France of a formation of level known as vat + 8 and the access roads various and are varied. The topics constitute as well the applied research as the basic research.

Taking into account the overlap major between research and practical in this discipline, much of researchers in neuropsychology also carried out a clinical formation ( to see low).

Many neuropsychologists clinicians also take part in many protocols of research, most of the time on subjects concerning the applied research, like the development of new tests.

Finally some Médecin S Neurologue S also take part in research in neuropsychology and can play a more or less important part there.

A clinical discipline

The neuropsychology is before a a whole clinical discipline which is exerted under multiple facets and in multiple structures or institutions. The role of the neuropsychologist is to evaluate the nature and the importance of the neuropsychological disorders following a cerebral dysfunction, that this one developed during a development in addition normal (epilepsy, Dyslexie,…) or that it occurs after a cerebral affection (lesion, cranial Traumatism, cerebral Tumeur, infections, MST…). Its role is also to take part in the development of the diagnosis. It can also ensure a follow-up with the patient to even take part in a rehabilitation or a cognitive stimulation of the patient.

The neuropsychologist thus exerts, in great majority, at the hospital, in a service of Neurologie. It will be brought to see suffering patients of neurodégénératives diseases or degenerative insanity (Maladie of Alzheimer, Parkinson's disease, Démence frontotemporale, progressive Paralysie supranucléaire, Démence with body of Lewy, cortico-basal Démence, Multiple sclerosis…), having undergone focal lesions continuation for example with a Cerebral vascular accident (vascular Insanity, Aphasia S…), having consecutive less frank disorders with a cranial traumatism (frontal Syndrome), having various and more or less important disorders during and after a cerebral Tumeur (which depend on the localization and wide on the tumor). More rarely, it will be brought to see patients having rare genetic diseases (Syndrome of the left-handed person, Gangliosidose…), of the metabolic diseases, or of the sexually transmitted diseases as the AIDS which present an important neurological syndrome at the time of the last stages of the disease. He will also see suffering of psychiatric disorders or psychopathological patients strongly resembling neurologic affections; its role will be then to differentiate both and to reorientate the patient towards a service of psychiatry if necessary.

In a service of Pediatry or Neuropédiatrie, the population seen by the neuropsychologist will be made up children epileptics, dyslexiacs, dysphasic…

In a service of Surgery, the neuropsychologist will have to make pass to the patient a pre-surgical assessment (inter alia determining the lateralization of the linguistic functions) then post-surgical to evaluate the impact of the surgery.

One will be able to find neuropsychologists in the services of Gériatrie, of Physical therapy and Readjustment, like in certain old people's homes.

The neuropsychologists exerting as a liberal constitute a minority. The reason first is the high fees of the neuropsychologist which restrict its “customers” with relatively easy patients (a fortiori let us point out that the social security does not refund the fees of the psychologist, of the neuropsychologist). There exist several private clinics where neuropsychologist and Neurologue or neuropsychologist and Orthophoniste propose a common work for the patients. These private clinics remain rare taking into account the administrative and financial difficulties of such an operation.

Lastly, certain neuropsychologists are paid pharmaceutical companies and are thus charged with appreciating the neurological and neuropsychological effects of a drug before it is launched on the market.

In all the cases, the neuropsychologist should not be regarded as a technician whose work is reduced to make pass from the tests. He must present a luggage important of knowledge and competences on the normal functioning and pathological of the cognitive system like his organization. This knowledge as well as good bases of general and pathological psychology enables him to interpret in a relevant way the results obtained by a patient with judiciously selected tests. Indeed, a failure with a test can be ascribable with the disturbance of various cognitive subsystems, which it is important to know and know to distinguish. A contrario , success with an insufficiently specific test, can be related to a substitute strategy and mask a real deficit. The neuropsychologist is an senior officer, (in the Hospital Public office, tallies has, as well as a Médecin). The conditions of wages remain unfortunately well in lower part of its “value” since the statute of the neuropsychologist is still very fuzzy. A recognition of the statute of neuropsychologist (and an improvement of the statute of the psychologist) would be necessary to a revalorization of the wages and at more precision on the hierarchical place of the psychologist at the hospital, places very strange where theoretically, it does not give an order and cannot receive some.

Means of investigation

The neuropsychological tests constitute the first means of investigation of the neuropsychologist. An impressive quantity of tests exists to allow the neuropsychological evaluation at a patient. These tests aim at exploring the cognitive capacities of an individual in the broadest way and most precise which is, this in order to identify precisely its pathological state or not.

The clinical observation is also in the center of the investigation. The neuropsychologist is a clinician, he is not satisfied to analyze the results of the patient to his tests but can judge the behavior of this last, while being ready to appreciate a more or less obvious Sémiologie during neuropsychological maintenance.

The speech of the close relations, the family in particular, makes it possible more precisely to date the appearance of the disorders and to judge in a more objective way of the impact of those in the daily life of the patient.

The cerebral Imagerie makes it possible to direct or confirm the neuropsychological assumptions by locating the seat of a Tumeur, of a lesion, a cerebral Dégénérescence (IRM), of an anomaly of the flow cerebral Sang uin (IRMf, Mtoe), by confirming an assumption epileptic (EEG, MEG)…

Training of the neuropsychologist clinician

In France, the title of neuropsychologist is not yet a protected title since the discipline, and especially the corresponding university formation are relatively new. The neuropsychologist is thus a Psychologue clinician specialized in neuropsychology. He carried out a general training in psychology (Clinic psychology, cognitive Psychologie, Psychologie of the development, experimental Psychologie, compared Psychologie, social Psychologie, Statistiques, Biologie, Neurosciences, neuropsychology) and specialized in neuropsychology for his master or following his formation, on the ground. In all the cases, it has of a OF the (Diploma of Specialized Higher learning) or a professional Master with the mention psychology , formations university corresponding in France at the level known as Bac +5 . An access under Psychologue was also possible after a DEA or a Master seeks mention psychology and long track records according to the decree of December 26th, 1990 and the circular of November 2nd, 1992 but this way will not be soon practicable any more.

These last years saw the emergence of masters being marked directly neuropsychology (and either only psychology ) within the catalog of the university formations, thus the future neuropsychologists specialize in their discipline as of the fourth year of their course.

With the USA, the title of neuropsychologist is accessible after a formation of the type doctorate (PhD), and the student must carry out a boarding school, as in medicine. The profession of this fact is developed there than in Europe.

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