History of Neuropsychological Assessment

This chapter presents a historical overview of observations, instruments, and approaches in the area of neuropsychological assessment. In the 17th and 18th century literature dealing especially with language disorders following a brain disorder, one finds observations of physicians of striking dissociations of mental faculties that were impaired while others remained intact. Around the middle of the 19th century, neuropsychiatrists like Carl Wernicke began to develop procedures for assessing more specific components of mental functioning. German physicians, Conrad Rieger and Theodor Ziehen, seem to have developed the first neuropsychological test batteries. Kurt Goldstein, inspired by the rising Gestalt theory, argued that not the test score but the strategy used by a patient to perform a task is important. Alexander Luria also promoted an approach to assessment that was mainly based on subjective judgment. Studies on individual differences led to the development of an intelligence test battery by Alfred Binet. This battery was later transformed into the Army Alpha and Army Beta tests for selecting soldiers. Components of these intelligence tests have survived in the test kit of the modern neuropsychologist. This tradition also stimulated the development of psychometric analysis of tests. Two pioneers in the field of neuropsychological assessment were Shepherd Ivory Franz, favoring a clinical approach, and Ward Halstead, stimulating a strongly psychometric-based approach. The evaluation of language disorders has always been a specific area, requiring its own set of tests. The first comprehensive language battery was compiled by Bastian. Around the middle of the 20th century, when the localization of function approach had been rejected, neurologists preferred to examine language disorders clinically, using a battery that evaluated speech, comprehension, reading, and writing.