Assessment of Change of State

Assessment of Change of State

Many patients have fluctuating mental states, such as in schizo-phrenia and affective disorder, medical illness (e.g., renal disease, diabetes), or abuse of drugs or alcohol, or as a result of somatic therapies (medication or electroconvulsive therapy). Repeated testing is often desirable to clarify the patient’s cognitive capaci-ties. The effects of a treatment such as electroconvulsive therapy on cognitive function (e.g., verbal memory functions) can persist for months (Squire and Shimamura, 1996). Monitoring cogni-tive status by repeated testing allows an objective measure of subjective complaints and of recovery of function. Baseline test-ing early in the course of an illness such as schizophrenia or brain tumor can be compared with later evaluations to clarify the course of the disorder or to assess the impact of various interventions.

Neuropsychological evaluations differ not only in length but also in conceptual focus and in selection of the particular instruments that compose a battery of tests. In general, three batteries are used commonly throughout the USA: the Halstead– Reitan Battery (Reitan and Wolfson, 1993), the Luria–Nebraska Battery (Golden et al., 1980), and a flexible, hypothesis-testing approach typified by the Boston process neuropsychological approach (Goodglass and Kaplan, 1979; Holmes-Bernstein and Waber, 1990; Kaplan, 1990; Milberg et al., 1996). The decision to use one or the other of these approaches depends to some ex-tent on the training of the practitioner, the nature of the referral questions, and a number of other factors discussed in more detail elsewhere (Seidman and Toomey, 1999).