The word “neuropsychology” is a mouthful. It feels like one of those words you might use when you want to seem smart. Like “nomenclature”, or “cumulative”. Because it takes so much time to say, neuropsychologists have come up with a clever way to shorthand the term – they say “neuropsych”. Leaving out the last two syllables has, over the decades, undoubtedly saved countless cumulative hours in university department conversations across Canada.
Add the word “clinical” and you’re in a whole new world of nomenclature. One which Dr. Kristina Gicas, Chair of the CPA’s Clinical Neuropsychology Section, is happy to unpack. Dr. Gicas is a clinical neuropsychologist and an assistant professor at York University, where she trains clinical neuropsych students. She teaches, does research, and also does some clinical work in Toronto. She says,
“Clinical neuropsychology is the study of the relationship between your brain and your behaviour. We look at the structure and function of the brain, and study how that relates to thinking abilities. This includes things like attention, memory, language, visual skills, processing speed and even emotional functioning.”
Neuropsychologists are experts in investigating these brain-behaviour relationships, and using that information to do a number of things. The number one thing they do is diagnosing things like injuries or diseases that are affecting the brain (concussion, stroke, tumors, dementia). They also seek to understand normal human development and aging. Another area of specialty of neuropsychologists is in designing and implementing interventions to improve peoples’ day-to-day functioning.
The CPA calls the section Clinical neuropsychology because all neuropsychologists are trained as clinical psychologists first. The neuropsych part is a specialization, where practitioners take additional courses – for example, doctorate courses in neuroanatomy (another mouthful of a word – only this one has no convenient contraction). They learn about assessment tools and cognitive tests – what they mean, how they’re used. Most psychologists can administer these tests, but it’s neuropsychologists who can link them to brain functioning – that brain-behaviour relationship.
Maybe you’ve noticed that one of your parents is starting to become more forgetful, and is less able to pay attention to tasks than they once were. You might take them into the doctor, who might then administer a test to them – like the MoCA (Montreal Cognitive Assessment) test. This is a preliminary screener that can help determine the degree to which intervention is needed. If your parent meets a certain threshold, they might be referred to a clinical neuropsychologist like Dr. Vinay Bharadia.
Dr. Bharadia splits his time between a private practice, as Lead of Neuropsychology at TELUS Health Care Centres in Calgary and the University of Calgary where he trains PhD and Masters level psychologists.. He works mostly with brain injuries, dementia, Parkinson’s, Multiple Sclerosis, and other neurological conditions that affect cognition. He says,
“If you get referred to us, we do more robust testing of memory and attention and other cognitive areas, after a screener from your GP like a MoCA. We also look for depression and anxiety, as those can affect cognitive ability as well. We then relate the tests we do to the hippocampus, or the thalamus – brain parts that we know are related to memory, or other areas and neural networks. We look at your medical history, your MRIs and CT scans and so on, and we put it all together and look to get a diagnosis or treatment moving forward.”
A lot of the research done by cognitive scientists – like Jonathan Wilbiks in the Brain and Cognitive Sciences Section (see earlier Psychology Month piece) informs the work done by clinical neuropsychologists. The cognitive scientists come up with research and data, and it’s then up to clinical neuropsychologists to apply that knowledge in a clinical setting to enhance the lives of their patients. And those patients vary a great deal depending on their condition, their symptoms, and their age. Says Dr. Bharadia,
“If you’re a 25-year-old presenting with symptoms of depression, you’re probably not going to see a neuropsychologist. You’re more likely to see a clinical psychologist, or a counselor, and maybe a general practitioner (GP) for medication. But if you’re a 55-year-old with depression, hopefully the GP is thinking ‘what else could this be? What else looks like depression in your 50s?’ With a few other factors in your medical history and things you might see on an MRI, it could be a symptom of Frontotemporal Dementia, which can look like depression in certain age groups. At which point they might be a good candidate for testing with a neuropsych to refine the diagnosis.”
This means neuropsychologists work a lot with GPs, psychiatrists, neurologists who are doing MRIs, and many other professionals in the world of brain science all of whom have overlapping expertise. If the 55-year-old with symptoms of depression meets with this team, they may determine that the cause is neurological – in which case they will suggest one treatment path. If, however, they determine the cause is psychological, a neuropsychologist is trained (remember – they are clinical psychologists first) to work with the person to heal.
Neuropsych as a formal field is 70 years old. The seminal work of Dr. Brenda Milner at McGill in the 50s with patient H.M. was groundbreaking in our understanding of memory. This revolutionary work was done alongside neurosurgeon Dr. Wilder Penfield. Dr. Milner is STILL PRACTISING at McGill at age 102. Some other pioneers set up a neuropsychology program at the University of Victoria, where Dr. Gicas did her undergrad. This, (along with her fascination with the brain and fervor for science in general) led her down this path. She says,
“I remember reading a book by Oliver Sacks, called The Man Who Mistook His Wife For A Hat (1985). It’s a series of neurological kinds of cases and I was just hooked after that.”
In an episode of Parks and Recreation, Ben can’t understand the relationship between Jerry (Jim O’Heir) and his noticeably better-looking wife Gayle (Christie Brinkley) and speculates that it is as a result of a neurological disorder (“one of those Oliver Sacks disorder thingies – like maybe she thinks Jerry is a friendly hat?”). It may not be the best example of neuropsychology in popular culture, in that it gets it quite wrong – but it isn’t that easy a study to get right! That is, unless you can circumvent the cumulative effect of all the difficult nomenclature.