ABSTRACT
Owing to the complexities of potential cognitive injury following traumatic brain injury (TBI), it is important to quantify the measurement of cognitive status following TBI. This is necessary in order to document the deficits of the patient and necessary in order to develop a comprehensive treatment plan for the patient. For instance, without baseline memory testing, how does one document memory change after prescription of cognitive enhancers? This chapter focuses on the strengths and weaknesses of neuropsychological assessment. Our neuropsychology colleagues have contributed greatly to the understanding of cognitive measurement. Adolf Meyer1 also contributed to the consistency of the examination of human mental status. When the formal mental status examination was introduced by Meyer at Johns Hopkins University Medical School in 1918, the procedure became the sine qua non for the training of American psychiatrists to this day. However, its inherent weakness is its lack of standardization, and it contains no significant reproducible metrics. On the other hand, its qualitative power is immense, and it has been incorporated into the mental examinations of persons with psychiatric diseases in every country in the world where psychiatrists practice. To say that it is not standardized means that it was not empirically tested and it contains neither precise rules for administration nor precise rules for scoring. It is an extensive narrative description of patient behavior based on face-to-face observation by the physician and the application of a few bedside oral tests. It retains significant subjectivity. This examination, while an important part of clinical psychiatry, is not sufficiently quantified to detect the often subtle changes that may occur in the mental status of persons afflicted with TBI. Lord Kelvin has reminded us of the importance of measurement,2 and his admonition applies to cognitive examination as well:
Psychiatrists have applied recently many qualitative questionnaires and standardized forms for recording various aspects of mental status including depression, anxiety, psychosis, and others.3
These are widely useful when applied to the longitudinal assessment of patients receiving treatment with antidepressants, antipsychotics, and in various research paradigms where the study of new psychiatric medicines is undertaken during phase II and phase III clinical studies before marketing. Table 6.1 outlines the strengths and weaknesses of these examinations. The reader requiring further information or the direct use of forms such as the Beck,3 Hamilton,3 and others should consult with reference 3.
