Current limitations of neuropsychological tests and assessment procedures

Objective: Neuropsychological tests are used for a wide variety of purposes: assessing basic cognitive abilities or disabilities; determining cognitive patterns associated with brain disorders or injury; exploring brain-behavior relationships; and, in some cases, addressing psycho-legal issues. This paper will focus on the limitations of current neuropsychological tests for these purposes. Method: Current limits of neuropsychological tests and assessment procedures are reviewed and recommendations for improvements are made. The relationship between the conceptual basis of neuropsychological tests and modern theories of brain functional organization is discussed. In addition, psycho-legal concerns are briefly outlined. Conclusions: Existing tests and techniques can be improved. Normative data for some neuropsychological tests are based on small samples or have limited validity or reliability data. A variety of neuropsychological tests are available but particular cognitive domains are underrepresented, particularly those involving high-level cognitive skills and social skills. Progress is being made in the availability of tests in multiple languages, but the restricted range of languages and cultural influences demands more attention. Standard test procedures often deviate from real-world activities. In this modern age, some tests have become too familiar because of the Internet. Understanding of complex neural networks activated by cognitive tasks is only beginning to be appreciated. Procedures for determining psycho-legal issues need improvements in some areas.