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March 6th, 2015

Damasio in Descartes’ error: Emotion, reason, and the human brain (1994), observes:

The standardized psychological and neuropsychological tests revealed a superior intellect. . . Elliot performed normally on memory tests employing interference procedures.. . . In short, perceptual ability, past memory, short‐term memory, new learning, language, and the ability to do arithmetic were intact. Attention, the ability to focus on a particular mental content to the exclusion of others, was also intact, and so was working memory. . . My prediction that Elliott would fail on tests known to detect frontal lobe dysfunction was not correct. . . . What was the chance he would fare well in the prime personality test, the Minnesota Multiphasic Personality Inventory, also known as the MMPI? As you may have guessed by now, Elliot was normal in that one too. . . After all these tests, Elliot emerged as a man with a normal intellect who was unable to decide properly, especially when the decision involved personal or social matters.

Could it be that reasoning and decision making in the personal and social domain were different from reasoning and thinking in domains concerning objects, space, numbers, and words? Might they depend on different neural systems and processes? I had to accept the fact that despite the major changes that had followed his brain damage, nothing much could be measured in the laboratory with the traditional neuropsychological instruments. Other patients had shown this sort of dissociation. (pages 41–43)

As neuropsychologists, we are asked to assess an individual’s ability to carry out complex everyday tasks including social interactions and juggling plans for the future. We try our best, in a limited amount of time, to capture executive functions with standardized measures in an artificial setting. It’s important to remember the importance of supplementing formal measures with informal information gathering. This could entail the addition of a process approach to assessment, or, more indirect methods such as naturalistic observation, collateral interviews, and an item-level analysis of behavioral-executive-function rating scales.

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