Washington, DC; April 1, 2020: New, Simple Blood Test Renders Neuropsychology Irrelevant
Are neuropsychologists now obsolete? New testing just approved by the government would suggest yes. The NIH and FDA jointly announced a new blood test today called Neurbegone ™ that will further erode the relevance of neuropsychologists. It comes on the heals of studies like this one on another blood test, as noted in this NIH Press Release about how “researchers report an advance in the development of a blood test that could help detect pathological Alzheimer’s disease in people who are showing signs of dementia. This approach could be less invasive and less costly than current brain imaging and spinal fluid tests.” The emergence and proliferation of medical tests leading to a decline in the relevance of neuropsychology should come as no surprise; there have been warnings. For example, Ronald Ruff wrote in A friendly critique of neuropsychology: facing the challenges of our future that “Neuropsychology emerged as a discipline in the 1940s when prior to performing a craniotomy, neurosurgeons based their localization on EEGs, X-rays and neuropsychological test results. This practice ended in the mid 1970s when computerized tomography became available. As the neuropsychologists’ role in localizing has become miniscule, the referral questions have shifted to obtaining quantitative descriptions of the patient’s cognitive status. The current paper explores future directions for neuropsychology on the basis of asking the following question: Are we meeting the needs of the patients? The answer is clear: Patients’ needs are not met by merely diagnosing cognitive deficits.” Ruff writes in the paper “our test scores do not directly determine functional consequences. “
With this lack of looking at real world “functional consequences–” actual impairment (not just pretend statistical impairment)– along with this new blood test approved today, neuropsychology has become irrelevant. Of course, the typical neuropsychology report is rife with the word impairment but it is often not applied in a way which reflects actual, real-world impairment. Instead of comparing test scores to peoples’ abilities to do specific tasks or other real world criteria, many simply rely on norms which compare their scores to a hypothetical normal population. They assume a bell curve or normal distribution in the population and then tag the term “impairment” on to people who have scores that deviate too far from what we describe as normal based on those assumptions. Decker and others noted “Neuropsychologists frequently rely on a battery of neuropsychological tests which are normally distributed to determine impaired functioning. The statistical likelihood of Type I error in clinical decision-making is in part determined by the base rate of normative individuals obtaining atypical performance on neuropsychological tests. Base rates are most accurately obtained by co-normed measures, but this is rarely accomplished in neuropsychological testing.” It goes beyond this however. While these people statistically-labeled impaired may or may not be real-world impaired, attaching labels using statistical means like mild impairment or moderate impairment or borderline impairment means next to nothing. It is of little or no use and is more likely to cause confusion in a consumer of the report rather than help. It certainly didn’t help neuropsychologists’ chances at relevance that the field has no good way to effectively communicate functional consequences– actual real world impairment– in a standardized fashion. It didn’t help them that there is limited data available to translate their testing results in to real-world functional consequences. It likely would have slowed the impending irrelevance of neuropsychology if they used terms other than impairment as qualitative descriptors for their quantitative test score ranges. Perhaps then their researchers would have focused more attentively on the problem. Perhaps then their reports might have actually contained more detailed clinical interviews with anecdotes about real-world functional impairment that they could clinically correlate with the obtained test scores. Perhaps then their reports might have actually contained more detailed mental status observations- directly observed signs of impairment which they could clinically correlate with the obtained test scores. These could be used to then support actual opinions about how any cognitive problems may impact their daily lives. Simply giving us a vague qualitative term spit out directly from a test score statistically derived from a normal curve didn’t save neuropsychology. It is amusing given that the qualitative terms used change from test to test, are vague and as noted in the WISC-V Technical and Interpretative Manual (pg. 152) “qualitative descriptors are only suggestions and are not evidence-based.”
Is there something wrong with using assumptions based on a normal curve? The normal curve can be helpful, but remember the real world can often be more squishy. We’ve had a tumultuous few months with the coronavirus (COVID-19). Imagine what life would be like if there was a zombie virus and the majority of the population suddenly craved human flesh? Before the zombie apocalypse we could administer a neuropsychological battery and statistically derive who was impaired compared to the theoretical normal population. After the zombie apocalypse we’d just need new norms to see which percentage of the zombies were the most cognitively impaired and near the bottom few percent– though in reality none of them could accomplish the cognitive tasks we would likely put in front of them (or go to work without impulsively trying to eat a coworker). A huge percentage of the population would have significant functional consequences, not just the bottom two percent. The incidence in the population isn’t always the most important factor when it comes to “functional consequences,” is it? Amusingly, some neuropsychologists will put a patient through hours and hours of testing and only produce a one page report as a result. Some are better than others. Hey, while Dr. Jacobus Donders writes reports that are only a miserly two to three pages long, at least he includes all of the test scores. Some neuropsychologists won’t even include the supporting test results. Neuropsychologist’s reports are often the postcards of the psychological world; they spent two long weeks on a vacation but the only news we get is a glossy picture with a terse and pithy scrawl that tells us next to nothing about it. If neuropsychology hadn’t hitched their wagon to writing vague, overly brief reports (often refusing to even release their supporting data) that relay the statistically-derived “impairment” of somewhat imaginary psychological constructs, perhaps neuropsychology may have survived the release of this new blood test. Instead, like a horde of zombies major advances in biomarkers and biological testing have devoured the relevance of what was once a proud profession. Is there still time for neuropsychologists to correct their ways and improve their reports before the impact of Neurbegone ™ diminishes their specialty to nothing? I don’t think so. Neurbegone ™ testing is available now at a healthcare provider near you.
Thanks for reading this annual April 1st satire post. I was snoozing and missed April 1, 2019 last year (sorry); so I’m giving you TWO April Fools blog posts this year.
Here are a few more April 1 posts from past years that you can also read:
- T-Minus 6 Months ’til the APA Practice Organization Self-Destructs (2018)
- ASPPB Partners with Amazon to Disrupt Mental Health with EPPP Step 2 (2017)
- American Psychological Association to end use of APA Style by 2020 (2016)
P.S. Don’t shout “brains!” when pretending to be a zombie- no self-respecting Zombie Virus would ever evolve to quickly destroy the means for its own transmission, i.e. zombies won’t likely be interested in eating brains if the virus itself can help it because then that victim would only be a corpse not a new zombie to further transmit the virus because zombies are killed by destroying the brain forgive the run on sentence I figured I’d just go ahead and make it worse and I hope you have enough toilet paper and bottled water and cough medicine and smiles and stay safe and stay amused: Hey! You can Subscribe to get the latest Psychology.news blog posts in your email! and/or visit me at: Todd Finnerty, Psy.D.