Scandinavian Journal of Psychology, 2014, 55, 189–190
DOI: 10.1111/sjop.12097
Introduction A lifetime in neuropsychology – perspectives on an era IVAR REINVANG University of Oslo, Department of Psychology
The period from late 1960s to the present has seen a revolution in neuroscience, including cognitive neuroscience and neuropsychology. This coincides with the period that the author has been active in the field, and some personal observations may provide a window on development in this time period as experienced by a scientist/practitioner in the field. My career has taken me via several institutions, several patient groups, several problems facing neuropsychologists, and several methodological and conceptual ways of thinking about them. These are the trends I would like to look back on, concluding with some remarks on neuropsychology on the present scene of cognitive and clinical neuroscience. During the years I have worked with many good colleagues, including the present editors and many of the contributors, and I ask their understanding for not explicitly acknowledging their names. I became interested in neuropsychology as a psychology student in the middle 1960s, when it became clear to me that some philosophical issues, such as the importance of language for abstract thinking, could not make progress without being made object of empirical study. Patients with language problems after brain injury seemed to me to be a highly relevant study population. I was fortunate enough to be welcomed at the Department of Neurosurgery at Ullev al Hospital in Oslo, and I was able to complete my master thesis there. In the 1950s and 60s there were still some issues about cerebral specialization, and Karl Lashley’s theory of cortical equipotentiality would often be quoted as a possible model for cerebral organization. A not uncommon view was that general clinical assessment methods like the Rorschach ink blot test were good tests of “organicity.” The term organicity denoted a loss of “abstract attitude” common to patients with brain injuries. At the Department of Neurosurgery, professor Kristian Kristiansen was performing epilepsy surgery, and he was keenly aware of the work in Montreal showing specialized functions of the left and right temporal lobes. The ground was therefore prepared for a more specific approach to neuropsychology, and at that time the modified Halstead battery (Halstead, 1947) was our methodology of choice. There were at this time only crude and stressful radiological and physiological procedures available for localization of cerebral abnormalities, and neuropsychological methods were an important part of the pre-operative workup. My interest in language problems fit well with plans for establishing a center for study of stroke patients at the Sunnaas rehabilitation hospital. Through the influence of my mentors I had the opportunity to prepare for a role in the project by way of a post-graduate training position at the Department of Cognitive and Brain Sciences at Massachusetts Institute of Technology. © 2014 Scandinavian Psychological Associations and John Wiley & Sons Ltd
The department had recently been established according to the visions of Hans-Lukas Teuber, who was also the chairman. The vision included an interdisciplinary faculty, including neuroanatomists, neurophysiologists, psycholinguists, developmental psychologists and neuropsychologists. A paradigm shift in psychological thinking substituting cognitive for behavioristic models (Neisser, 1967) had taken place, and experimental cognitive studies of hemispheric specialization was a dominant topic. I was exposed to all these influences, which were expounded by brilliant people, and needless to say they had a profound influence on me. My work on aphasia and stroke included developing a Norwegian aphasia test along the principles of the Boston Diagnostic Aphasia Examination (Goodglass & Kaplan, 1972). The classic schema of language localization of Broca and Wernicke had been revitalized and come to be accepted again, and methodologies to classify patients into the major aphasia types were developed in several countries. During my time at Sunnaas Rehabilitation Hospital we studied close to 250 patients with aphasia, and looked at the prognosis and non-verbal deficits associated with different aphasia types. By the late 1970s computerized tomography (CT) had become available, and I was able to ascertain that the correspondence between aphasia type and localization of lesion was far from perfect. That got me started thinking that the relation between localization of lesion and symptomatology was more dynamic and complex than could be captured in a simple schema, and I presented these speculations in a book summarizing my research on aphasia (Reinvang, 1985). Moving on to Rikshospitalet (Oslo University Hospital) in 1986 I was confronted with the diagnostic demands of a busy clinic with time pressure and a wide range of referrals. It became clear that the classic cases with localized lesions could be diagnosed with newly developed radiological tools (CT, MRI and SPECT). The need for neuropsychological support for diagnosis was now focused on cases with possible diffuse injuries, metabolically based impairments, and neuropsychiatric cases. I was uncomfortable with only applying methods based on validation in patients with large localized injuries to these conditions and tried in different ways to extend our range of tools. Firstly by introducing different reaction time based batteries and later by adding event related potentials (ERP) to our neuropsychological laboratory. To venture into ERP research was a challenging and complex undertaking, and I must admit that it never became a standardized procedure that could be fully integrated in daily clinical practice. However, some significant clinical research came out of it, which I think threw light on processing
190 I. Reinvang mechanisms in mild head injury (Solbakk, Reinvang, Nielsen and Sundet, 1999). The neuropsychological thinking of Alexander Luria (see Christensen, 1975) had become popular in several Scandinavian countries. While being sympathetic to the process oriented approach implied, Norwegian neuropsychologists remained solidly anchored in an Anglo-American tradition. Major developments leading to the professionalization of Norwegian clinical neuropsychology took place in the 1980s. Clinical neuropsychology was recognized as a specialty by the Norwegian Psychological Association, and refunds for neuropsychological testing was successfully negotiated with the National Health Insurance Scheme. Professor Halgrim Kløve at the University of Bergen played a major role in this development. Later the Norwegian Neuropsychological Association was formed, with an important role in securing continuing high professional standards. In the middle 1990s I became full professor of clinical neuropsychology at the University of Oslo. It soon became clear to me that aging is the most significant neurobiological process taking place in all of us, besides being a biasing factor for many neurodegenerative diseases. For establishing a broad research program including molecular genetics, brain imaging and cognition, we needed a collaborative effort comprising researchers with different areas of expertise and representing different institutions. I was fortunate in securing support from the Norwegian Research Council and later from the Center for Advanced Study at the Norwegian Academy of Sciences for such a program of research. The Norwegian Cognitive NeuroGenetics (NCNG) sample (Espeseth, Christoforou, Lundervold et al., 2012) is a life-span sample of healthy individuals, and data from this sample has enabled us to take part in several international multicenter studies (Davies, Tenesa, Payton et al., 2011). In looking at the contemporary scene in cognitive and clinical neuroscience research I cannot help noting with some concern that there has been little methodological progress in clinical neuropsychology. Pencil and paper examinations that were introduced more than 50 years ago are still household items, and the same methods are used regardless of context and purpose. Neuropsychological tests may be useful for two reasons, one because they are predictive of daily life function and the other because they are informative of underlying neurocognitive mechanisms.
© 2014 Scandinavian Psychological Associations and John Wiley & Sons Ltd
Scand J Psychol 55 (2014)
Localization of lesion is no longer a major concern. Our methods cannot fulfill both these needs, and I think that our current methods load more heavily on the first than the second objective, while being optimal for neither one. I can see a trend towards more differentiation of methods in which some move even more closely in the direction of ecological validity, while others aim for dissecting specific mechanisms. In schizophrenia research this is seen clearly with development of the CNTRICS effort focusing on cognitive neuroscience methods that lend themselves to integration with animal models and molecular genetics studies (Carter & Barch, 2007). While both trends are important, I hope to see a continuing effort to place cognitive neuropsychology as a central conceptual and methodological aspect of interdisciplinary neuroscience.
REFERENCES Carter, C. S. & Barch, D. M. (2007). Cognitive neuroscience-based approaches to measuring and improving treatment effects on cognition in schizophrenia: The CNTRICS initiative. Schizophrenia Bulletin, 33(5), 1131–1137. Christensen, A.-L. (1975). Luria’s neuropsychological investigation. Copenhagen: Munksgaard. Davies, G., Tenesa, A., Payton, A., Yang, J., Harris, S. E., Liewald, D., Ke, X., Le Hellard, S., Christoforou, A., Luciano, M., McGhee, K., Lopez, L., Gow, A. J., Corley, J., Redmond, P., Fox, H. C., Haggarty, P., Whalley, L. J., McNeill, G., Goddard, M. E., Espeseth, T., Lundervold, A. J., Reinvang, I., Pickles, A., Steen, V. M., Ollier, W., Porteous, D. J., Horan, M., Starr, J. M., Pendleton, N., Visscher, P. M. & Deary, I. J. (2011). Genome-wide association studies establish that human intelligence is highly heritable and polygenic. Molecular Psychiatry, 16(10), 996–1005. Espeseth, T., Christoforou, A., Lundervold, A. J., Steen, V. M., Le Hellard, S. & Reinvang, I. (2012). Imaging and cognitive genetics: The Norwegian Cognitive NeuroGenetics sample. Twin Research & Human Genetics, 15(3), 442–452. Goodglass, H. & Kaplan, E. (1972). The assessment of aphasia. Philadelphia, PA: Lea and Febiger. Halstead, W. C. (1947). Brain and intelligence. Chicago, IL: University of Chicago Press. Neisser, U. (1967). Cognitive psychology. New York: Appleton-CenturyCrofts. Reinvang, I. (1985). Aphasia and brain organization. New York: Plenum Press. Solbakk, A. K., Reinvang, I., Nielsen, C. & Sundet, K. (1999). ERP indicators of disturbed attention in mild closed head injury: A frontal lobe syndrome? Psychophysiology, 36(6), 802–817.
DOI: 10.1111/sjop.12097
Introduction A lifetime in neuropsychology – perspectives on an era IVAR REINVANG University of Oslo, Department of Psychology
The period from late 1960s to the present has seen a revolution in neuroscience, including cognitive neuroscience and neuropsychology. This coincides with the period that the author has been active in the field, and some personal observations may provide a window on development in this time period as experienced by a scientist/practitioner in the field. My career has taken me via several institutions, several patient groups, several problems facing neuropsychologists, and several methodological and conceptual ways of thinking about them. These are the trends I would like to look back on, concluding with some remarks on neuropsychology on the present scene of cognitive and clinical neuroscience. During the years I have worked with many good colleagues, including the present editors and many of the contributors, and I ask their understanding for not explicitly acknowledging their names. I became interested in neuropsychology as a psychology student in the middle 1960s, when it became clear to me that some philosophical issues, such as the importance of language for abstract thinking, could not make progress without being made object of empirical study. Patients with language problems after brain injury seemed to me to be a highly relevant study population. I was fortunate enough to be welcomed at the Department of Neurosurgery at Ullev al Hospital in Oslo, and I was able to complete my master thesis there. In the 1950s and 60s there were still some issues about cerebral specialization, and Karl Lashley’s theory of cortical equipotentiality would often be quoted as a possible model for cerebral organization. A not uncommon view was that general clinical assessment methods like the Rorschach ink blot test were good tests of “organicity.” The term organicity denoted a loss of “abstract attitude” common to patients with brain injuries. At the Department of Neurosurgery, professor Kristian Kristiansen was performing epilepsy surgery, and he was keenly aware of the work in Montreal showing specialized functions of the left and right temporal lobes. The ground was therefore prepared for a more specific approach to neuropsychology, and at that time the modified Halstead battery (Halstead, 1947) was our methodology of choice. There were at this time only crude and stressful radiological and physiological procedures available for localization of cerebral abnormalities, and neuropsychological methods were an important part of the pre-operative workup. My interest in language problems fit well with plans for establishing a center for study of stroke patients at the Sunnaas rehabilitation hospital. Through the influence of my mentors I had the opportunity to prepare for a role in the project by way of a post-graduate training position at the Department of Cognitive and Brain Sciences at Massachusetts Institute of Technology. © 2014 Scandinavian Psychological Associations and John Wiley & Sons Ltd
The department had recently been established according to the visions of Hans-Lukas Teuber, who was also the chairman. The vision included an interdisciplinary faculty, including neuroanatomists, neurophysiologists, psycholinguists, developmental psychologists and neuropsychologists. A paradigm shift in psychological thinking substituting cognitive for behavioristic models (Neisser, 1967) had taken place, and experimental cognitive studies of hemispheric specialization was a dominant topic. I was exposed to all these influences, which were expounded by brilliant people, and needless to say they had a profound influence on me. My work on aphasia and stroke included developing a Norwegian aphasia test along the principles of the Boston Diagnostic Aphasia Examination (Goodglass & Kaplan, 1972). The classic schema of language localization of Broca and Wernicke had been revitalized and come to be accepted again, and methodologies to classify patients into the major aphasia types were developed in several countries. During my time at Sunnaas Rehabilitation Hospital we studied close to 250 patients with aphasia, and looked at the prognosis and non-verbal deficits associated with different aphasia types. By the late 1970s computerized tomography (CT) had become available, and I was able to ascertain that the correspondence between aphasia type and localization of lesion was far from perfect. That got me started thinking that the relation between localization of lesion and symptomatology was more dynamic and complex than could be captured in a simple schema, and I presented these speculations in a book summarizing my research on aphasia (Reinvang, 1985). Moving on to Rikshospitalet (Oslo University Hospital) in 1986 I was confronted with the diagnostic demands of a busy clinic with time pressure and a wide range of referrals. It became clear that the classic cases with localized lesions could be diagnosed with newly developed radiological tools (CT, MRI and SPECT). The need for neuropsychological support for diagnosis was now focused on cases with possible diffuse injuries, metabolically based impairments, and neuropsychiatric cases. I was uncomfortable with only applying methods based on validation in patients with large localized injuries to these conditions and tried in different ways to extend our range of tools. Firstly by introducing different reaction time based batteries and later by adding event related potentials (ERP) to our neuropsychological laboratory. To venture into ERP research was a challenging and complex undertaking, and I must admit that it never became a standardized procedure that could be fully integrated in daily clinical practice. However, some significant clinical research came out of it, which I think threw light on processing
190 I. Reinvang mechanisms in mild head injury (Solbakk, Reinvang, Nielsen and Sundet, 1999). The neuropsychological thinking of Alexander Luria (see Christensen, 1975) had become popular in several Scandinavian countries. While being sympathetic to the process oriented approach implied, Norwegian neuropsychologists remained solidly anchored in an Anglo-American tradition. Major developments leading to the professionalization of Norwegian clinical neuropsychology took place in the 1980s. Clinical neuropsychology was recognized as a specialty by the Norwegian Psychological Association, and refunds for neuropsychological testing was successfully negotiated with the National Health Insurance Scheme. Professor Halgrim Kløve at the University of Bergen played a major role in this development. Later the Norwegian Neuropsychological Association was formed, with an important role in securing continuing high professional standards. In the middle 1990s I became full professor of clinical neuropsychology at the University of Oslo. It soon became clear to me that aging is the most significant neurobiological process taking place in all of us, besides being a biasing factor for many neurodegenerative diseases. For establishing a broad research program including molecular genetics, brain imaging and cognition, we needed a collaborative effort comprising researchers with different areas of expertise and representing different institutions. I was fortunate in securing support from the Norwegian Research Council and later from the Center for Advanced Study at the Norwegian Academy of Sciences for such a program of research. The Norwegian Cognitive NeuroGenetics (NCNG) sample (Espeseth, Christoforou, Lundervold et al., 2012) is a life-span sample of healthy individuals, and data from this sample has enabled us to take part in several international multicenter studies (Davies, Tenesa, Payton et al., 2011). In looking at the contemporary scene in cognitive and clinical neuroscience research I cannot help noting with some concern that there has been little methodological progress in clinical neuropsychology. Pencil and paper examinations that were introduced more than 50 years ago are still household items, and the same methods are used regardless of context and purpose. Neuropsychological tests may be useful for two reasons, one because they are predictive of daily life function and the other because they are informative of underlying neurocognitive mechanisms.
© 2014 Scandinavian Psychological Associations and John Wiley & Sons Ltd
Scand J Psychol 55 (2014)
Localization of lesion is no longer a major concern. Our methods cannot fulfill both these needs, and I think that our current methods load more heavily on the first than the second objective, while being optimal for neither one. I can see a trend towards more differentiation of methods in which some move even more closely in the direction of ecological validity, while others aim for dissecting specific mechanisms. In schizophrenia research this is seen clearly with development of the CNTRICS effort focusing on cognitive neuroscience methods that lend themselves to integration with animal models and molecular genetics studies (Carter & Barch, 2007). While both trends are important, I hope to see a continuing effort to place cognitive neuropsychology as a central conceptual and methodological aspect of interdisciplinary neuroscience.
REFERENCES Carter, C. S. & Barch, D. M. (2007). Cognitive neuroscience-based approaches to measuring and improving treatment effects on cognition in schizophrenia: The CNTRICS initiative. Schizophrenia Bulletin, 33(5), 1131–1137. Christensen, A.-L. (1975). Luria’s neuropsychological investigation. Copenhagen: Munksgaard. Davies, G., Tenesa, A., Payton, A., Yang, J., Harris, S. E., Liewald, D., Ke, X., Le Hellard, S., Christoforou, A., Luciano, M., McGhee, K., Lopez, L., Gow, A. J., Corley, J., Redmond, P., Fox, H. C., Haggarty, P., Whalley, L. J., McNeill, G., Goddard, M. E., Espeseth, T., Lundervold, A. J., Reinvang, I., Pickles, A., Steen, V. M., Ollier, W., Porteous, D. J., Horan, M., Starr, J. M., Pendleton, N., Visscher, P. M. & Deary, I. J. (2011). Genome-wide association studies establish that human intelligence is highly heritable and polygenic. Molecular Psychiatry, 16(10), 996–1005. Espeseth, T., Christoforou, A., Lundervold, A. J., Steen, V. M., Le Hellard, S. & Reinvang, I. (2012). Imaging and cognitive genetics: The Norwegian Cognitive NeuroGenetics sample. Twin Research & Human Genetics, 15(3), 442–452. Goodglass, H. & Kaplan, E. (1972). The assessment of aphasia. Philadelphia, PA: Lea and Febiger. Halstead, W. C. (1947). Brain and intelligence. Chicago, IL: University of Chicago Press. Neisser, U. (1967). Cognitive psychology. New York: Appleton-CenturyCrofts. Reinvang, I. (1985). Aphasia and brain organization. New York: Plenum Press. Solbakk, A. K., Reinvang, I., Nielsen, C. & Sundet, K. (1999). ERP indicators of disturbed attention in mild closed head injury: A frontal lobe syndrome? Psychophysiology, 36(6), 802–817.
