What traditional neuropsychological assessment got wrong about mild traumatic brain injury. I: historical perspective, contemporary neuroimaging overview and neuropathology update.

Abstract

Primary objective: This is Part I of a four-part review that examines traditional neuropsychological assessment methods and techniques in mild traumatic brain injury (mTBI). Absence of neuropsychological findings has been used to argue no residual neuropathological effects from mTBI. However, given the current potential that advanced multimodality and quantitative neuroimaging can now demonstrate about underlying neurobiology of brain-behavior relations, this review shows that traditional neuropsychological test as standalone findings cannot directly address the underlying complexities of detecting mTBI neuropathology.

Research design: This is a review.

Methods and procedures: Traditional neuropsychological tests, their development, methods and conclusions over the past 50+ years are the centerpiece of this review juxtaposed with 21^st century advanced neuroimaging and improved understanding of the neurobiology and potential neuropathology of mTBI.

Main outcome and results: Traditional neuropsychological methods were never developed for detecting subtle changes in neurocognitive or neurobehavioral functioning as a standalone procedure and likewise, never designed to address the multifaceted issues related to symptom burden from having sustained a mTBI, especially after three-months post-injury. Advanced neuroimaging methods have the potential to inform the clinician and researcher about potential neurobiological factors to best understand relevant neuropsychological outcome factors associated with mTBI outcome. A model is presented that helps explain how adaptation and accommodation may occur after mTBI within the context of 'normal' traditional neuropsychological test findings.

Conclusions: The limitations of traditional neuropsychological testing in mTBI outlined within the context of how advanced neuroimaging improves our understanding of mTBI outcome.