Trajectories #5: Clinical Neuropsychology: The Role of the Practitioner Between Brain Injury and Dementia

Introduction to the theme of the month

This month, our library delves into territory made up of neurons, memories, and identities: the world of clinical neuropsychology.

Talking about the brain means talking about ourselves — about how we construct reality, how we remember it, how we recognize ourselves over time. And when these functions falter, what is at stake is not just a diagnosis, but a life story.

In this issue, we explore the neuropsychologist's work between acquired brain injuries, dementia, and the suspended, delicate territory that is Mild Cognitive Impairment: a space where prevention and support become as therapeutic an intervention as any standardized test.

You'll find first-person accounts from those who chose this profession out of curiosity and carefully embraced it, reflections on multidisciplinary teamwork, clinical tools, and reading prompts for those who want to continue exploring the relationship between mind, brain, and person.

An invitation, as always, to stay in complexity — and remember that behind every cognitive function there is someone who tries to find each other.

Happy reading! The Developmental Library

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I tell my world of neuropsychology

Good morning everyone,

I'm Agnese Del Rosso, a psychologist in the neuropsychological field, and my journey stems from a simple yet powerful curiosity: understanding how the brain constructs who we are.

I attended the three-year program in Technical and Psychological Sciences in Florence, during whose last year I discovered this fascinating world of neuropsychology. This prompted me to choose an extremely specific master's degree, in Neuroscience and Neuropsychological Rehabilitation in Bologna (based in Cesena). After graduation, I began my internship in the hospital, in the rehabilitation medicine department. It was there that the theory began to take real form.

No longer just cognitive functions studied in books, but people: people who had lost words, memories, autonomy; people trying to rebuild a daily life after a brain injury; family members trying to navigate a suddenly changed reality.

It is in that context that I really understood what it means to be a neuropsychologist.

At the same time, part of the internship consisted of cognitive stimulation activities with people with Mild Cognitive Impairment (MCI), a condition that lies between physiological aging and dementia. It is a delicate, suspended space, where it is still possible to intervene to slow decline and promote active aging through cognitive stimulation.

And perhaps this is the heart of my work: not just evaluating or rehabilitating, but accompanying.

Who is the neuropsychologist and what does he or she do

A neuropsychologist is a professional who studies and intervenes in the relationships between the brain and cognitive, emotional, and behavioral functions.

I work mainly with people who present:

• Acquired brain injuries (stroke, head trauma, brain tumors)

• Neurodegenerative diseases (such as dementias)

 (Let's talk about adulthood, for developmental age there is much much more)

Adulthood - Acquired Brain Injuries:

A stroke, hemorrhage, or trauma can alter fundamental functions such as:

• Language 

• Memory

• Attention

• Executive functions

• Visuospatial skills

• Behavior

The damage is not just neurological: it is existential. The person must reorganize their identity, and the neuropsychologist is an active part of this process.

Dementia and aging

Dementias, including Alzheimer's disease, the one best known to all*, represent a major global health challenge.

According to the scientific literature, early interventions on cognitive decline (such as in MCI) can slow progression and improve quality of life.

In a context like the Italian one, characterized by a progressive aging of the population, neuropsychology plays a central role not only in treatment but also in prevention.

The role of the neuropsychologist in the hospital

In the hospital setting, the neuropsychologist works within multidisciplinary teams together with doctors, physiotherapists, speech therapists, physiatrists and occupational therapists. His contribution is fundamental to:

• Evaluate the patient's cognitive profile through standardized tests and batteries 

• Contributing to diagnosis

• Plan personalized neuropsychological rehabilitation interventions (for different cognitive functions)

• Support patients and family members

The literature highlights how a multidisciplinary approach significantly improves rehabilitation outcomes, especially in the post-acute phases of brain injury.

Methods and tools of neuropsychological work

Neuropsychological assessment:

In very many cases it is the starting point. Through standardized tests, the neuropsychologist analyzes various cognitive functions:

• Memory (e.g. verbal and visual memory tests)

• Attention

• Language

• Executive functions

These tools allow you to:

• Identify specific deficits

• Make differential diagnosis

• Monitor evolution over time

• Neurological skills

The neuropsychologist must know:

• Anatomy and functioning of the brain

• Neuroanatomical correlates of cognitive functions

• Mechanisms of neurological pathologies

This integration of psychology and neurology is what makes neuropsychology a unique discipline.

Rehabilitation and intervention

Interventions are based on scientific evidence and include:

• Cognitive stimulation (particularly effective in dementias)

• Specific training for memory, attention, executive functions

• Compensatory strategies (agenda, routines, external supports)

• Psychoeducational interventions for patients and caregivers

Numerous studies show that cognitive stimulation can improve or maintain cognitive function and reduce behavioral symptoms in dementias.

Clinical Case

A 72-year-old man arrives for evaluation accompanied by his wife.

• “He forgets  things”, she says.

• “It's normal, I'm my age”, he replies.

During the interview, something emerges: difficulties in short-term memory tasks, but with an overall picture that is not extremely compromised, which affects his daily autonomy (a discriminating factor for a diagnosis of dementia!)

The neuropsychological evaluation highlights a profile compatible with Mild Cognitive Impairment, therefore not yet a picture of dementia! 

But the work doesn't stop at diagnosis.

The wife looks tired, worried.

He alternates moments of awareness with denial.

In this space, the work of the neuropsychologist is twofold:

• Cognitive, through stimulation interventions

• Psychological, through emotional support and adaptation to the diagnosis

Because we don't just work with cognitive functions, but with people and their relationships.

Reflection

When we talk about memory, we're not just talking about a cognitive function.

We’re talking about identity. 

When this falters, what is at stake is not just “remembering”, but recognizing oneself.

Neuropsychology teaches us that care is not just recovery, but also adaptation, accompaniment, dignity.

Tools and Resources

• Scientific readings

  • Petersen et al. (2014) – Mild Cognitive Impairment

  • Clare & Woods (2004) – Cognitive training and rehabilitation in dementia

  • Livingston et al. (2020) – Dementia prevention, intervention, and care (Lancet Commission)

• Clinical instruments

  • MMSE (Mini Mental State Examination)

  • MoCA (Montreal Cognitive Assessment)

  • Standardized neuropsychological batteries

• Evidence-based interventions

  • Cognitive Stimulation Therapy (CST)

  • Individualized cognitive training

  • Psychoeducational interventions for caregivers

Questions for the reader

• What does “aging well” mean to you?

• How much space do we give, in our daily lives, to brain health?

Conclusion

In a rapidly aging society, neuropsychology is no longer a niche discipline, but a necessity.

Understanding cognitive functioning, preventing decline, and accompanying frailties: all of this is part of our work.

But perhaps, even more profoundly, our task is another: to stay by our side.

When words get lost, when memories get confused, when identity falters — being there becomes the first therapeutic intervention.

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Concluding this month… 

We close this issue with an image that perhaps says more than many definitions: a 72-year-old man who says, "It's normal, I'm my age," and a wife who accompanies him, tired and worried, searching for words for what she sees.

Neuropsychology also arises here — in that space between denial and awareness, between the measurable deficit and the relational suffering that surrounds it. Evaluate, rehabilitate, stimulate: all of this is part of the job. But perhaps the deepest gesture is another, the one Agnese called with a simple word: accompany.

In a rapidly aging society, questioning what it means to care for the brain —and those who live in it— is not a niche issue. It's a question that concerns all of us, as professionals, as children, as people.

If this issue has sparked curiosity about neuropsychology, or resurfaced reflections on aging, identity, and what it means to "be cognitively well" — then it's already done its job. Our library grows right here: where science meets human experience and allows itself to be questioned.

As students or psychology professionals, how much space do we give to cognitive health in our education and our view of the life cycle? Is it a topic you feel close, distant, urgent?

Want to share your world of psychology or share your resources? Send us an email: thedevelopmentallibrary@gmail.com — our library grows thanks to you. 

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