What do neuropsychological tests assess?

Background. Contemporary neuroimaging techniques, particularly fMRI and PET, have demonstrated that cognitive abilities do not strictly depend on specific brain areas, but rather on complex brain circuits or systems. Methods. Using PubMed and Google Scholar databases, a search for functional studies (fMRI and PET) during the performance of several neuropsychological tests was done. The pattern of brain activity found during the solution of some executive functions, language, memory, calculation, and visuospatial/visuoconstructive abilities is reviewed. Results. Brain activity supporting the performance in these tests is usually quite extended, and involves not only those brain areas traditionally assumed in neuropsychology, but also other cortical and sometimes subcortical regions. Conclusions. Most neuropsychological tests are simultaneously evaluating different cognitive abilities associated with the activity of diverse brain areas. "Cognitive/anatomical" correlations could only be established for some relatively simple functions. This change in the understanding about the brain organization of cognition has not been reflected in the interpretation of the neuropsychological tests yet. The interpretation of neuropsychological tests should be based not only in clinical observations but also in functional studies. This is a necessary further step in clinical neuropsychology.