cognitive domain Various modalities of behavior as expressed by the terms attention, executive function, memory (short-term and remote), visuospatial ability, motor function, and mood and affect.

critical effect The earliest discernible or measurable effect of exposure to a toxic substance.

critical organ The initial tissue to be affected by an exposure to a toxic substance.

encephalopathy A state of impaired functioning of the brain, which may include motor, sensory, and cognitive abnormalities and changes in mood and affect, as well as disturbances in attentiveness and consciousness.

executive function The behavioral process by which a person utilizes current sensory input and previously stored information and the complementary interactions of several cognitive domains to process and carry out complex independent, purposive, and problem-solving behaviors.

The adverse effects of exposure to neurotoxic chemicals on the brain manifest themselves behaviorally as changes in mood and in cognitive function. Neuropsychological testing has emerged as a means of documenting and measuring these changes. This methodology has several advantages for use in both the clinical diagnosis of chemically induced disorders and the epidemiologic investigation of neurotoxicant exposure-outcome relationships. These advantages include the documented validity and reliability of neuropsychological tests and their known sensitivity for detecting the effects of cerebral pathology and for localizing the probable specific anatomical sites associated with many neuro-pathological and neurodegenerative processes. In addition, methods of neuropsychological testing used to estimate premorbid intellectual abilities allow investigators to uncover acquired changes in cognitive functioning associated with brain insults, including the effects of exposure to neurotoxicants. The pathological effects following brain insults that may produce measurable deficits on formal neuropsychological testing may or may not be detectable by conventional magnetic resonance imaging (MRI), computed tomography (CT), and electroencephalography studies. Although the newer imaging technologies [i.e., positron emission tomography (PET), single photon emission computed tomography (SPECT), functional MRI (fMRI), and magnetic resonance spectroscopy (MRS)] can provide additional objective evidence of an organic basis of the neurobehavioral manifestations, formal neuropsycho-logical assessment nevertheless remains the principal means for documenting impaired function among patients exposed to neurotoxicants. This article discusses the neurobehavioral syndromes related to neu-rotoxicant exposure and presents a review of the clinical diagnostic approaches most utilized in their evaluation.

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