Neuropsychological evaluations - for assessing an individuals higher order cognitive functions (i.e., intelligence, learning/memory, concentration, perception, etc.), sensory-motor abilities, and social-emotional functioning in the context of a known or undetermined medical, neurologic, and/or psychiatric condition. In order to identify cognitive deficits and strengths to assist with diagnosing and/or providing recommendations for treatment planning.
A clinical neuropsychologist uses standardized tests to measure an individual’s pattern of cognitive deficits, as well as behavioral observations during the exam, and the individual's history (viz., medical, educational, vocational, family/relationships, etc.) in order to make diagnosis and provide possible treatment strategies.
In terms of the testing, the individual's performance is compared to what is expected for individuals of the same age and education. The individual pattern of strengths and weaknesses is then defined based on these comparisons. The neuropsychologist uses his/her knowledge of brain function and behavior, neurologic, psychiatric, and medical conditions/disease to guide the assessment process. Following the completion of the face-to-face evaluation with the patient, the neuropsychologist will then spend an equal amount of time or more depending on the complexity of the case, in the scoring and interpretation of each of the administered tests, review of the overall test results and medical records, which guide diagnosis and the formulation of recommendations for treatment, accommodations, and future planning. Each evaluation is individually tailored to the individual in the context of the referral question and purpose of the neuropsychological evaluation.
What is the difference between neuropsychological evaluations and general clinical psychological evaluations?
The differences are many and often start with the differences in the training of the professional who will be performing the evaluation and how the tests are used and interpreted. For instance a neuropsychologist, clinical psychologist, and school psychologist may use some of the same tests; however a neuropsychologist differs from these other types of psychologists in not only the additional tests they use, but also their knowledge base, and what they do with the test results. An example may be the difference between a primary care physician, a neurologist, and a neurosurgeon. All are physicians (medical doctors), but their knowledge base and treatment strategies are different because of their specializations.
Regarding adult neuropsychological evaluations, the neuropsychologist is often interested in determining changes in brain functioning (acquired cognitive deficits) due to conditions such as stroke, traumatic brain injury, dementia, brain tumors, epilepsy/seizures, and psychiatric disorders.
Often the neuropsychologist will evaluate a broader range of cognitive abilities not usually tested by a clinical or school psychologist. A neuropsychological assessment may include tests of intelligence, academic achievement, attention and concentration, learning and memory, processing speed, visual perception, visual spatial abilities, language functions, visual motor and fine motor skills, sensory perception, planning, organization, initiating and inhibiting behaviors, and social/emotional functioning.
The neuropsychologist interprets the pattern of results in the context of the person’s age, education, vocational history, and his/her current situation and medical history. Evaluations can help with diagnosing and formulating treatment and future planning.
What’s involved in a typical adult neuropsychological assessment?
Neuropsychological evaluations can be brief, focusing on specific problems areas or comprehensive, with evaluation of each of the main cognitive domains as described above. Because of the often complex and thorough nature of these assessments, the process can take several hours, typically requiring 4 to 8+ hours of time with the patient/client and family member(s) followed by 4 to 8+ hours of indirect time to score, review, and interpret test results; review the medical records; and finally write a detailed report.
Depending on the required face-to-face time, two appointments may be necessary to complete the evaluation. The purpose of two testing sessions is to avoid the fatigue and stress that can accompany an all-day evaluation. The initial appointment often consists of a clinical interview, determining the focus for the evaluation, and then initiating the testing procedures. The second meeting would focus on completing the remaining test procedures not completed during the first appointment.
Once the testing is complete and the tests are scored, the neuropsychologist may need to obtain further information from collateral sources (viz., physicians, family members, teachers, employers, etc.) to help provide additional information regarding the patient/client's functioning day-to-day. The neuropsychologist will then review the test results, all information gathered, and available medical records to then complete a clinical report. A feedback session is scheduled with the patient/client to review the findings and recommendations.
When should I consider having a neuropsychological assessment?
Neuropsychological evaluations can help if you or a family member has:
- A neurologic condition such as hydrocephalus, cerebral palsy, epilepsy (seizures), brain tumor, or a type of dementia (i.e., Alzheimer's disease), for example.
- A neurodevelopmental diagnosis that may require a comprehensive evaluation as an adult to help with receiving college/work accommodations, social security claims, applying for other services/accommodations, etc.
- A brain injury as a result of an accident, concussion, stroke, or infection of the brain.
- Other medical problems that place him/her at an increased risk of brain injury such as diabetes, chronic heart or respiratory problems, certain genetic disorders, sleep related problems, or treatment for cancer.
- Been exposed to toxins, street drugs, inhalants. electric shock, etc.
- Had an assessment, but interventions resulting from the assessment failed to help and you want a second opinion.
Your physician, psychologist, or other health care provider may recommend a neuropsychological evaluation to:
- Assist in establishment a diagnosis and treatment plans.
- Document current cognitive abilities prior to a planned medical intervention such as a change in medications, a surgical treatment or treatment for cancer.
- After the medical intervention, testing can be repeated to determine if the treatment has had an effect on your cognitive abilities. Your physician may refer to this process as “baseline testing.”
How will neuropsychological assessment help me?
The neuropsychological assessment and report will provide you with:
- A description of your cognitive strengths and weaknesses (impairments).
- Help in understanding your experienced cognitive changes from a new or worsened medical illness or condition.
- Suggestions for what you can do to improve your deficits or accommodate for your deficits.
- Help in knowing what is fair to expect in terms of your abilities for the future.
- Help in knowing what your needs may be going forward, so that you can plan appropriately.
- Suggestions for improving your quality life.
- Referral to another professional such as a clinical psychologist, neurologist or occupational, physical or speech therapist for ongoing help with your deficits.