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What is a neuropsychological evaluation for adults?

Neuropsychology is a specialty that joins the medical fields of neurology, psychology and psychiatry. Neuropsychological evaluation designed to determining how well the brain is working, whether it is disrupted by a brain injury, stroke, dementia, epilepsy, ADHD, movement or learning disorder, or psychological disorder. Neuropsychological assessment is a comprehensive test of a wide range of cognitive functions including behavior.

The neuropsychological evaluation involves an interview and the administration of tests. The tests are typically pencil and paper type tests. Some tasks might be self-reports, meaning that they are completed by the patient with the assistance from a technician, but the majority of the tests require administration by a skilled psychometrist.

 

Neuropsychological tests (unlike bedside cognitive and behavioral neurologic screens) are standardized, an individual’s scores on tests are interpreted by comparing their score to that of healthy individuals of a similar age, education, gender, and/or ethnic background and to expected levels of functioning.

In this way, a neuropsychologist can determine what areas of the brain are functioning in a normal way, which are impaired or sleeping, a pattern of cognitive strengths and weaknesses to understand more about how the brain is functioning, and how to help to develop impaired areas of the brain.

Therapist

Neuropsychological tests evaluate functioning in a number of areas including:

  • attention

  • executive functions (such as planning, abstraction, conceptualization)

  • intelligence

  • language

  • memory

  • mood state and emotion

  • motivation

  • perception

  • personality styles

  • quality of life

  • sensorimotor functions

The areas addressed in an individual’s evaluation are determined by the referral question (what the referring doctor and patient wants to know), patient’s complaints and symptoms, and observations made during interview and test administration.

Neuropsychological tests can diagnose particular symptoms or diagnoses, such as:

  • Alzheimer’s Disease

  • Anxiety (Social anxiety, GAD, Panic disorder, Phobias)

  • Attention Deficit Disorder (ADHD)

  • Autism

  • Bipolar Disorder

  • Cognitive changes Post COVID19

  • Cognitive Evaluation Surgical Candidates (gastric bypass/sleeve/lap-band, deep brain stimulator, pain pump)

  • Competency Evaluations

  • Depression

  • Disability vs. Return to work

  • Dysgraphia

  • Dyslexia

  • Huntington’s Disease

  • Intelligence (IQ) Testing

  • Learning Disorders

  • Memory Loss

  • Mild Cognitive Impairment

  • Neurodegenerative Diseases (ALS, MS, Parkinson’s)

  • Obsessive-Compulsive Disorder (OCD)

  • Other Dementias

  • Personality Disorders

  • Postconcussion Syndrome

  • Post-Traumatic Stress Disorder (PTSD)

  • Schizophrenia

  • Stroke & Recovery

  • Tourette Syndrome

  • Transient Ischemic Attack (TIA)

  • Traumatic Brain Injury (TBI)

How long does a neuropsychological evaluation take?

A complete evaluation generally takes between four and five hours to complete, depending on the complexity of the issues to be addressed by the evaluation and the patient’s condition (for example, fatigue, confusion, and motor slowing can extend the time required for an evaluation). In general, the clinician attempts to elicit the patient’s best possible performance under optimal conditions.

Why has a neuropsychological evaluation been requested?

A neuropsychological assessment is a comprehensive test of a wide range of mental functions including behavior. It can be requested for a number of reasons including:

  • To help with diagnosis: Test results are sometimes used to help understand the cause of problems with your thinking and understanding. For example, test results might be used to determine if your cognitive (mental) changes are due to normal aging, a neurological illness, depression, anxiety or other causes. Your healthcare provider can then use the results of your neuropsychological examination along with the results of other tests, such as brain scans, EEGs, and blood tests, to arrive at a diagnosis that will help to guide your healthcare.

  • To determine cognitive strengths and weaknesses: In some cases, a healthcare provider may order tests if you’ve had a known neurological event or injury, such as a stroke or traumatic brain injury, to find which cognitive functions have changed and how much they have changed.

  • To establish a baseline: In some instances, an exam is performed before and after a medical or surgical treatment to determine if cognitive abilities were affected by the intervention. Re-examination at some point after the baseline can also demonstrate how well you’re recovering from a stroke or traumatic brain injury and whether or not you’re ready to return to work, resume driving or take on other duties.

  • To help plan a treatment or other intervention: Test results can be used to identify which cognitive abilities should be the focus of rehabilitation if you’ve had a brain injury. Results also help therapists determine which strengths might be able to compensate for weaknesses. The evaluation can provide the basis for making decisions and/or adjustments to school or work schedules and determine the skills to work on that are most important to you.

  • Assist in a differential diagnosis (e.g., to determine whether possible mental and behavioral changes are related to the movement disorder, depression, another brain disease or treatment).

  • Assist with evaluation before and after functional neurosurgical procedures (e.g., deep brain stimulation) or neurofeedback, to help determine if a given treatment is appropriate for a particular person and whether treatment has had any positive or negative effects on mental functions and behavior.

  • Provide a baseline against which subsequent evaluations can be compared. Thereby your doctors can decide whether your functioning has declined because of the disease process or document whether your functioning has worsened or improved as a result of treatment (e.g., medications, neurofeedback or DBS).

  • Reveal areas of daily functioning (e.g., financial management) with which the patient may need assistance indicate rehabilitation potential. For example, will the individual benefit from certain cognitive or behavioral treatments, occupational therapy, neurofeedback or pharmacotherapy?

Is there any way to prepare for a neuropsychological evaluation?

These are not tests that one can study for, but there are several things that one can do to facilitate the evaluation:

  • The patient should bring a current list of all medications and doses (because medicines may change frequently for some persons, it is important to make sure the list is up to date)

  • If the patient has difficulty providing information about their history, it is helpful for a family member or friend to accompany them (for at least part of the clinical interview).

  • It is helpful if the patient can provide records of previous neurodiagnostic testing (e.g., brain scans such as CT or MRI scans) and/or results from previous neuropsychological evaluations if completed at another hospital or institution.

It is the goal of the neuropsychologist to get the best possible picture of the patient’s current brain functioning. Several things can interfere with this goal such as if the patient is:

  • Excessively tired or fatigued or has sudden, unexpected “sleep attacks”.

  • Not motivated to put forth their best effort.

  • Very emotionally distraught or has a severe psychiatric condition.

  • Under the influence of medications or illicit substances which interfere with cognitive functioning.

  • Experiencing frequent changes in the ability to move.

Patients should let the examiner know if they anticipate that any of these issues are likely to interfere with the evaluation.

It is important to get a good night’s rest before evaluation. Patients who live far away might consider spending the evening prior to the evaluation at a local hotel or with friends or family rather than getting up and driving or flying most of the night to get to the appointment. Patients are encouraged not to consume any alcohol 24 hours prior to the evaluation. If taking sleep medicine, patients should check with their doctor whether it might affect test performance the next day. Patients should not take any memory or attention medication 24 hours prior to testing. Patients should not worry about whether they will “pass” the tests. The tests cannot be passed or failed; instead, they describe how well a person performs relative to peers.

Schedule an appointment now to get your neuropsychological evaluation done!

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