What is a neuropsychological exam?
A neuropsychological evaluation is an analysis of brain-behavior relationships. Typically the examination involves approximately seven hours of time with the patient plus interpretation and report preparation. The neuropsychologist will interpret a wide variety of standardized tests designed to assess and measure different areas of neurobehavioral/neurocognitive functioning.
There are various types of examinations and the exam is usually determined by the problems the patient presents or by the referral question(s). An examination involves many hours of direct contact with the patient, interpretation of the testing data and report preparation. Often times, a follow-up appointment is scheduled with the patient to review the data and outline specific treatment recommendations.
Examples of where a neuropsychological assessment is of value would include a variety of suspected cerebral/brain-based insults or traumas. This ranges from assessment and diagnosis of various levels and forms of brain injury
A neuropsychological evaluation:
- represents the standard for identifying cognitive impairments resulting from brain injury.
- can be especially sensitive to subtle brain injury often missed by standard CT, MRI or neurological examinations.
- provides information as to the legitimacy of the patient’s complaints and concerns or competing hypothesis.
- assesses deterioration, resolution, or stabilization through repeated assessments.
- can be helpful in determining if a patient is able to return to work, school, or previous level of functioning.
- provides information as to patient’s current and future remediational or therapeutic needs.
What are the areas assessed?
A comprehensive neuropsychological evaluation can involve the detailed examination of the following functions:
- Sensory Perceptual Functioning
- Motor/Visual Motor Functioning
- Spatial Abilities
- Attention and Concentration
- Language Functioning
- Memory Functioning (Verbal and Visual-Spatial)
- Intellectual/Higher Integrative Functioning
- Academic Abilities
- Personality Functioning
Who can do these exams?
Who is qualified to perform such an examination? A clinical neuropsychologist, specifically trained beyond the doctoral level in neuropsychology, and with subsequent years of experience, can most accurately evaluate and identify injury or deterioration of brain functioning. Pre-doctoral training and two years of post-doctoral training was recommended at the Houston conference with delegates from the American Board of Clinical Neuropsychology (ABCN), the National Academy of Neuropsychology (NAN), the American Academy of Clinical Neuropsychology (AACN), the Association of Postdoctoral Programs in Clinical Neuropsychology (APPCN), and division 40 (Neuropsychology) of the American Psychological Association (APA) see http://www.div40.org/pub/Houston conference.pdf.
Who refers people for these exams?
The primary referral question is often dictated by the specific specialty area referring. For example a neurosurgeon typically refers for a pre/post operative examination of a tumor or AVM patient to determine whether or not resection of the tumor or vascular anomaly has resulted in improved neurocognitive functioning, to assess the speed of neurocognitive recovery, or to compare pre and post functioning.
- A neurologist would often refer to aid in a quantifiable understanding of a patient’s strengths and weaknesses related to a suspected or diagnosed medical condition. Many individuals (medical and forensic) wish to distinguish functional from organic impairments, identifying focal and non-specific effects of brain injury as well as monitoring the efficacy of treatment and identifying underlying cognitive behavioral and/or affective impairment.
- A psychiatrist may wish to identify whether or not the patient’s areas of difficulty are physiologically or psychologically based. Diagnostic clarity can assist in selecting the appropriate medication.
- An attorney may refer to assess the presence and/or extent of brain-based damages, permenancy of problems, or to question the legitimancy of the complaints.
- A pediatrician or school district may refer to help understand why a child is having learning difficulties, attention and focus problems, or to additionally investigate emotional issues.
- A Self-referral often happens when a person is concerned about ongoing problems in thinking, memory, or other cognitive concerns after an injury to the head.
What are some other reasons for a referral?
The following list (which is not all encompassing) provides some examples of diagnostic questions presented for assessment:
- Determine changes in neuropsychological status post treatment or permanency of deficits.
- Rule out a dementia (e.g. Alzheimer’s disease, Pics disease, etc.)
- Identify functional evidence of an organic component to current psychological presentation and vice-versa.
- Identify functional evidence of ADD with our without hyperactivity, as well as learning disability.
- Rule out mental retardation.
- Delineate the nature and extent of neuropsychological problems resulting from
- Stroke (Cerebral Vascular Accident CVA) or acquired brain injury
- traumatic brain injury (ranging from a mild concussion to severe head injury)
- polysubstance abuse, etc.
- suspected deceleration injury after a motor vehicle accident (with or without a loss of consciousness)
- Toxic exposure (e.g. carbon monoxide, lead, toluene, etc.)
- pre or post surgical evaluation,
- Shaken Baby Syndrome,
- and a host of other potential sources of injury to