Neuropsychological Testing and Assessment

What is neuropsychological testing?

Neuropsychological testing refers to a number of tests that healthcare providers use to get information about how your brain works. Specially trained psychologists — neuropsychologists — look at the results to better understand the relationship between your brain health and behavior, and mood and thinking (cognition). These tests can help healthcare providers:

• Determine a diagnosis. Your healthcare provider may use your neuropsychological test results to help understand the cause of your issues with thinking and understanding. For example, let’s say you’re having difficulties with memory. Your results might help your provider distinguish between normal changes from aging, a neurological illness, depression, anxiety or other causes.
• Identify strengths and weaknesses in your thinking processes (cognition). Sometimes, your healthcare provider may order tests if you’ve had a neurological injury, like a stroke or traumatic brain injury. They may also test you to get a baseline, for instance, if you play contact sports or have a family history of dementia. This way, your healthcare team can compare future test results to help understand how you’re doing. They may also use baseline results to see whether a treatment is helping you.
• Understand your personal risk for changes in your ability to think that can occur with certain brain surgeries.
• Develop plans for future treatment and interventions like occupational or speech therapy. Providers can use test results to decide the focus of rehab or which strengths might be able to compensate for weaknesses. They may also use neuropsychological test results to recommend adjustments to school or work schedules or to determine which skills are most important to you to work on.

What does a neuropsychological evaluation test for?

In a neuropsychological evaluation, your provider tests your mental functions, which may include:

• General intellect.
• Reading/reading comprehension.
• Your ability to use language and understand what others say.
• Attention/concentration.
• How much time it takes you to receive, understand and respond to information (processing speed).
• Learning and memory.
• Reasoning.
• Higher-level skills you use to organize and plan, manage your time, problem solve, multitask, make judgments and maintain self-control (executive functions).
• Your ability to understand the relationships between objects and space (visuospatial skills). This includes things like drawing, tying shoes, making a bed, etc.
• Fine motor skills.
• Mood and personality.

What does neuropsychological testing diagnose?

Neuropsychological testing doesn’t diagnose a condition directly. But it can give your healthcare providers more information to help them diagnose and manage conditions like:

• Alzheimer’s disease.
• Brain tumors.
• Dementia.
• Epilepsy.
• Learning disabilities.
• Transient ischemic attack and stroke.
• Traumatic brain injury.
• Parkinson’s disease and other movement disorders.
• Multiple sclerosis.

When is neuropsychological testing done?

Healthcare providers, like neurologists and primary care specialists, might want neuropsychological testing if they notice trends or changes such as:

• An unexplained change in personality, like an increase in anxiety or depression, the development of delusions or hallucinations.
• Changes in short-term memory, like asking the same question over and over.
• Difficulty communicating or interacting with others.
• Difficulty speaking or finding words.
• Difficulty drawing or using a map.
• Frequently losing items or getting lost easily.
• New difficulty with understanding or managing bills or finances.
• Poor attention and concentration.
• Poor judgment/decision-making.
• Trouble recognizing familiar people, like close family members and friends.
• Trouble staying organized or completing tasks.

How does the neuropsychological testing work?

Your neuropsychologist may ask you to complete surveys about your mood and psychological symptoms before your testing appointment. Or if your child is having neuropsychological testing, their healthcare team will likely ask you to fill out questionnaires about your child’s behavior.

At the appointment, they’ll talk with you so they understand any concerns you and your family members might have about your cognitive (mental) functioning. They’ll also review your medical and psychological history and educational and work background. If a family member comes to the evaluation with you, your provider may also ask for your permission to interview them. And if your child is getting tested, the neuropsychologist will interview you both as appropriate.

This initial groundwork helps your neuropsychologist choose which tests to give you. A trained technician who works under the supervision of a neuropsychologist — a psychometrist — gives you the tests.

You’ll complete several tests for memory, cognition, verbal communication and motor skills. They typically involve:

• Writing or drawing.
• Solving puzzles or answering questions.
• Responding to things presented on a computer.

Most people find some of the tests to be quite easy and others to be difficult. You aren’t expected to get everything right and no one “fails.” The point of the testing is to identify your personal strengths and weaknesses. It’s important to work as hard as possible on all the tests so the results are accurate and helpful.

Finally, your healthcare team scores and interprets the results.

How do I prepare for the test?

You’ll want to function at your best to get the most accurate results. To do this:

• Get a good night’s sleep.
• Try to eat a good breakfast.
• Take all of your medications as usual unless you’re directly instructed to do otherwise.
• Bring along any glasses, contact lenses, hearing aids or other assistive devices.
• Share with your care team the results of any past neuropsychological, psychological or academic testing. This includes records of any intellectual evaluation, psychoeducational evaluation, multifactored evaluation (MFE). If your child has an individual education program (IEP), bring a copy of that as well.

What are the risks of this test?

There aren’t really any risks related to neuropsychological tests. But the testing often takes several hours. This can lead some people to feel tired, over-stimulated and agitated. Be sure to plan an easy dinner for the evening of the test. If your child is getting tested, don’t expect much from them for the rest of the day (and be gentle with yourself, too).

How are neuropsychological test results interpreted?

Most of the tests are given the same way to everyone (standardized). Your neuropsychologist will compare your results with those of others who are the same age, and sometimes, with people who have the same educational background (norm-referenced).

What type of results do you get and what do the results mean?

Your neuropsychologist will write an in-depth report that explains your results. The report identifies both your strengths and any areas where you didn’t perform as expected. It includes recommendations and interventions to improve these skills, and possibly, referrals to other professionals. They won’t give you a diagnosis, but with your permission, they’ll share your results with your healthcare team.

When should I know the results of the test?

It usually takes a couple of weeks for your neuropsychologist to score the tests, interpret the results and make recommendations. During this time, try to busy yourself with daily tasks and activities so you don’t worry too much about your results.