Neuropsychological Testing and Assessment

What is neuropsychology?

Neuropsychology is a specialty field that joins the medical fields of neurology, psychology and psychiatry. Neuropsychology involves determining how well the brain is working when it is disrupted by a brain injury or psychological disorder. A neuropsychological assessment is a comprehensive test of a wide range of mental functions including behavior.

What mental functions are assessed in a neuropsychological exam?

If you are undergoing a neuropsychological assessment, the mental functions tested include:

• General intellect.
• Reading/reading comprehension.
• Language usage and understanding of what others say.
• Attention/concentration.
• Processing speed.
• Learning and memory.
• Reasoning.
• Executive functions, which are higher-level skills you use to organize and plan, manage your time, problem solve, multi-task, make judgments and maintain self-control.
• Visuospatial skills.
• Motor speed and dexterity.
• Mood and personality.

Why has a neuropsychological assessment been requested?

A neuropsychological assessment 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.

How will I know if my cognitive abilities have changed if I have not had an exam in the past?

Some cognitive abilities tend to be very stable despite neurologic illnesses or injuries. Those abilities often provide an estimate of the level of your other cognitive abilities if no injury or illness had occurred. Your results will be compared to the pattern of results associated with various illnesses or injuries to help determine if changes have occurred.

What common complaints might signal the need for a neuropsychological test?

See your healthcare professional for a referral for a neuropsychological assessment if you or a loved one show any of the following signs:

• Changes in short-term memory, asks the same question repeatedly.
• Frequently loses items, gets lost easily.
• Confusion.
• Poor attention and concentration. Doesn’t appear to listen. Gets confused in conversation.
• Language difficulty. Has difficulty speaking or finding words or cannot understand what others say.
• Can’t recognize things.
• Visuospatial difficulties including difficulty drawing or using a map.
• Poor judgment/decision-making.
• An unexplained change in personality, increase in anxiety or depression, development of delusions or hallucinations.
• New difficulty with understanding or managing bills or finances.
• Can’t recognize familiar persons.

What does a neuropsychological exam involve?

The neuropsychologist will talk with you to understand any concerns you and your family members might have about your cognitive (mental) functioning. He or she will also review your medical and psychological history and educational background. If a family member comes to the evaluation with you, the neuropsychologist may ask for your permission to interview him or her as well.

Your neuropsychologist will choose the tests that you are given. The tests are given and scored by a trained technician called a psychometrist who works under the supervision of the neuropsychologist. The tests typically involve writing or drawing, solving puzzles or answering questions, and responding to things presented on a computer. Most people find some of the tests to be quite easy and others to be difficult. It is important to work as hard as possible on all of the tests in order for the results to be most informative.

You will also complete questionnaires about mood and psychological symptoms. Parents of children referred for neuropsychological examinations often complete questionnaires about their child’s behavior.

Finally, the neuropsychologist writes a report that summarizes the results and includes recommendations for improving cognition (e.g., attention, memory) and possibly referrals to other professionals.

How long does a neuropsychological exam take?

The length of time for testing varies considerably based on the nature of the reason for the examination. Depending on the situation, testing can take anywhere between one and eight hours, although two to four hours is typical. The testing time depends on which tests need to be administered and how quickly you are able to work comfortably. You will be allowed to take some breaks depending on how you are feeling and the length of the test.

What should I do to prepare for the neuropsychological examination?

• Get a good night's sleep.
• Try to eat a good breakfast.
• Take all of your medications as usual unless you are directly instructed to do otherwise.
• If you use glasses, contact lenses, or hearing aids, make sure you have them with you.
• If you have had any neuropsychological, psychological or academic testing done in the past, bring those records with you.
• If your child is undergoing the testing, and he or she has completed an intellectual evaluation, psychoeducational evaluation, multifactored evaluation (MFE), or individual education program (IEP), bring copies of the results of those evaluations.

How are test results interpreted?

Most of the tests used in neuropsychology are standardized, which means they are given the same way to everybody. The tests are also norm-referenced, which means that a patient’s performance on those tests will be compared to the performance of other people who are about the same age and, sometimes, people who have the same educational background. The test results are used to answer many types of questions.

What type of medical conditions might change cognitive functions?

Many neurologic conditions can result in changes in cognitive function. Some include:

• Alzheimer’s disease.
• Transient ischemic attack and stroke.
• Traumatic brain injury.
• Epilepsy.
• Parkinson’s disease and other movement disorders.
• Multiple sclerosis.
• Brain tumors.
• Infections of the brain and spinal cord.

Many non-neurologic conditions and their treatments can also effect cognitive function, particularly when they are advanced or severe. Some include diseases of the liver, kidneys, heart, lungs, digestive system, and endocrine systems, as well as some cancers.

Does insurance cover a neuropsychological testing?

Insurance coverage varies greatly, depending on individual insurance plans. Some portion of the assessment is usually covered. If you have any concerns about insurance coverage, please check with your insurance company. If you want to check with your insurance company before the evaluation, you will need to let them know the following CPT (procedure) codes:

• 96116, 96132, 96133: Interview, examination, and interpretation by a neuropsychologist
• 96138, 96139: Test administration

How do I find a neuropsychologist?

Typically, your family physician or medical specialist will refer you to a neuropsychologist.