Neuropsychological evaluation is based upon the study of brain-behavior relationships and a combination of knowledge from neuroscience, functional neuroanatomy, neuropathology, behavioral neurology, psychopathology, psychophysiology, and psychological assessment and intervention. Neuropsychological evaluations are provided by clinical neuropsychologists who specialize in neurocognitive and behavioral assessment, neuropsychological testing, diagnosis, and rehabilitation of neuropsychological and brain disorders. Clinical neuropsychologists routinely render opinions regarding the presence, nature, extent, prognosis, functional implications, appropriate treatment, and causation of cerebral dysfunction.
Just as CT and MRI studies are often useful in addressing concerns related to the structural integrity of the brain, neuropsychological evaluation can be invaluable in providing needed clinical information regarding the functional implications of identified ability deficits that result from a neurologic event.
Comprehensive neuropsychological evaluation employs standardized assessment procedures that are designed to systematically sample an individual’s behavior/performance on measures that require certain intact brain functions for successful completion of the task. Neuropsychologists may vary in their use of specific measures and/or methods of analysis, but the test results are analyzed utilizing research findings related to normal and abnormal functioning of the brain in various populations and clinical conditions. The choice of test measures may vary depending upon factors such as the referral question(s) or patient limitations such as pain, upper extremity weakness, hearing or vision problems, or language difficulties. In addition to formal testing, obtaining a good medical, psychological, educational, and occupational history is an important part of the evaluation. Information regarding the individual’s history and current condition can also be obtained via self-report, other report (spouse, family member, employer), past records (medical, school, military), findings of diagnostic medical procedures, and/or behavioral observations.
Neuropsychological evaluation procedures can address a variety of neurologic conditions including:
- Traumatic Brain Injury (TBI)
- Cerebrovascular Accidents
- Metabolic and toxic encephalopathies o Pre- and post-surgical conditions
- Medical and neurologic disorders affecting central nervous system functioning.
Neuropsychological evaluation procedures typically incorporate measures of:
- Intellectual functioning
- Academic skills
- Attention and concentration
- Information processing speed
- Learning and memory
- Conceptual and problem-solving capacity
- Visuospatial abilities
- Sensory-perceptual functioning
- Motor performance
- Emotional adjustment/personality
- Response bias (effort and motivation)
While it is commonly accepted that screening evaluations do not provide the same level of understanding of the person’s condition or its implications, neuropsychological screening evaluations are often a helpful starting point to rule in/rule out significant neurocognitive dysfunction.
Clinical concerns commonly addressed in a comprehensive neuropsychological evaluation include:
- Presence, nature, and extent of cognitive impairment
- Differential diagnosis in the presence of multiple symptom clusters
- Etiology and/or causative factors contributing to cerebral dysfunction
- Baseline determination that allows for systematic comparisons across time
- Identification of developmental/learning disabilities
- Prediction of the adult’s ability to resume his/her premorbid lifestyle and prior level of functioning (e.g. employment, educational training, interpersonal involvements)
- Prediction of the child’s potential to achieve specific developmental milestones (e.g. language, academic, social)
- Formulation of individualized cognitive and behavioral rehabilitation programs
- Direction for the planning and development of remedial education or vocational rehabilitation programs
- Impact of specific intervention strategies on the individual’s everyday functioning (e.g. neurosurgery, psychopharmacology, cognitive retraining, psychotherapy, etc.)
- Functional impact of brain injury on cognitive and interpersonal behavior, implications for vocational disability determination, etc.
- Likely influence of identified deficits on the individual’s capacity to function adaptively and/or independently in daily life
- Likely contribution of confounding variables that may produce a less than optimal performance (e.g. psychological conditions, pain, medications, acute drug or alcohol effects, poor motivation, behavioral disturbance, litigation)
Neuropsychological evaluation findings can guide rehabilitation:
- Thorough characterization of functional cognitive and behavioral problems provided by neuropsychological evaluation can serve as a guide to the rehabilitation team in planning and implementing practical, individually-tailored treatment interventions.
- Neuropsychological evaluation reports provide information to help direct psychotherapy and education activities intended to assist the patient and his/her family in adjusting to functional changes imposed by cerebral dysfunction.
- Initial and subsequent neuropsychological evaluations provide ongoing monitoring of the patient’s recovery, and assist the rehabilitation team in refining and adapting treatment goals/strategies over time.
Common neuropsychological evaluation referral questions include:
- Does the patient show evidence of organic brain dysfunction?
- Is the patient depressed, demented, or both?
- What is the patient’s (baseline) functioning now so that we can measure anticipated change over time (extent of recovery or progression of illness)?
- Are the patient’s deficits neurologically based? What is the role of emotional/personality factors?
- The patient complains of memory problems. Does he/she show evidence of memory or other cognitive deficits that would be consistent with the complaints?
- The patient does not follow through with treatment planning. Is this related to memory or other cognitive deficits?
- What are the nature and degree of the patient’s neurocognitive impairments? o Are the level and pattern of the patient’s neuropsychological functioning consistent with a particular etiology?
- What are the implications of the patient’s deficits for his/her everyday functioning (e.g. capacity to live independently, comply with medication regimen, work in a competitive or sheltered capacity)?
- Would the patient benefit from cognitive rehabilitation? If so, what should the focus of the treatment be?
Membership in the Colorado Neuropsychological Society (CNS) commits members to conform to the CNS Guidelines.
For further information regarding CNS or neuropsychology, please contact us.