The Neuropsychological Evaluation

What It Is and What You Should Expect

Your neurologist or physician may order a neuropsychological evaluation if there are concerns that your cognition (thought processes) have been changed by dementia or other neurological disorders.

This type of assessment may help determine if you are experiencing changes that are typically part of aging or experience a change due to a disease process. It can help your physician confirm a diagnosis and aid in your overall healthcare. Finally, with diseases that tend to be progressive, your physician may be interested in obtaining a baseline of your typical cognitive function in order to have a point against which to evaluate any changes that might occur over time.

Neuropsychology is a specialty area within the larger field of clinical psychology. A neuropsychologist has acquired an extensive understanding of brain-behavior relationships through academic study, specialized clinical training, and experience working with individuals who are neurologically compromised by diseases like Parkinson’s. The neuropsychologist is called upon to answer specific clinical questions through careful selection of a battery of tests designed to acquire relevant data. Typically, these tests are administered in a standardized manner and performance is compared with data obtained from a group resembling the individual being evaluated. This comparison group is almost always matched for age and sometimes for education level and gender.

A neuropsychological evaluation assesses functional elements of your thought processes by means of a battery of specialized tests. It differs from a clinical psychological assessment because the focus is on how an individual processes information rather than on how personality and psychiatric factors are influencing a person’s life. However, because psychiatric concerns such as depression and anxiety can have a tremendous impact on cognitive function, these are also typically evaluated. Generally, this is accomplished through a good clinical interview, specialized symptom inventories, questionnaires, and simple observation. You are not likely to see ink blots during a neuropsychological evaluation but you will be exposed to a variety of tasks that challenge individual elements of human cognition.

Neuropsychological testing can be somewhat lengthy because it is impossible to test function without having a person do a variety of tasks. For example, it is not possible to peer into the human brain to determine if there is a memory problem. That must be assessed directly by having someone learn and later recall new information. Moreover, a question of whether (and why) memory is poor requires that the various steps involved(getting the information in, holding it, processing it in some manner so it can be stored, putting it in storage, retrieving it later) are investigated. This process is similar to trying to figure out why a car won’t start. If a mechanic simply replaces the ignition system without checking the battery, the quality of the circuitry joining the components, and other potential areas of breakdown, the problem will not be adequately addressed.

Anyone can do poorly on one or more tests for a variety of reasons. Fatigue, failure to “get” the test, and anxiety about being tested can all contribute to less than optimal performance. However, if there is a problem with a specific area of cognitive function, it tends to appear across a number of similar tasks. Moreover, when test data differs very markedly from what has been observed in a comparison group, it suggests that there may be come cognitive compromise. The neuropsychologist makes a number of educated guesses (“clinical hypotheses) based on all the data obtained and integrates the data, including psychiatric information, into a clinical report that attempts to answer the clinical question.

The best way to prepare for a neuropsychological evaluation is to treat it like any other medical test. Get a good night’s rest the evening before and eat a normal meal the day of the evaluation. Unless specifically requested otherwise by a physician, take all your medications on your normal schedule. You may want to bring a snack. Arrive at the evaluation with any questions you have written down so you will remember to ask them. Before you get started, the examiner will discuss how the information is to be reported, confidentiality issues, and a number of other details (“informed consent process”). Again, be sure to ask as many questions as you need to so you feel comfortable you understand what is happening.

When the testing begins, put forth your best effort. No one is expected to be able to do perfectly on every task. In fact, many tasks you do will become progressively harder because the examiner is interested in learning where you performance has reached a limit. Do not try to guess what the examiner wants and most importantly, do not judge how well you are doing or become frustrated. The examiner is certainly not making judgments about you and typically knows little about your performance until the data are compared with the norms group.

I hope this overview of neuropsychological testing is helpful. It certainly is not intended to answer all questions you might have. For additional information, please feel free to contact me.