Tag Archive for: assessments

What is a neuropsychological evaluation?

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A neuropsychological evaluation typically involves assessment with a group of standardized tests that are sensitive to the effects of brain dysfunction.

Unlike CT or MRI scans which show abnormalities in the structure of the brain; or EEG, which shows electrical abnormalities in the brain; neuropsychological assessment is used to show the ways in which a person can or cannot perform certain functions or tasks that are dependent upon brain activity.

These functions or tasks (for example, memory and learning) form the necessary building blocks of successful living in the individual’s daily life.

Impairment in many of these functions may exist because of brain abnormalities that cannot be detected on CT or MRI scans. Therefore, modern neuropsychological assessment is a procedure with a unique purpose; it can be used to reveal or diagnose brain dysfunction when no structural brain abnormalities can be seen.

Furthermore, when structural abnormalities have been found, neuropsychological assessment provides a way to determine what functions may be impaired because of structural defects, and to determine the degree to which they may be impaired.

What is the purpose of a neuropsychological evaluation?

A neuropsychological evaluation is used to obtain several types of information. Reasons you have been referred for a neuropsychological evaluation may include, among others:

  • To find possible problems with your brain functioning.
  • To help lead to a diagnosis.
  • To define your brain-related strengths and weaknesses.
  • To guide treatment for your personal educational or vocational needs and make relevant recommendations to your other health care provider(s).
  • To document possible changes in your functioning over time.

What tests are used?

The standardized tests used in a neuropsychological evaluation typically assess functioning in the following areas: attention and memory, problem-solving and other complex abilities, visual-spatial functions, language functions, sensory-perceptual functions, and motor functions.

Assessment of academic skill development and emotional functioning, while not exclusive to neuropsychological evaluation, is typically performed as well.

The perspective of the neuropsychologist is frequently requested to understand subtle brain-related factors involved in academic failure or impaired emotional functioning, even when no biological courses are suspected.

However, the specific areas assessed depend upon the referral questions presented.

An interview with the individual and/or family members is typically included. Observations in other settings, such as school or hospital, and review of school/medical records also may be included in the evaluation process.

What is the outcome?

The product of outcome of a neuropsychological evaluation is a conclusion or set of conclusions made about the individual’s functioning. If requested, the product also may include specific recommendations to guide treatment or otherwise enhance the individual’s functioning. The conclusions and recommendations are developed by integrating information obtained from the standardized testing, interviews, records, and other observations.

Interpretation of the test results and the information obtained from other sources is performed by the neuropsychologist, who is a licensed professional within the field of psychology with a specialty in the applied science of brain-behavior relationships. A neuropsychologist typically has a doctoral degree in psychology and additional training in the specialty field of clinical neuropsychology.

Setting the record straight about assessments

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In an article published in The Wall Street Journal last month, a retired physician named Dr. Seth Stern reported that he began experiencing cognitive deficits at age 59. Having dementia running in his family, he was attuned to the possibility that he may be experiencing the initial signs of cognitive decline.

The article (which is behind a paywall) goes on to state that, “It is nearly impossible for people such as Dr. Seth Stern to be diagnosed with dementia because neurocognitive testing is normed to a 12th-grade education level.” This statement is misleading: While it is true that highly educated people can present challenges in detecting impairment, neuropsychologists are skilled in using cognitive tests that have been designed to detect decline in people with greater than a 12th grade education (i.e., tests are normed for highly educated people).

Let’s unpack this a little further.

Yes, it is true that the detection of cognitive impairment in high-functioning older adults is often difficult. This is in part because high-functioning persons tend to have increased cognitive capacity—also known as “cognitive reserve.”

Cognitive reserve can result in later expression of clinical symptoms. Dr. Yaakov Stern, a professor of neuropsychology at Columbia University, defined it as, “the ability to optimize or maximize performance through differential recruitment of brain networks, which perhaps reflect the use of alternate cognitive strategies.”

Importantly, high-functioning individuals may maintain a high level of verbal skills, which can serve to mask any cognitive impairments.

The WSJ article also suggests that primary care doctors are often reluctant to diagnose dementia early on for a variety of reasons, among them a concern that “nothing can be done.” This may have been true in the past, but presently there are several effective treatments for dementia when detected early, and several other treatments under trial right now.

(Current data on Alzheimer’s drugs under trial in 2023 was released earlier this month; you can access 2022 data here.)

Given the challenges in detecting cognitive impairment in highly educated people, neuropsychologists can serve an important function. Skilled in detecting cognitive deficits, neuropsychologists identify and characterize impaired cognitive functions as well as those functions that have been spared. Furthermore, neuropsychologists work closely with other medical specialists to determine underlying neuropathology and to predict clinical outcomes.

The role of neuropsychology is likely to be elevated with the introduction of medications such as Aducanumab, which can be a treatment option for early-stage dementia and result in people having increased time to participate independently in activities of daily living.

Expanding healthcare teams to include primary care physicians, geriatric specialists, neurologists, and neuropsychologists will help to initiate interventions that may delay progress of cognitive disorders. Providing more comprehensive approach also will provide an opportunity for patients and families to collectively participate in making care decisions and health care plans.

Dr. Perry is Executive Director of NAN.