The Neuropsychological Evaluation

WHAT IS A NEUROPSYCHOLOGICAL EVALUATION?

A Neuropsychological evaluation consists of an individual assessment done with the patient by a Neuropsychologist (and sometimes, though not in our office, by a second person called a "psychometrician.")

A clinical interview will be performed, usually first, between the Neuropsychologist and patient (and his or her family, if appropriate) to find out what the patient and friends or family are concerned about, who referred them, why they were referred and what their goals are for participating in the evaluation--for example, "what do you hope to gain by having this evaluation done with you?"

The patient will be asked to describe, in the interview, any recent medical history and the problems he or she has noticed or experienced. If hospital or medical records have not been received, a plan will be made to obtain them. The patient may be asked to fill out a few forms, such as history forms or symptom checklists, to give the Neuropsychologist background information about the patient's past and current problems and issues.

The Neuropsychologist explains why the tests are done and how she or he will report the results after testing is completed.

Testing consists of the administration of a series of tests designed to assess the quality of the individual's current cognitive and emotional functioning. The testing is performed in one or more visits by the Neuropsychologist with the patient, face to face for the most part, in the quiet of the office (with breaks about once an hour or as needed). Testing is usually done on an individualized basis, at the Neuropsychologist's office--there is no invasive "medical" testing involved in the Neuropsychological evaluation.

While the tests administered may vary by the Neuropsychologist's preference and the particular needs of the client, they will usually include tests of the client's speed of thinking or processing, as well as his or her capacity for attention and concentration, memory, mental flexibility, comprehension and language, reasoning and problem solving skills, and general level of intellectual functioning. The tests are presented orally or in writing for the most part, where the client is asked to perform tasks involving answering questions, drawing or manipulating materials.

The evaluation usually consists of tests that are published and standardized--this is important to be able to compare the patient's results with what is average or typical/normal compared to others in her/his age range, and with a similar level of education and other demographics. Since the patient has most likely never been tested before, we cannot know exactly how he or she would have scored and performed prior to their injury or illness. So we need to estimate and compare the patient's current results with what is average for others similar to him or her.

Skills tested may include attention (holding information in 'your head'--that is, your working memory), new learning and memory, how fast you can think (process information) and how well you can solve problems and think flexibly; reading and communicating may also be tested. Facts and other ideas you learned in school or along the way are also covered, but are not the main areas tested--so you can't "study" for these tests... The amount of time that testing takes depends on several factors; it is usually from 3 to 6 hours per visit (about 6 hours total testing time is typical), depending on the needs of the situation and the patient's stamina and endurance.

The amount of time needed for the testing will vary as well, from three to six hours or more, according to the needs of the situation and the client's general ability to undergo this procedure. Most Neuropsychologists will decide on the kind and amount of testing based on his/her experience, and the clinical interview and history the Neuropsychologist takes from the client.

Results may not be given at the time of testing, because of the need to score and interpret the results. A feedback session is recommended and scheduled--at this meeting, which lasts 30-60 minutes, the Neuropsychologist meets with the patient, as well as family or friends the patient invites, to review the results, what they mean and what recommendations may be made.

How are these tests helpful?

Results of the tests are useful because they can be compared to norms, that is, numerical information that gives us a good idea how the client performs in comparison with the average performance of similar individuals. Also important is the client's performance in comparison to his or her overall level of functioning before the injury or illness, taking into account such things as educational history, work history, age and other factors.

The results of the evaluation should be shared with the client and, if the client requests, his or her family or significant others, as well, to explain what the results mean. The person who referred the client for the neuropsychological evaluation, usually a physician, rehabilitation nurse or other helping professional, will usually be given the results as well, with the client's permission. This helps that person understand the whole picture about the client's current condition.

Sometimes, if it's appropriate, results of this evaluation lead the Neuropsychologist to recommend that the client receive treatment to help them improve their cognitive or psychological functioning and learn ways to overcome or compensate for skills that may be less good because of their neurologic injury. It is usually appropriate for the Neuropsychologist to give the client appropriate referrals and education about the reason for recommending any rehabilitation or therapeutic treatments.

To summarize:

In conclusion, the neuropsychological evaluation is often a useful tool in determining whether an individual has experienced changes in his or her cognitive and behavioral skills as a result of a neurologic injury or illness. It is equally important, once the evaluation is completed, to determine what kind of treatment, if any, might be appropriate to help the individual function more normally again. Referral of the client or his/her family to support groups, educational and advocacy organizations, is also important to help the client make the best possible recovery from his or her illness or injury.

DISCLAIMER: The information in this presentation is intended as a guide and for educational purposes only; the particular evaluation techniques, diagnoses and treatment recommendations for each individual case will vary and should be thoroughly explained by the Neuropsychologist performing the evaluation.

Somerset Neuropsychological Services

Neuropsychological and psychological services in the greater Somerset and Hunterdon areas for over 20 years