II. Background
- Neuropsychological Testing is typically performed by a doctoral level psychologist
- Testing is comprehensive and covers multiple domains in cognition and emotion
- Testing is time intensive (hours) in contrast with cognitive screening (minutes)
- Neuropsychological Testing is often combined with other evaluation modalities
- Laboratory and Diagnostic testing (e.g. see Dementia)
- Excluded secondary causes (e.g. Vitamin B12, TSH, Urinalysis, Depression Screening)
- Neuroimaging (e.g. MRI Brain)
- Brain Lesion location typically correlate with neuropsychological deficits
- Electroencephalogram (if Seizure Disorder is suspected)
- Laboratory and Diagnostic testing (e.g. see Dementia)
III. Indications
- Distinguish forms of Dementia and other psychiatric or cognitive disorders (>90% accuracy)
- Clinical history and Mental Status Exam are not consistent with symptoms or history
- Pre-surgical evaluation prior to Epilepsy surgery or ventricular shunting
- Pre-surgical evaluation prior to Deep Brain Stimulation to aid in lead placement
- Specific cognitive deficit management via behavior management (e.g. memory aids)
- Associated cognitive problems secondary to underlying conditions
- Sleep Apnea
- Multiple Sclerosis
- Traumatic Brain Injury (e.g. functional prognosis, ADL independence, return to work)
- Postconcussion symptoms >30-90 days (distinguish psychological and other non-cognitive factors)
- Cerebrovascular Accident
- Brain Tumor
- Parkinsonism
- HIV Encephalopathy
- Attention Deficit Disorder
- Seizure Disorder
- Schizophrenia
- Bipolar Disorder
- Predict ability to work, drive, perform ADLs
- Assign prognosis of cognitive deficit
- Evaluate decision making capacity or competence (e.g. health care decision making capacity)
- Evaluation as part of a Disability claim or criminal case
- Identify underlying psychological disorders (.e.g Somatoform Disorder, Major Depression)
IV. Contraindications: Reasons for Insurance Claim Denial
- Active Substance Abuse (inaccurate results)
- No cognitive deficit identified
- Changes in living status or other transient conditions that may impact testing (e.g. NH placement)
- Patient cannot meaningfully participate in the evaluation (e.g. advanced Dementia)
- Testing cannot answer the clinical questions asked (will not differentiate conditions pursued)
- Testing will not impact medical decision making
- Testing only intended for screening or for educational or vocational use
V. History: Review of Prior History
- Reason for referral and history of present illness
- Psychiatric history and neurologic history
- Past medical history and Family History
- Medications
- Substance Abuse history
- Test results (e.g. labs, imaging)
VI. History: Clinical Interview
- Developmental history
- Related psychological factors (e.g. emotion, personality)
- Symptom course and impact on daily living
VII. Exam
VIII. Diagnostics
- See Psychological Testing
- Validity testing accompanies psychological tests to identify Malingering
IX. Management
- Patient
- Answer patient and family questions about cognitive and behavioral functioning
- Discuss compensatory strategies and possible treatments with patient and family
- Patient and family receive results, impression, prognosis and treatment recommendations
- Referring Provider
- Testing results, impression, prognosis and treatment recommendations
X. Resources
- Neuropsychologist Directory (ACCN board certified providers)