Neurology Book


Neuropsychological Assessment

Aka: Neuropsychological Assessment, Neuropsychological Testing, Adult Neuropsychological Evaluation, Neuropsychological Test
  1. See Also
    1. Developmental Evaluation (children)
    2. Mental Status Exam
    3. Psychosis Exam
    4. Emergency Psychiatric Evaluation
    5. Appearance, Behavior and Attitude Exam
    6. Attention and Concentration
    7. Higher Integrative Function (Executive Function, Intellectual Function)
    8. Thought Process ( Thought Content, Thought Form, Delusion, Obsession, Abstract Thought)
    9. Speech Exam
    10. Affect Examination
    11. Insight and Judgement
    12. Memory Evaluation
    13. Orientation Exam
    14. Perception Exam ( Misperception, Illusion, Hallucination)
  2. Background
    1. Neuropsychological Testing is typically performed by a doctoral level psychologist
    2. Testing is comprehensive and covers multiple domains in cognition and emotion
      1. Testing is time intensive (hours) in contrast with cognitive screening (minutes)
    3. Neuropsychological Testing is often combined with other evaluation modalities
      1. Laboratory and Diagnostic testing (e.g. see Dementia)
        1. Excluded secondary causes (e.g. Vitamin B12, TSH, Urinalysis, Depression Screening)
      2. Neuroimaging (e.g. MRI Brain)
        1. Brain Lesion location typically correlate with neuropsychological deficits
      3. Electroencephalogram (if Seizure Disorder is suspected)
  3. Indications
    1. Distinguish forms of Dementia and other psychiatric or cognitive disorders (>90% accuracy)
      1. Clinical history and Mental Status Exam are not consistent with symptoms or history
    2. Pre-surgical evaluation prior to Epilepsy surgery or ventricular shunting
    3. Pre-surgical evaluation prior to Deep Brain Stimulation to aid in lead placement
    4. Specific cognitive deficit management via behavior management (e.g. memory aids)
    5. Associated cognitive problems secondary to underlying conditions
      1. Sleep Apnea
      2. Multiple Sclerosis
      3. Traumatic Brain Injury (e.g. functional prognosis, ADL independence, return to work)
      4. Postconcussion symptoms >30-90 days (distinguish psychological and other non-cognitive factors)
      5. Cerebrovascular Accident
      6. Brain Tumor
      7. Parkinsonism
      8. HIV Encephalopathy
      9. Attention Deficit Disorder
      10. Seizure Disorder
      11. Schizophrenia
      12. Bipolar Disorder
    6. Predict ability to work, drive, perform ADLs
    7. Assign prognosis of cognitive deficit
    8. Evaluate decision making capacity or competence (e.g. health care decision making capacity)
    9. Evaluation as part of a Disability claim or criminal case
    10. Identify underlying psychological disorders (.e.g Somatoform Disorder, Major Depression)
  4. Contraindications: Reasons for Insurance Claim Denial
    1. Active Substance Abuse (inaccurate results)
    2. No cognitive deficit identified
    3. Changes in living status or other transient conditions that may impact testing (e.g. NH placement)
    4. Patient cannot meaningfully participate in the evaluation (e.g. advanced Dementia)
    5. Testing cannot answer the clinical questions asked (will not differentiate conditions pursued)
    6. Testing will not impact medical decision making
    7. Testing only intended for screening or for educational or vocational use
  5. History: Review of Prior History
    1. Reason for referral and history of present illness
    2. Psychiatric history and neurologic history
    3. Past medical history and Family History
    4. Medications
    5. Substance Abuse history
    6. Test results (e.g. labs, imaging)
  6. History: Clinical Interview
    1. Developmental history
    2. Related psychological factors (e.g. emotion, personality)
    3. Symptom course and impact on daily living
  7. Exam
    1. See Mental Status Exam
  8. Diagnostics
    1. See Psychological Testing
    2. Validity testing accompanies psychological tests to identify Malingering
  9. Management
    1. Patient
      1. Answer patient and family questions about cognitive and behavioral functioning
      2. Discuss compensatory strategies and possible treatments with patient and family
      3. Patient and family receive results, impression, prognosis and treatment recommendations
    2. Referring Provider
      1. Testing results, impression, prognosis and treatment recommendations
  10. Resources
    1. Neuropsychologist Directory (ACCN board certified providers)
  11. References
    1. Michels (2010) Am Fam Physician 82(5): 495-502 [PubMed]
    2. Schroeder (2019) Am Fam Physician 99(2):101-8 [PubMed]

Neuropsychological Tests (C0027902)

Definition (MSH) Tests designed to assess neurological function associated with certain behaviors. They are used in diagnosing brain dysfunction or damage and central nervous system disorders or injury.
Definition (PSY) Use of tests, including intelligence, motor, and lateralization measures, to diagnose brain damage or other neurological dysfunction.
Definition (CSP) tests designed to assess neurological function associated with certain behaviors; used in diagnosing brain dysfunction or damage and central nervous system disorders or injury.
Definition (ALT) Performing a neuropsychological functioning test(s) on a client/patient to assess his or her intellectual capacity, cognitive functioning, achievement potential, learning disability and/or neuropsychological deficit(s). Service is billed in 15-minute increments.
Concepts Diagnostic Procedure (T060)
MSH D009483
ICD10 1829, 96000-02
SnomedCT 307808008
CPT 96118, 96119, 96120
English Neuropsychologic Test, Neuropsychologic Tests, Neuropsychological Test, Neuropsychological Tests, Test, Neuropsychologic, Test, Neuropsychological, Tests, Neuropsychologic, Tests, Neuropsychological, neuropsychological test, TEST NEUROPSYCHOL, TESTS NEUROPSYCHOL, NEUROPSYCHOL TESTS, NEUROPSYCHOL TEST, neuropsychological diagnosis, Neuropsychological assessment, neuropsychologic tests, neuropsychological tests, neuropsychological testing, neuropsychological assessment, assessment neuropsychological, testing neuropsychological, Neuropsychological tests, Neuropsychological testing, Neuropsychological testing (procedure), Neuropsychological Assessment, Neuropsychological testing each 15 minutes, neuropsych tstng ea.15min, Neuropsychological test
Dutch neuropsychologische test, Neuropsychologische test, Neuropsychologische tests
German neuropsychologischer Test, Neuropsychologische Tests
Portuguese Teste neuropsicológico, Testes Neuropsicológicos
Spanish Prueba neuropsiquiátrica, Tests Neuropsicológicos, pruebas neuropsicológicas (procedimiento), pruebas neuropsicológicas, Pruebas Neuropsicológicas
Swedish Neuropsykologiska tester
Japanese シンケイシンリガクテキケンサ, 図形記銘力検査, 図形記憶力検査, 失語症検査, 神経心理検査, 神経心理学的検査, 失語検査
Czech neuropsychologické testy, Neuropsychologický test
Finnish Neuropsykologiset testit
Italian Test neuropsicologico, Test neuropsicologici
Polish Testy neuropsychologiczne, Test pamięci wzrokowej
Hungarian Neuropsychologiai vizsgálat
Norwegian Nevropsykologiske tester
French Test neuropsychologique, Tests neuro-psychologiques, Tests neuropsychologiques
Derived from the NIH UMLS (Unified Medical Language System)

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