Psych

Neuropsychological Assessment

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Neuropsychological Assessment, Neuropsychological Testing, Adult Neuropsychological Evaluation, Neuropsychological Test

  • 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)
  • 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)
  • 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
  • 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)
  • History
  • Clinical Interview
  1. Developmental history
  2. Related psychological factors (e.g. emotion, personality)
  3. Symptom course and impact on daily living
  • Diagnostics
  1. See Psychological Testing
  2. Validity testing accompanies psychological tests to identify Malingering
  • 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
  • Resources
  1. Neuropsychologist Directory (ACCN board certified providers)
    1. https://theaacn.org/directory/