Link To And Excerpts From Neuropsychological Assessment From StatPearls

Tom Wade MD

Jun 30

In this post, I link to and excerpt from StatPearls' [Link is to the Table Of Contents] Neuropsychological Assessment, Lynn A. Schaefer; Tanu Thakur; Michael R. Meager. Last Update: May 16, 2023.

All that follows is from the above resource.

Introduction

Although physicians commonly utilize screening instruments to identify cognitive problems and psychological issues in patients with various neurological etiologies, situations frequently arise when referral to a neuropsychologist is needed for a more comprehensive assessment.[1]

Clinical neuropsychologists are doctoral level health care providers who have specialized training in brain-behavior relationships and perform comprehensive evaluations in addition to providing certain forms of treatment. Therefore, cognitive screening tests can be useful to indicate the need for a consult with a neuropsychologist for further, more formal, and comprehensive examinations.[3]

Function

Neuropsychological evaluations require the use of standardized instruments to assess cognitive functions, behavior, social-emotional functioning (i.e., mood, personality), and in certain cases, adaptive functioning and academic achievement. More specifically, cognitive functions can be organized into specific major domains such as intelligence, attention/concentration, learning and memory, language, visuospatial and perceptual functions, executive functions, psychomotor speed, and sensory-motor functions.

Comprehensive assessment typically begins with a detailed medical record review, including medical and psychiatric history, medications, laboratory results, and neuroimaging reports, and in-depth clinical interviews. The clinical interview includes behavioral observations and may last one to two hours. A wide variety of neuropsychological test instruments (primarily paper-pencil tests) are then administered; most are done sitting at a table in an outpatient clinic or private office or bedside in a hospital. Evaluations can vary from less than one hour to 6 to 8 or more hours of direct face-to-face examination, depending on the information sought and the patient's stamina and motivation.

The neuropsychological evaluation is tailored to the needs of the individual patient. The neuropsychologist selects, administers, and interprets the particular battery of tests that will yield the most comprehensive understanding of an individual's strengths and weaknesses and help to answer the referral question(s). Following the explanation of the primary problem areas and diagnosis, the neuropsychologist then provides tailored recommendations for the patient. Test batteries can be either "flexible" or "fixed." Flexible test batteries are more common and may revolve around a core set of tests with additional tests employed, as needed to address specific issues. A flexible battery approach permits test selection on a case-by-case basis. However, some clinical neuropsychologists utilize a fixed battery approach, such as the Halstead-Reitan Battery (HRB)* or the Luria-Nebraska Neuropsychological Battery (LNNB)**, although this is less common.[5]

*Halstead-Reitan Battery (HRB)

**Luria-Nebraska Neuropsychological Battery (LNNB)

Tests are administered in a standardized manner (meaning each test is administered according to the methods outlined in the respective test manuals for every patient), and scores are interpreted by comparing the patient's scores to an appropriate normative group. Depending on the test, norms should be selected to match the patient's gender, age, education, and ethnicity. The reader should note that neuropsychological evaluations are thorough examinations with multiple components and involve much more than the administration of a few tests. A neuropsychological evaluation is not limited to testing but also involves, as mentioned above, a clinical interview, review of medical records, testing current cognitive and academic abilities, tests of social-emotional functioning and personality, adaptive functioning, estimates of premorbid functioning, behavioral observations, and integration of all these components. In addition, the clinician may also need to obtain educational and employment records and conduct collateral interviews with family members.[6]

Issues of Concern

Neuropsychological assessment is performed for several reasons. The following are a few of the goals and benefits:

To establish a "baseline" if later changes are anticipated (e.g., pre- and post-surgery) or to help determine if a patient is a good candidate for surgical intervention.

To gauge an individual's cognitive and emotional profile (i.e., strengths and weaknesses) and aid in treatment planning.

Differential diagnosis, when brain-based impairment in cognitive function or behavior is suspected (e.g., memory complaints).

To establish possible lateralization or etiology of brain lesion.

To track progress in rehabilitation and the effects of treatment and medication.

To help with educational placement, interventions, and accommodations.

For determination of disability, return-to-work/school, driving ability, or forensic (legal) purposes.[7]

Clinical Significance

Patients with brain injury can benefit from neuropsychological assessment as part of an interprofessional team approach to care. As mentioned above, cognitive assessment can help dictate a treatment plan, monitor recovery, and help determine when a person is ready to return to work, driving, or sports.[8]

Another clinical population for which assessment is valuable is older patients with long-standing memory concerns along with other cognitive deficits with or without corresponding brain atrophy. These cases may require an assessment to help determine a differential diagnosis as well as aid in decision-making. Other groups with reported memory and other cognitive problems also may require dementia assessment and consideration of psychological factors contributing to a patient's symptoms (e.g., dementia versus depression).[9]