Neuropsychological Testing

Neuropsychological testing involves a comprehensive assessment measuring how healthy your brain is and how your thought processes affect your mood and behavior.

Your doctor may request a neuropsychological evaluation to help make an official diagnosis, better understand your ability to perform daily activities, or monitor the progress of your treatment plan. This information is invaluable when diagnosing and managing many neurological and psychological conditions.

A neuropsychological evaluation begins with referral questions. This article explores the purpose, types, and process of neuropsychological testing, highlighting its role in diagnosing various conditions and guiding treatment plans. ^[1]

What is Neuropsychological Testing?

Neuropsychological testing evaluates how you think and assesses your brain health by measuring several different brain functions called domains. ^[1]

These are examples of domains measured during neuropsychological assessment:

• Your overall intelligence
• How well you did (or are doing) in school
• How you adapt to changes in your environment
• How you function in your day-to-day life
• Your ability to concentrate (your attention span)
• Your ability to learn something new and remember it later
• Your personality traits
• Your mood(s)
• Your ability to make a plan and carry it out to completion
• How well you control your emotions and impulses
• How quickly you process new information
• How you process and interpret sensory information (gathered from your environment through your five senses.)
• Various types of movements ^[1][2]

Measuring some, or all, of these domains gives a neuropsychologist comprehensive insight into how your brain is functioning, and this allows them to evaluate your brain health more capably. ^[1][2]

Not everyone undergoes testing for every domain during a neuropsychological assessment. The specific areas evaluated will depend on your individual needs and the purpose of the assessment. ^[1][2]

Types of Neuropsychological Tests

Depending on your needs and the referral questions, your neuropsychologist will select from various categories of tests. Each of these standardized and validated tests is designed to assess one or more domains. ^[1]

Here are some of the types of tests available:

• General intelligence tests, such as IQ tests
• Tests assessing academic achievement for those who are in school
• Memory tests
• Tests of language and reading comprehension
• Tests of attention and concentration
• Puzzles or logical thinking tests
• Validity tests and tests of effort (to confirm that results are valid, accounting for your effort)
• Personality tests
• Mood questionnaires
• Tests of planning abilities
• Movement tests ^[1]

The number and types of tests you take are tailored to your specific needs and referral questions, meaning not everyone will undergo the same assessments.

What Conditions are Neuropsychological Tests Used for?

Neuropsychological tests can provide useful insight into a wide range of neurological, psychiatric, and developmental conditions. ^[1] These include:

• Traumatic brain injury
• Stroke
• Dementia
• Neurodegenerative disease
• Attention-deficit/hyperactivity disorder (ADHD)
• Epilepsy (seizures)
• Brain tumor
• Autism spectrum disorder (ASD)
• Psychiatric conditions, such as bipolar or schizophrenia
• Developmental disorders
• Learning difficulties or disabilities
• Difficulties at work or school ^[1][2][3]

How Does Neuropsychological Testing Work?

A neuropsychologist, a doctoral-level practitioner with specialized training in neuropsychological assessment, will conduct your evaluation. An assessment may range from a single session lasting an hour or less to multiple sessions, depending on the patient’s needs. It is often completed in an office with a desk and chairs, though it may sometimes be carried out at your bedside if you’re in the hospital. ^[1][2]

Your neuropsychological evaluation will start with a comprehensive review of your medical and psychiatric records, plus any neuroimaging and available laboratory results. You may also be asked to complete some questionnaires or forms before your appointment. Your answers help the neuropsychologist decide what tests you should undergo. At the beginning of your appointment, the neuropsychologist will consult you, and any family members who have accompanied you, to learn about any current symptoms, concerns, and other relevant information. ^[2][4]

To perform the evaluation, the neuropsychologist will administer several different neuropsychological tests.

You may be asked to complete these using pencil and paper, on a computer, or by answering questions orally. The tests are standardized, meaning that every person must complete the same version of each test. Each neuropsychological test has been carefully studied and validated to measure how you think, understand your brain health, review your personality, and assess your mood. You may also be asked to perform certain tasks or movements. ^[1][2]

Pros and Cons of Neuropsychological Testing

There are both positive and negative considerations when it comes to neuropsychological testing:

Pros

Neuropsychological testing can help your healthcare team diagnose why you may be having difficulties. Since several different disorders may have similar symptoms, it’s not always easy to pinpoint which you have. Being correctly diagnosed is central to bettering one’s symptoms, as this helps your doctor determine which medications, if any, are most suited to helping you. It can also help your doctor know which other health professionals could provide further assessment or help. ^[1][2][5]

Tests like the Wechsler Adult Intelligence Scale (WAIS) can help you and your family understand your cognitive strengths and weaknesses, and act accordingly to assist where necessary. It can also help your school or workplace cater to you effectively and, in doing so, get the best out of you. Once people in your sphere are aware of the idiosyncrasies of your situation, things can be put in place to help you thrive – neuropsychological evaluations are a helpful step towards this outcome. ^[5]

Cons

The generalizability of neuropsychological testing has been criticized in the past. Questions arise, such as whether the normal result would remain the same across different cultures, ages, and educational levels. ^[6]

Researchers have also raised concerns that many of the current neuropsychological tests may only be valid for people who grew up in Western, industrialized, and democratic countries; who are well-educated, comparatively rich, and enjoy the privileges of being so. There have also been concerns about how well the tests measure the abilities of someone whose first language is not English. ^[6]

Your neuropsychologist has been trained to account for differences in educational levels and cultural differences in their evaluation. If English isn’t your first language, you should inform your neuropsychologist before your evaluation so that a professional interpreter can be present during your appointment. ^[6]

How to Prepare for Neuropsychological Assessment

The idea of neuropsychological testing may cause you anxiety or fear, which is understandable. Sometimes, knowing more of what to expect can help.

Though it’s called neuropsychological testing, there is nothing to study before you attend your appointment. A neuropsychological evaluation is to see how you’re coping cognitively in your daily life. Just be honest about what you’re experiencing. ^[5]

To help your appointment go smoothly and make sure you receive an accurate evaluation, here are some things to bring with you:

• Any questionnaires or forms that your neuropsychologist has requested, completed to the best of your ability
• A list of your current medications, including dosages
• Any relevant medical records which have not previously been sent to the neuropsychologist
• A copy of any previous neuropsychological evaluations you may have had
• Your academic records if you’re still in school
• Glasses or contact lenses if you wear them
• Hearing aids if you wear them
• Snacks or drinks for breaks
• A photo ID and health insurance information ^[5][7]

Here are some things you can do to ensure that you do your best:

• Try to get a good night’s sleep the night before your appointment.
• Eat a healthy meal the morning of the appointment.
• Wear comfortable clothing and shoes.
• Take your regularly prescribed medications as normal.
• Don’t take any medications that might cause sleepiness or drowsiness. This includes some pain medications, anti-anxiety medications, or antihistamines. If you have questions about which medicines you should or should not take, please speak with your primary care provider before your appointment.
• Don’t take any mind-altering substances, such as alcohol or illicit drugs.
• Leave some extra time to arrive at the testing facility, park, and get to the clinic. ^[5][7]

What Happens After a Neuropsychological Assessment?

After you’ve completed the assessment, you can go home for a well-deserved rest!

Your neuropsychologist will score your tests. Your answers will be compared to standard response ranges from other people, matched by gender, ethnicity, age, and education level. ^[2][3][8]

Your neuropsychologist will then integrate the test results with your medical records, laboratory reports, and imaging results to provide a written report of your brain health and function, including your strengths and areas where you may need extra help. This report aims to answer the referral question or questions from your referring physician. It will also provide recommendations to help you live as normally as possible. ^[2][3][8]

The neuropsychologist will send this report back to your referring physician and any other members of your healthcare team who may require the information (for example, your primary care provider, neurologist, psychotherapist, and occupational therapist). ^[2][3][8]

Depending on the neuropsychology practice, a follow-up appointment may be offered to you and your family members. In this session, the neuropsychologist will go over the tests you took, your results and their recommendations. You and your family members can ask questions at that time. ^[5][8]

Possible Treatment Recommendations

Your neuropsychologist will recommend ways to help you live your life to the fullest while keeping you safe and maintaining as much independence as possible. These recommendations will be based on your test results and individualized to your case. ^[5]

Some examples of possible recommendations may include:

• Medication(s)
• Accommodations at work or school to allow you to perform to your highest potential
• Seeing a counselor if a mental health problem (such as depression or anxiety) is contributing to your symptoms
• Referral to other health professionals, such as physical or occupational therapists
• Ways to cope with any difficulties and to improve relationships with other people
• Ways your family can help you cope with any deficits ^[5]

If neuropsychological testing has been requested for legal reasons, such as disability claims or a court case, the report can confirm a diagnosis. If the neuropsychological assessment was conducted to establish baseline functioning before surgery or another treatment, you will likely have a follow-up evaluation to track your progress over time. ^[5]