Wondering what goes into a neuropsychological evaluation? You’ve come to the right place.
What is a Neuropsychological Evaluation?
A neuropsychological evaluation involves testing that is sensitive to problems in brain functioning. Unlike CT or MRI scans, which show what the structure of the brain looks like, neuropsychological testing examines how well the brain is working when it performs certain functions (for example, remembering). These functions or tasks form the necessary building blocks of successful living in the individual's daily life. Impairment in many of these functions may exist because of brain abnormalities that cannot be detected on CT or MRI scans. Therefore, neuropsychological assessment is a procedure with a unique purpose; it can be used to reveal or diagnose brain dysfunction when no structural brain abnormalities can be seen. Furthermore, when structural abnormalities have been found, neuropsychological assessment provides a way to determine what functions may be impaired because of the structural defects, and to determine the degree to which they may be impaired.
Why Get a Neuropsychological Evaluation?
A neuropsychological evaluation provides comprehensive assessment of patients in whom impairments of cognitive or neuropsychiatric functioning are evident or suspected. Assessment involves a systematic evaluation of higher cognitive abilities in order to identify possible problems with brain functioning, help lead to a diagnosis, define strengths and weaknesses, and make treatment recommendations.
A wide range of conditions may affect neuropsychological functioning, such as:
A neuropsychological evaluation may contribute to decisions about:
What Tests Are Used?
The types of tests that you will take depend upon the questions you and your doctor have. The tests may assess the following areas: attention and memory, reasoning and problem-solving, visual-spatial functions, language functions, sensory-perceptual functions, motor functions, academic skills, and emotional functioning.
The tests are not invasive; that is, they do not involve attaching you to machines or using X-rays. Most of the tests will involve answering questions, solving problems, drawing, or working with materials on a table. Some tests may use a computer and others may ask you to fill out forms and questionnaires. The testing may be performed by the neuropsychologist or by a trained staff member. The neuropsychologist or a staff member will also spend some time talking with you and your family about your medical, personal, and school history. The total time involved in your evaluation will depend upon the questions you and your doctor have. If you wear glasses or hearing aids, make sure to bring them with you. Also, if you have had previous testing, please bring any available records with you to the evaluation.
What Will Happen After the Evaluation?
The neuropsychologist may schedule an appointment to go over the results with you and/or may send you a written report. With your permission, the neuropsychologist may send the results to the doctor or healthcare provider who referred you. This doctor may talk to you about the results of testing on your next office visit. If requested, the neuropsychologist will give you specific recommendations to guide your treatment or otherwise help you in your daily life.
What is a Traumatic Brain Injury, aka TBI?
Traumatic brain injury (TBI) of all severities is a serious public health problem. In the United State alone, almost 1.7 million new cases of TBI present to emergency departments or require hospitalization each year (CDC, 2010). However, the actual incidence of TBI is likely significantly higher as many people who sustain milder injuries, which estimates suggest account for up to 75% of all TBIs, do not seek emergency medical care.
TBI is characterized according to injury-grading (severity) parameters. While many TBI or concussion grading systems exists, factors such as the amount of time the individual was unconscious following the injury (Loss of Consciousness or LOC) and the amount of time it takes for the individual to start forming new memories following the injury (Posttraumatic amnesia or PTA) are commonly used to determine if a TBI or concussion was mild, moderate, or severe.
TBI is a complex injury and no two injuries are alike. In many cases of mild TBI, a person may experience only brief LOC or not experience any LOC or any PTA. Instead, individuals may report “seeing stars” or feeling “dazed and out of it” immediately following injury. In fact, some individuals may not appreciate an injury occurred until other symptoms of TBI present. These post-concussive symptoms may include (and not all may be present):
While the majority of individuals experience a complete recovery within a week to several months following a mild TBI, a small subset of individuals do report persisting changes in their thinking abilities and mood. For these individuals, these changes can cause significant concern. A thorough neuropsychological evaluation can help determine the presence or extent of any cognitive or emotional changes related to the TBI, document a baseline level of cognitive functioning following injury, and, if necessary, offer treatment recommendations to help remediate any cognitive or emotional changes following TBI.
Common Myths of Mild TBI:
Myth: A concussion is different than a mild TBI.
Reality: Concussion is actually a form of TBI. The term concussion is often used to describe sports-related injuries consistent with the guidelines used to classify injury severity in sport-concussion (i.e., Cantu Guidelines, 1991; American Academy of Neurology Concussion Severity,1997). In fact, concussion and mild TBI, are frequently used interchangeably to describe the same injury. What determines if one has sustained a mild traumatic brain injury/concussion is the emergence of post-concussive symptoms following a credible injury event.
Myth: A mild TBI is no big deal.
Reality: In general, following a mild TBI, an individual can anticipate a period of disrupted brain functioning as the brain recovers from the initial injury event. During this period, it is not uncommon to have trouble focusing one’s attention, find learning to be more difficult, feel one’s thinking is slower, and experience changes in one’s mood (e.g., irritability, depression/apathy). However, with rest, within a few days to several months, the symptoms of mild TBI gradually improve as the brain returns to normal functioning. However, while the majority of individuals report complete recovery a week to a few months following a mild TBI, a small subset continue to report persisting problems with their thinking, memory, and mood changes. This subset proves a challenge for treating physicians and patients and often require further evaluation.
Myth: If I didn’t hit my head on something (come into contact with an object), I did not sustain a brain injury.
Reality: In some injuries, one does not necessarily have to make contact with another object (strike one’s head on an object or be struck on the head with an object). In fact, any event where it is possible that the head was displaced in space such as whip lash or side to side jarring during contact sports can be sufficient to cause brain injury as evidenced by the development of headache, nausea/vomiting, dizziness, and/or other post-concussive symptoms (e.g., visual disturbance). These acute symptoms can arise over a period of seconds to hours after an injury.
Myth: Once the initial post-concussive symptoms subside, I am “recovered.”
Reality: No two individuals or injuries are alike. Not everyone experiences the same symptoms following a brain injury. Recovery is a complex process with significant individual variability. In general, it is important to allow the brain and body time to heal after a brain injury. The effects of mild TBI can be subtle and recovery is best gauged by a professional trained in TBI.
If you would like to learn more about neuropsychology and our colleagues, visit the links below.