What is a neuropsychological assessment?

Whenever I say to someone that as part of my work I administer neuropsychological assessments, I know from their facial expression that I have lost them by the third syllable! However, I am keen to break down this term and make it accessible so that everyone can understand what it is all about. Therefore, the aim of this article is to introduce you to the world of neuropsychology by explaining you what the assessment is, how it is carried out, and why it is needed.

Let’s start with neuropsychology…

Neuropsychology studies the relationships between brain structure and behaviour. It bridges the disciplines of neurology and psychology, seeking to understand how the ways in which we think, perceive, feel, and act may be related to and underpinned by the central nervous system. The aim of clinical neuropsychology is the assessment and rehabilitation of people with disturbed function following a brain injury or illness.

Riiight… so when is a neuropsychology assessment needed and what does it offer?
At some point, because of a brain injury (e.g. a car accident, a fall, etc) or because of an illness (e.g. dementia, Parkinson’s disease, a brain tumour, clinical depression, hyperthyroidism, motor neurone disease, sleep apnoea, stroke, and …need I go on?) some of us may experience particular symptoms, which signal the need for a neuropsychological assessment. Some such complaints commonly include:

• Short-term memory problems
• Inability to care for finances
• Losing items frequently
• Failure to recognize peers
• Poor attention and concentration
• Poor decision-making
• Language problems (e.g. fluency, naming, pronunciation, comprehension, etc.)
• Confusion (about day, time, place)
• Repetition and perseveration
• An unexplained change in personality
• Changes in emotional functioning (e.g. increased anxiety or depression)
• Unexplained neurologic complaints
• Depending on the cause, these symptoms may develop acutely or progressively. Either way, they are noticeable by the individual and/or others around them and disrupt them from carrying out tasks in their daily life. At certain occasions, it can also affect how they are behaving.

The neuropsychological assessment provides a “snapshot” of how the brain is functioning, and what it can and cannot do. In other words, it is an evaluation of an individual’s ability to perform mental functions, such as remembering information, concentrating on a task or solving a problem. Based on this information, inferences can then be made about how everyday activities and interactions with others might be affected.

What does it involve?

The assessment has two parts: a semi-structured interview and an assessment using standardised tests.

Dur ing the interview, which usually lasts 10-20 minutes, the examinee will be asked to provide information about himself/herself and the difficulties s/he is experiencing as well as how these affect his/her day-to-day life. At this stage, s/he can ask any questions or inform the examiner about any concerns s/he might have. It is helpful having someone close to the examinee at the appointment who can comment on how s/he is coping with his/her difficulties.

However, during the assessment, it is best for the examinee to be alone in the room with the examiner as this will help him/her concentrate better. During the assessment, which usually lasts approximately 2 hours the examinee will be asked to undertake a range of mental tests covering several core areas of mental (cognitive) functioning. These include:

• Attention/Concentration – the ability to attend to information and sustain concentration
• Speed of information processing – how quickly the individual can mentally process information
• Verbal memory – the ability to register, store, and retrieve verbal information
• Visual memory – the ability to register, store, and retrieve visual information
• Language – a brief assessment of basic language functions, such as comprehension and ability to name objects
• Visual Perception – a brief assessment of the ability to accurately perceive objects, and process where they are in space
• Executive functions – this is an umbrella term that covers a range of skills including abstract thinking, conceptualisation, impulsivity/inhibition, set shifting, planning, and organisational skills
• Tests are in a pencil and paper format. For each test, the examinee will be provided with instructions prior to attempting to complete it. If they did not hear or comprehend the instructions, the examinee can ask the examiner to repeat them.

Some tests are designed so that they become progressively more difficult and most people do not complete them until the end. There is no pass or fail; the examinee is simply asked to concentrate and perform to the best of his/her ability.

The examinee may also be asked about his/her mood and asked to complete a brief questionnaire. Performance on the tests the examinee will be completing can be affected by mood, and so the examiner needs to monitor this.

The examinee is not required to do any preparation for the assessment, as it is a non-invasive procedure.However, it is useful if s/he uses reading glasses, to bring them along, because some of the tests may involve reading or looking at pictures. Also, if the examinee has hearing difficulties and utilizes a hearing aid s/he can bring this with along too.

What happens after the assessment is completed?

The examiner needs to score the examinee’s performance on the tests and so it is not always possible to give feedback straight away. After scoring, the examiner will prepare a report with the results. This report is usually sent to the person who referred the examinee for a neuropsychological assessment (e.g. the GP, neurologist or neurosurgeon) who will then invite him/her back for a feedback appointment to discuss the findings.

How often will this assessment be undertaken?

It is usually done only once. However, sometimes the examinee might need to be re-assessed after a certain period of time, for example, 6-12 months later, to test for any improvement or deterioration and help the examiner monitor his/her cognitive functioning over time.

Why do a neuropsychological assessment?

The results will help the individual and the doctor or other health care professionals to better understand the difficulties s/he is experiencing. This can lead to a more accurate diagnosis or it can help them to put together a coherent treatment plan for the individual.

At the end of this page you can find a video with some more information on this topic.

ABOUT THE AUTHOR

Dr Patapia Tzotzoli founded My Psychology Clinic where she gained her reputation working as Clinical Psychologist with clients on one to one basis in London and worldwide via online therapy. She specialises in adult mental health and couples therapy. Studied at the universities of East London, Oxford and Cambridge and trained at the Institute of Psychiatry where she worked across world-renowned NHS Trusts.

Click here to book an online session or in person with Dr Patapia Tzotzoli at My Psychology Clinic.