Clinical neuropsychology is a specialty profession concerned with the brain and behavior. A clinical neuropsychologist is a licensed psychologist with expertise in how behavior and skills are related to brain structures and systems. In clinical neuropsychology, brain function is evaluated by objectively assessing memory and thinking skills. Unlike bedside neurological screenings, neuropsychological tests are standardized, meaning that they are given in the same manner to all patients and scored in a similar manner time after time. An individual's scores on tests are interpreted by comparing their score to that of healthy individuals of a similar demographic background ( i.e., age, education, gender, and /or ethnicity) and to expected levels of functioning. A detailed assessment of abilities is done and the pattern of strengths and weaknesses is used in important health care areas such as diagnosis and treatment planning. The clinical neuropsychologist conducts the evaluation and makes recommendations regarding intervention and monitoring of identified, underlying conditions. In general, the neuropsychologist attempts to elicit the patient's best possible performance under optimal conditions.
NEUROPSYCHOLOGICAL EVALUATIONS (i.e., NPEs) are requested to help understand how different brain systems are working and to assess the cognitive and functional deficits resulting from a central nervous system disorder or injury. The evaluation helps you and your health care providers by assisting with differential diagnosis, helping to determine appropriate treatments and providing a baseline against which subsequent evaluations can be compared. Thereby, your doctors can decide whether your functioning has declined because of disease or document whether your functioning has worsened or improved as a result of treatments (e.g., medications, rehabilitation, surgery or deep brain stimulation). NPEs can reveal areas of daily functioning with which the patient may need assistance or that may benefit from rehabilitation. Most often, patients have experienced symptoms of difficulty with memory, thinking or psychological functioning. Your difficulties may be due to a number of medical, neurological, psychological or genetic causes and testing will be helpful in understanding your specific situation.
The evaluation usually includes a review of medical and other records, an interview of yourself and others who are familiar with your functioning and testing of important areas of cognitive and psychological functioning. The referral question determines the focus of your evaluation which may include some or all of the following areas of functioning :
Testing can identify cognitive weaknesses in specific areas and is very sensitive to mild memory and thinking problems. When problems are very mild, testing may be the only way to detect them. For example, testing can help determine whether memory changes are normal age-related changes or if they reflect a neurological disorder. Test results can also help differentiate among illnesses, which is important because appropriate treatment depends on accurate diagnosis. Different illnesses have different "neuropsychological signatures" resulting in different patterns of strengths and weaknesses on testing. Testing can help differentiate among Alzheimer's disease and other forms of dementia, stroke, depression and other disorders. Your physician will use this information along with the results of other tests, such as brain imaging and blood tests, to come to the most informed diagnosis possible.
Some tests are in a question-answer format and others require paper and pencil responses or use of a computer. Tests are both easy and complex. Your test scores will be compared to scores from people who are like you in important ways to determine if your performances are normal for your age and educational background. Using these methods, your strengths and weaknesses can be identified for the purpose of diagnosis and treatment planning. The time required for your evaluation depends on the problem being assessed. In most cases, several hours of interview and testing are necessary to assess the many skills necessary for effective information processing. Forensic evaluations are usually more detailed and often require more time to complete.
After your evaluation is completed, additional time is spent scoring and analyzing test results and preparing summary reports. Patients referred in a clinical context will be seen for a follow up appointment to discuss results and recommendations.
The most important thing to remember is to always give your best effort. Bring glasses and hearing aids if you use them. Try to rest and relax before your evaluation. Most people find the testing interesting and are encouraged that a thorough assessment of their functioning has been provided.
It is essential to the disposition of your case that a determination is made as to whether your referral is a clinical vs. forensic matter. Sound ethical and professional practice requires clarification of the nature of referral before services are rendered.
Generally speaking, when a referral is made by an employer, insurer, educational institution, IME vendor, licensing board, attorney, or by court order, forensic standards apply since the case has legal or financial ramifications. When a patient is referred by their physician or health care provider for diagnosis and treatment, the context is usually clinical in nature.
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