Your neurologist has requested that you undergo a neuropsychological evaluation and you are not quite sure what this entails. Most people don’t, so you are not alone. Here are some frequently asked questions about neuropsychological evaluations.
A neuropsychological evaluation is a comprehensive assessment of cognitive processes (brain functions) that provides a wealth of information to the referring doctor and patient, by answering important diagnostic and treatment-related questions. This type of evaluation describes an individual’s brain-behavior functions by looking at several areas of cognition (e.g., thinking), including: verbal comprehension, problem-solving abilities, processing speed, learning and memory, attention, executive functions, language abilities, personality, adaptive functioning skills, emotional expression, perception, sensorimotor functions, motivation, quality of life, and visual-motor skills. Results from a neuropsychological evaluation reveal an individual’s strengths and impairments in each of these areas and, combined with results from other tests, offer valuable information to aid in diagnosis and treatment.
Every brain is a unique puzzle of genetics (nature) and experience (nurture), physical health, learned responses, personality, injuries, and diseases. The purpose of a neuropsychological evaluation is to sort out the factors that influence how the brain works in order to understand and explain changes and/or abnormalities.
Only fully licensed doctoral level psychologists who have been trained in psychological testing AND neuropsychology should perform a neuropsychological evaluation. Specifically, he or she should have completed a doctorate (PhD, PsyD) in clinical psychology and possess additional post-doctoral training in neuropsychology. They should have extensive experience in psychological testing, knowledge of brain-related diseases and injuries, and a thorough understanding of the aging process.
You are likely being asked to undergo a neuropsychological evaluation due to changes in one or more of your cognitive functions. You may have experienced an identifiable injury (e.g., car accident, head trauma, subdural hematoma, stroke) or a confirmed diagnosis of a disease that affects the brain’s functioning (e.g., Dementia, Alzheimer’s, Parkinson’s, Huntington’s, and Multiple Sclerosis). It may be that none of these has occurred, but you have noticed some changes, primarily in your memory abilities. Memory loss can be a symptom of less serious conditions than those listed above, such as depression, anxiety, stress, nutritional/vitamin deficiencies, or medication side-effects. In order to make an accurate diagnosis, information from a neuropsychological evaluation is needed.
A Neuropsychological evaluation involves four phases:
• Interview and information gathering
• Face-to-face testing
• Analysis, interpretation/formulation, and report writing
• Feedback to the patient
The amount of face-to-face testing time you will need to spend with the psychologist varies among individuals. A rough estimate is generally around six (6) hours to complete all face-to-face testing; however, it can take up to eight (8), depending on the person. Most often testing occurs over multiple appointments, although some psychologists may suggest or agree to complete the face-to-face testing all in one day. This amount of testing in one day is not advised. The goal is to get the most reliable information possible, and doing a marathon all-day testing session is not the way to do it. Preferably, two 3-hour appointments are scheduled; a third appointment added if necessary. Step 3 is another 6-8 hours without you present.
Phase One: Interview and information gathering: You and another person (who knows you very well), usually a spouse, sibling, or adult child, will meet with the psychologist to gather information related to your neurologist’s referral. This information includes a comprehensive history (family, physical health, emotional health, education, employment, daily activities, relationships, changes in memory and/or other cognitive functions, etc.) and a description of current symptoms. Information from someone other than yourself is especially important, given that they can offer a perspective that you may not be able to see.
Phase Two: Face-to-face neuropsychological testing: You will meet with the psychologist (at least twice) for the testing sessions, which are conducted in his/her office. You may come alone, bring a person with you, or have someone drop you off and pick you up at the end of your appointment. If someone brings you, they cannot be in the testing room while the evaluation is underway but are welcome to wait in the lobby or go run errands. During the face-to-face testing, you will be asked to do a variety of things. These include puzzles, memory and word games, drawing shapes, sharing your general knowledge, identifying pictures, etc. You may take breaks during this time – get up walk around, use the restroom, get something to drink or eat a snack, make a phone call, etc.
Phase Three: Analysis, interpretation/formulation, and report writing: This is the easiest part for you, as the psychologist must now take all the information gathered from your face-to-face testing and make sense of what it means. You won’t have to do anything.
Phase Four: Feedback to the patient: You, and anyone else you would like to accompany you, will return to meet with the psychologist and review all the results of your evaluation. You will receive feedback about strengths and weaknesses in your cognitive profile as well as explanations as to what these may mean. In addition, the psychologist will provide you with recommendations based on these results. Your evaluation will be forwarded to your neurologist and any other doctor you wish after you have received your feedback from the psychologist. You will receive a copy of your evaluation for your records.
Many people become anxious prior to a neuropsychological evaluation. Frequently this is because they have no idea what to expect. Although you now know much more about it, you still may become nervous or apprehensive. Try not to worry about “passing.” The psychologist is not looking for right or wrong answers, but rather, patterns of strengths and weaknesses. Be sure to get good sleep the night before. Do not drink any alcohol 24 hours prior to the evaluation and have a good breakfast or lunch before your appointment. Bring a current list of all medications with dosages and the reason they are being prescribed and any medical records or prior evaluations you feel would be helpful – the psychologist will be able to determine if this information is relevant to your evaluation. You may also bring anything you wish to drink or eat should you decide you would like a brief break. Bring any glasses or hearing aids with you, even if you don’t always use them.
Most major insurance companies include neuropsychological testing as a covered benefit; however, this would need to be verified prior to undergoing any testing. If it is covered by your insurance, any policy copays, coinsurance, and/or deductibles still apply. Insurance companies can be confusing to deal with, especially if you are not familiar with billing and procedure codes (CPT codes). Therefore, when making an appointment for a neuropsychological evaluation, ask the psychologist if he or she verifies insurance coverage for the codes to be used. If the psychologist is not willing to help facilitate this information, find one who will. This is a costly procedure and you need to be aware of any fees that may not be covered by insurance. If you are private paying for the evaluation (not using insurance), ask the psychologist how they determine cost. Is it based on individually billed hours or do they charge a flat fee for specific types of evaluations? If based on individually billed hours, ask what is typical for the type of evaluation you will be having and ask for an estimate (just like you would do if you were hiring someone to replace your roof). It is standard that you will be asked to pay any known outstanding balances before you receive your results.