Laboratory, neuroimaging, and previous neuropsychological results when available. Clinical interview with patient and collateral informant. Emotional, personality, and background factors that may warrant clinical attention. Communicate findings, diagnosis, prognosis, and treatment plan with referring clinician. Neuropsychological tests are different in purpose and scope from cognitive screening tests such as the Mini-Mental State Examination 3 Table 4.
Screening tests usually take five to 10 minutes to complete and are designed to screen for general cognitive impairment that may warrant a more comprehensive workup. Although screening tests can indicate problems in general cognitive functioning, they have poor ability to assess for deficits in specific cognitive domains. This has been highlighted by research showing that screening test items weakly correlate with scores in the same cognitive domains on neuropsychological testing correlations range from 0.
Neuropsychological evaluations are often complementary to neuroimaging and electrophysiologic procedures. Electroencephalography detects electrical activity of the brain, which is commonly used to assess for epileptic activity. Positron emission tomography identifies cerebral glucose metabolism to determine whether brain activity is reduced in specific regions.
However, these procedures have limited diagnostic sensitivity for some neurologic conditions and cannot assess the functional output of the brain. Neuropsychological testing provides an objective assessment of the cognitive, behavioral, and emotional manifestations from cerebral injury or disease. Because of the unique data that neuropsychological testing provides, physicians have increasingly utilized neuropsychological services.
Commonly referred clinical conditions and primary care referral questions are listed in Table 5. Information from references 6 and 7. Commonly used neuropsychological test batteries are highly reliable, with reliability coefficients often at or above 0.
For example, patients with right temporal lobectomies perform below the normative mean on visual memory tests, whereas those with left temporal lobectomies perform below the normative mean on verbal memory tests.
Guidelines from several organizations stress the importance of neuropsychological assessment in the diagnosis and management of dementia. The National Institute on Aging—Alzheimer's Association Workgroup recommends that neuropsychological testing be conducted when the clinical history and mental status examination do not yield confident diagnoses. Approach to the patient in whom there is concern about dementia.
Neuropsychological evaluation in primary care. Am Fam Physician. Although Alzheimer disease is the most common cause of dementia in adults 60 years and older, dementia is often the result of other disease processes e.
Understanding the cause of a patient's dementia can guide family physicians in prescription decisions e. A month follow-up is often used to determine whether patterns of cognitive decline are consistent with a suspected etiology, identifying conversion of mild cognitive impairment to dementia, or to monitor the rate of cognitive change over time.
Neuropsychological assessments are helpful in tracking changes that may affect daily functioning as cognitive impairment and dementia progress. Reduced visuospatial abilities moderately predict on-road driving performance. Neuropsychologists are often involved in post—acute TBI management to help determine and predict patient-specific cognitive, emotional, and adaptive functioning 27 Figure 2 2 , 28 — Approach to the patient with subacute mild traumatic brain injury.
Information from references 2 , and 28 through In patients with mild TBI concussion , in whom long-term cognitive deficits are less likely, a neuropsychological evaluation can identify psychological and other noncognitive factors that may masquerade as cognitive dysfunction and, therefore, can guide appropriate treatment recommendations.
Neuropsychologists routinely use performance validity tests in cases where legal issues may be confounding recovery after TBI. These tests assess the validity of a patient's reported symptoms. Referrals for neuropsychological consultation are commonly made by family physicians, neurologists, psychiatrists, and other primary care clinicians.
Assessments are typically covered by health insurance if psychological, neurologic, or medical issues are suspected that could affect cognitive or neurobehavioral functioning and if referrals are related to making clinical diagnoses or developing treatment plans. Table 6 shows common indications and exclusions for insurance coverage of neuropsychological evaluations. To determine if adverse effects of therapeutic substances could impair cognition.
To determine if a patient can participate in health care decision making or independent living. To diagnose cognitive or functional deficits based on an inability to develop expected skills. To differentiate between psychogenic and neurologic syndromes e. To establish a neurologic or systemic condition known to affect CNS functioning.
To establish rehabilitation or management strategies for patients with neuropsychiatric disorders. To monitor progression, recovery, or response to treatment in patients with CNS disorders.
To provide presurgical cognitive evaluation to determine the safety of the surgical procedure. Standardized test batteries are not individualized to the patient's symptoms or referral question. Tests administered for educational or vocational purposes that do not establish medical management.
Information from reference To reduce patient stress and optimize outcomes, physicians should briefly discuss with patients the reason for the referral, the anticipated benefit of the assessment, and the general testing format. This article updates a previous article on this topic by Michels, et al. Preventive Services Task Force were the primary sources for the article. Key words included neuropsychological, neuropsychology, cognitive, cognition, dementia, mild cognitive impairment, brain injury, and concussion.
Search dates: July 26, , to October 12, Editor's Note: Dr. Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. Address correspondence to Ryan W. Kansas St. Reprints are not available from the authors. Clin Neuropsychol. Cognitive screening tests versus comprehensive neuropsychological test batteries: a National Academy of Neuropsychology education paper. Arch Clin Neuropsychol.
Moafmashhadi P, Koski L. Limitations for interpreting failure on individual subtests of the Montreal Cognitive Assessment. J Geriatr Psychiatry Neurol. Neuropsychological assessment: a valuable tool in the diagnosis and management of neurological, neurodevelopmental, medical, and psychiatric disorders.
Cogn Behav Neurol. A national survey of physicians' use of and satisfaction with neuropsychological services. Wechsler D. San Antonio, Tex. The WAIS as a lateralizing and localizing diagnostic instrument: a study of patients with unilateral cerebral lesions. Verbal and design fluency in patients with frontal lobe lesions. J Int Neuropsychol Soc. The diagnosis of dementia due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease.
Alzheimers Dement. Eur J Neurol. World Health Organization. Geneva, Switzerland: World Health Organization; American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Diagnostic accuracy of memory measures in Alzheimer's dementia and mild cognitive impairment: a systematic review and meta-analysis.
Neuropsychol Rev. The CERAD neuropsychological assessment battery total score detects and predicts Alzheimer disease dementia with high diagnostic accuracy. Am J Geriatr Psychiatry. The clinical utility of structural neuroimaging with MRI for diagnosis and differential diagnosis of dementia: a memory clinic study. Int J Geriatr Psychiatry. Medial temporal lobe atrophy and memory dysfunction as predictors for dementia in subjects with mild cognitive impairment.
J Neurol. Early detection and differential diagnosis of Alzheimer's disease and depression with neuropsychological tasks. For example, individuals suffering from alcoholism often exhibit impairments in concentration, problem-solving, and abstraction.
While depression and other mental illnesses are associated with cognitive decline, they are also associated with a loss of motor skills, memory, and cognitive ability Neuropsychological Testing. Neuropsychological tests can also support people with mood disorders. Mood disorders can be challenging to detect, but a neuropsychological testing can help pinpoint the issue. A neuropsychological test may help patients with bipolar disorder, extreme depression, or psychosis, to name a few conditions.
To make a diagnosis, doctors must also rule out other conditions. As a result, a differential diagnosis can be used in a neuropsychological testing. A physical examination may be required to conduct a differential diagnosis. Evaluations such as those listed above may benefit recovery and treatment centers. An individual can be supported most appropriately by learning how their brain functions and what leads to those behaviors. FRN is home to a fantastic team of psychologists, counselors, and nurses who are dedicated to your overall health and wellbeing.
Our recovery plans include neuropsychological testing as one component. We will formulate an individualized rehabilitation and recovery plan personalized to your particular needs and objectives. Please contact us right away to get more information about Neuropsychological Testing. Ben Lesser is one of the most sought-after experts in health, fitness and medicine.
His articles impress with unique research work as well as field-tested skills. We are honored to have Ben writing exclusively for Dualdiagnosis. Schools do these tests at no cost to families to help figure out which kids need special education services.
So why do some families turn to private clinics? Here are a few reasons:. But by law they have to at least look at it when deciding if a child is eligible for special education.
A neuropsychological evaluation can cost thousands of dollars. In some cases, health insurance will cover it. In most cases, families have to pay for it out of pocket. One reason neuropsychological exams cost a lot is because they look at the whole child. But many kids may not need a comprehensive evaluation.
They may benefit from targeted tests like those for speech and language problems. Learn more about the difference between school-based and private evaluations. And find out what to ask before hiring an evaluator.
Podcast Wunder community app. Main menu Our work Blog Surveys and research. Join our team Privacy policy Terms of use Fundraising disclosure Sitemap. It measures many things, like attention span, memory, and language skills. The Goal of Neuropsychological Evaluations for Kids. Academic skills in reading, math, and writing Executive functioning skills like planning and organizing Intelligence Language skills Memory Motor skills like drawing and handwriting Visual-spatial processing like predicting what a square would look like if you folded it in half Social-emotional skills.
Some families get this kind of testing instead of or on top of a school-based evaluation. The results often say which kind of teaching and supports can help kids thrive.
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