Components of the Neuropsychological Evaluation

Abstract

Neuropsychological evaluation examines brain–behavior relationships as they pertain to cognitive, emotional and behavioral manifestations of central nervous system trauma, disease or dysfunction. Neuropsychological evaluation includes examination of sensory, motor and perceptual functioning as prerequisite for evaluation of increasingly complex cognitive, emotional and behavioral func-tions. Evaluation is typically on an ordinal scale (i.e., impaired/non-impaired) for sensory and perceptual skills and progresses to an integral scale for more complex functions (i.e., percentile relative to normative group). Rapid bedside or interview assessment of functions such as attention, language and memory can be done; however, it is important to note a brief evaluation will yield less precise information than formal testing. Brief evaluation has several advantages. These evaluations are quick to perform and can be repeated as necessary to mark prog-ress or suspected deterioration. Information from such evaluations are typically used to assist in patient management, set immediate goals and assist in treatment planning. In later chapters, we discuss brief assessment methods in each domain of cognition. Further details regarding the interpretive process, prerequisite knowledge base for adequate neuropsychological evaluations, psychometric principles guiding interpretation of neuropsychological psychometrically-derived data, and common errors in interpretation can be found throughout this book, but particularly Chapters. 1, 2, and 29–31). Sample neuropsychological reports are provided in Chapter. 1, Appendix A. The clinical neuropsychologist will integrate the patient's current complaints and his-tory (medical, psychiatric, educational, etc.), with available imaging, laboratory data, knowledge of brain–behavior relationships, functional neuroanatomy, neuropathol-ogy, cognitive psychology, psychometrics and test theory, psychopathology, and neurodevelopment. The assessment data obtained are compared against a comparison standard to identify relative neuropsychological deficits. The pattern of deficits mani-fested by patients are associated with brain function, which guides the answers to the referral questions. This information is integrated into a consultation or more lengthy formal report. This information is helpful to assess acutely the functioning of the patient and assist in guiding nursing staff and hospital staff (i.e., Physical therapist, Occupational therapist, Speech pathologist, etc.) in their expectations and care of the patient. This detailed consultation or formal assessment can also help family in rec-ognizing deficits, adjusting to change in the patient, and in beginning to set expecta-tions for the future functioning and accommodations which may be necessary. Below, we review critical patient history and medical information to be obtained followed by a sequential process of skills and behaviors of increasing complexity, which are essential in evaluating brain function. This sequential process is necessary because