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A Guide to Neuropsychological Testing

Comments [15]

Jeffrey Kreutzer, PhD and Victoria Powell, PhD, Department of Physical Medicine and Rehabilitation Virginia Commonwealth University

A Guide to Neuropsychological Testing

Many people who have a brain injury undergo psychological testing, a specialized evaluation method. In this article, we describe the purpose and procedures involved in testing and answer common questions.

Research reveals that brain injury often affects abilities, behavior, and emotions. Commonly reported symptoms include trouble remembering things, thinking of the right word, seeing clearly, concentrating and doing more than one thing at a time (multi-tasking). Academic abilities are often affected as well. People may have difficulty spelling, doing simple math problems, and understanding what they read. Emotional changes may include frustration, depression, and difficulty controlling anger. After a brain injury, you, your doctor, therapists, and family members may want to know exactly how you have been affected. Testing helps answer important questions like:

  • How good are the patient’s memory, attention, and problem-solving skills?
  • At what grade level is the patient’s reading, arithmetic, and spelling?
  • Does the patient need accommodations and a specialized education plan?

On a more global level, testing can help answer questions like:

  • Can a person with the injury:
    • live safely by themselves?
    • successfully go back to work or school?
    • manage their finances or medications safely?
    • drive safely?

Who gives the test?

Neuropsychological tests are given, scored, and interpreted by a licensed clinical psychologist or neuropsychologist. A neuropsychologist is a professional who specializes in understanding how the brain and its abilities are affected by neurological injury or illness. Psychometrists are professionals specially trained in giving and scoring tests under the supervision of a licensed psychologist.

What should I expect on the day of the testing?

Before your appointment, you will usually be asked to provide records about the history of your injury and what rehabilitation treatments you have had. You may also be asked to give your medical, psychological, and educational history. The neuropsychologist also needs to know which living, work, and educational skills are most important for you now. For example, different jobs require different skills. A teacher may need to be very good at math and reading. A construction worker may need good attention and visual skills.

On the day of your appointment, you and a family member or close friend will meet for an interview with the neuropsychologist. Try to get a good night’s sleep, eat breakfast, and take your medications as prescribed. The neuropsychologist will ask questions about your current problems and recovery so far. Testing will then begin.

Usually testing takes between two and six hours, thought some patients take longer. During testing you will be asked to answer questions, do tasks with pencil and paper, remember information, and possibly respond to questions on a computer. You will be given breaks depending on how you feel and how long the evaluation takes. Afterward, your tests will be scored and the scores will be compared to those of other people the same age and level of education.

The Neuropsychological Report

The neuropsychologist writes a detailed report that includes important information form the interview and tests including diagnostic conclusions. Information will be provided on your strengths, weaknesses, and limitations and your emotional well-being. The rport will often include recommendations for improving memory, therapy to improve your mood, or referral to other rehabilitation professionals. The report will usually be sent to you and your doctor. You may request a feedback session with the neuropsychologist to discuss your results and ask questions.

In summary, neuropsychological testing is an important tool. The process can help you and your doctors better understand your injury and recovery and better plan for you to receive the most effective therapy.

Written by Jeffrey Kreutzer, PhD and Victoria Powell, PhD, Department of Physical Medicine and Rehabilitation Virginia Commonwealth University, Richmond, VA. Used with permission. www.pmr.vcu.edu.

Comments [15]

I'm scheduled next month to get this test done.  Almost 28 years ago I incurred head trauma.  I was in a coma for 1 month.  I had to relearn everything from 7 years old and up..  I'm 42 years old now and symptoms of forgetfulness, depression,, etc, seem to be getting bad again.. I'm looking forward to this test to give us some answers... I have a husband and we ace 2 children together..

Sep 25th, 2015 10:41pm

I am scheduled for a tbi evaluation by the VA in a few weeks. I incurred my head injury in 1993 and my life has been one train wreck after another since. I display and experience nearly every noted/listed long term/chronic symptom of the aftereffects of moderate tbi. It has taken more than 20 years to get some recognition that I am not faking all this crap. Those stating that there is a conspiracy to mitigate and minimize the long term affects of tbi by the DOD and VA are right on the money. Professional athletes and old football players are being recognized and compensated pretty well for there injuries......when is the military and VA going to stop pretending it isn't happening?

Aug 7th, 2015 2:22pm

I have come to believe that there is a well-organized conspiracy to deny diagnoses of brain injury now that so many veterans are coming home suffering and so many states are whining about not having funding to support or treat those with TBI - or enough providers trained to recognize and treat it.

My family is suffering incredible cruelty in many ways because I have advocated for my daughter to get the proper diagnosis and help - or at least not treat her like a criminal and involuntarily addict her to benzos - then take her off cold turkey, just because she is suffering from multiple accidents. In other words if the state of NC won't help us, then at least leave us alone.  They have taken my grandson from ME because I believe the TBI diagnosis given by a reputable neuropsychiatrist, and I requested the support the state claims we are entitled to but our area does not "have the funding for."  Isn't TBI punishment enough without taking my grandson from me and my son from my daughter?

All this material by the BIA and the VA on TBI and how they're helping so many and educating so many is all crap if the states claim they don't have funding for treatment.  I can prove that the doc the state agents took my daughter to for what was supposed to be a neuropsychological eval but turned out to be a computer screening -- misrepresented the interpretation of her test results.

And a veterans website says VA is doing the same.  If the states need more funding, and HRSA claims everyone ought to be screened who's had an accident that could affect the brain, then why doesn't HRSA give the states enough money to treat TBI?  If they don't then the states are not going to allow people to be screened, much less diagnosed.  It's all a farce coming down from the feds and the VA. The reality is people are being denied proper evaluation and treatment. They are being drugged with benzos - taken off cold turkey and truamatized more my the medical community that should be helping them.

Jun 5th, 2015 1:06am

there is a subset of clinical neuropsychologists who (unfortunately IMO) believe that all cognitive symptoms should resolve within 3 months of a mild TBI.  IF you have symptoms that persist past that point in time, you must be 'faking'.  Chances are you were evaluated with a professional who subscribes to this apriori mindset.

Please do not give up on the field of neuropsychology because of that.  In the future you may wish to ask the clinician what their beliefs are about mTBI prior to the assessment.  Or google them- most of us have been published in one location or another.

May 14th, 2015 6:59pm

To the Scientist - see a clinical psychologist, your symptoms are consistent with PTSD.

Mar 19th, 2015 3:21am

I had testing only to be told that I was faking.  That was 2 years ago.  I still have brain fog. BUT, I spent the past 2 years doing research. Here is what I learned: "There is only a little evidence for the diagnostic validity of cognitive testing and other diagnostic tools for mild traumatic brain injury."   This includes the MMPI; IQ testing; and all other neuro psych testing activities.

Here is who did the study.

Diagnostic procedures in mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury.J Rehabil Med. 2004 Feb;(43 Suppl):61-75.

Borg J1, Holm L, Cassidy JD, Peloso PM, Carroll LJ, von Holst H, Ericson K; WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury.

Mar 10th, 2015 2:48am

I'm really concerned as all of the others have been. I will be tested soon. Since my TBI I have headaches, vision problems, lack of patience, no focus, and I've heard a personality change. Of course with all of this goes frustration and depression. My scans appear to be find, yet the problems exist. I work around inmates so the thought of going back to work terrifies me. I have had lapses in memory that I don't know where I am. If this is all done and they say I'm fine, I don't know what I will do. I'm not faking and I'm really scared about how bad this may get. No dementia or Alzheimer's present on scans. What do you do from this point!

Feb 24th, 2015 7:47am

I had 2 concussions, one in 2007 and another in 2012. I used to be the most literate and articulate business woman. then following the 2012 I have tbi (diagnosed 4 months after the concussion), mild spasticity, vestibular disorder, constant daily vertigo, unable to walk more than 100mt, little balance, I slur, I have blackouts... even have widespread hyperintensities all through my brain mri...and have had 2 neuropsych evals. Both had me ill in bed for weeks afterwards. I did my best and I guess I was too good? They both said I dont have tbi even though it was diagnosed. I don't think that any thought goes into the mental fatigue of their tests or any consideration of pre-injury IQ and abilities. Am disgusted by the process tbh, my children are shocked at the reports.. the neuropshyc evaluater had made up all sorts of things in the report - and made tonnes of mistakes in history taking. All that effort, weeks to recover both times, only to be treated like a faker? Not impressed!

Sep 23rd, 2014 4:44am

I think it's very interesting that every single comment in this thread states that neuropsychological testing has NOT been helpful to the patient, yet when I search the literature about what do to assess loss of function after a head trauma this is presumed to be the gold standard of diagnostic testing. How can there be such a discrepancy between what professionals tell us and what patients experience? Obviously no test is 100% accurate, but maybe this type of testing is favored by practitioners for their convenience and reimbursement dollars and not it's value to a patient.

Sep 5th, 2014 1:06pm

To the Scientist. Sounds like PTSD.

Jul 23rd, 2014 3:39pm

I suffered gun shot wounds to chest that have taken almost two years to recover from, yet I still struggle with vivid pictures of the fight for my life that took place at the time. I am forced to go through the complete sequence of events several times a day and night, without being able to turn the sequence off. Whatever can this kind of testing prove? it;s clearly a physiological issue and is not going to be resolved by having someone tell me where I fit within some set of gaussian distributions cross-correlated to different skill sets of differing occupations. I am a Ph.D scientist with > 20 years experience in physics and having someone who is not able to offer either medical or scientific reasoning ask me how I feel about this, without the capacity to understand neuroscience is a waste of time.

May 15th, 2014 9:21am

I have been through two, and now need to go again to please the insurance company.

My TBI was over a decade ago, and I did well for a while. Problems (noise sensitivity, transposing numbers...) have re-emerged.

The first Dr. was very good and went over the results with me. The second Dr. got upset when I asked if the high doses of three medications (4,000mg/day gabapentin, 300mg/day tegretol, and 200mg/day lexapro) I was taking could affect the results. She didn't know the common side effects, so in her review said I needed to 'pick himself up by the bootstraps". She was obviously upset when I asked if she knew the side effects. so she stated I have borderline personality disorder; no other Dr. agrees with her.

Pity the patient can't evaluate the administrator of the exam!

Now I am having problems again, and dread being judged by someone who's aim is to to prevent insurance claims. My problems are real, I am motivated to return to work, but find the healthcare system severely lacking for TBI injuries.

Apr 14th, 2014 2:42pm

Same thing happened to me, and I'm not lying. I can't run my own company since the car accident and I'm losing money but can't do anything about it. I don't know how to get better by myself.

May 13th, 2013 7:50am

According to the Dr.'s my grandson passes these tests in the normal range,when administered in a dark room, undisturbed, however he still has a total personality change, extreme headaches when subjected to lights, confusion etc, and appears to be unable to function in relationships etc. Can this be? he received a very high impact kick to the head over a year ago.

Dec 16th, 2012 2:02pm

My husband was hit by a car while riding a bike. He went through this battery of tests and they said he was faking. He is dyslexic AND has right/left dyslexia. Part of the test involves left/right questions. The person giving the test yelled at "don't you know your right from your left?" He never answered that, just kept trying. The results infuriated me.

Nov 13th, 2012 5:19pm

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