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A Guide to Neuropsychological Testing

Comments [33]

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 [33]

Try drivers license was yanked after a MVA which I passed out very briefly. I have had 3 neuropsych tests in which I was told I failed. Had driver testing on machines and passed with flying colors. Report from driver evaluator said great but must rely on neuropsych results. I have depression, PTSD, anxiety and chronic back pain. I have been told no one will sign off for me to take testing for DL for fear of their license. They want me to take another Nuero testing. Very down and frustrated 😂

Sep 11th, 2016 2:46pm

My name is Amanda Sowell and I am a TBI survivor. I am scheduled for a evaluation soon. I was a nurse prior to an accident a little over a year ago and a mother to 3 boys 2 that are autistic. I specialized in taking care of Alzheimer patients prior as well. I now know way too much regarding neurological problems. These comments scare me to no end. I'm already getting the same response from all my doctors (mind-blown) some things are not in a book and I feel like a puzzle they're all trying to put together but there's so many missing pieces. The only true ones that understand brain injuries are the ones that unfortunately have them. If anyone would like to discuss this matter more with me please contact me via email @ amandacarolsowell@gmail.com

Aug 18th, 2016 12:15pm

what are the tests like? Is it difficult?

Jul 2nd, 2016 5:58pm

I was rear-ended at a stop light,  15 days hospital, had 2 test already and going for a third one to appease the insurance co. These test are so mentally stressful afterwards takes weeks to recover, one says "faked part" other says "worked very hard", this is a opinion from a doctor who never knew me and didn't see me early on, and is comparing me to other people he doesn't know. That's is ridiculous to rely on this test for anyone's care and treatment. It's insulting to me that the doctor that charges big bucks for this test doesn't even give you the test and then gives opinion on someone's life changing situation after meeting them for 15 minutes. This is a medical scam to all those who have suffered brain trauma. The exception for football players and boxers who volunteered to get their heads bashed in for big money, I didn't ask to get hit, and they get all the medical attention and money. Something needs to change, 

Jun 20th, 2016 6:39pm

I suffered TBA in 2010 and had my 3rd N/Psch test 3 days ago and are awaiting the results. From the Corp field to now being unable to work it has taken it's toll on me and those close to me. My support people monitor me expecting me to trip up but I won't! The world doesn't understand Brain injury until they personally experience it, because we appear normal. Just trying to read this article and follow the big words and descriptions sent my brain into a spin, then replying on my smartphone is an achievement for me...I rest my case and my brain...cheers. We must continue to push or boundaries.

Apr 22nd, 2016 5:24am

Ever think who pays the bills...insurance companies pay the most. What do insurance company's do...they fight claims...tooth and nail...who do you think these guys most want to please...my guess would not be the survivor!!!!!

Apr 19th, 2016 12:17pm

I am writing this comment as a reply to last some people below. These tests are not a sham. There is plenty of evidence that they provide scientifical information about how your behavior is related to your brain. The problem is not in the tests, but in who applies and interprets them. Any clinical/school psychologist and apply, let's say, some memory tests. But only those that have proper training (PhD in clnical psych with neuro track, neuro intenrship, neuro residencny) cand interpret scores in a professional an accurate way. I'm sorry to say, but a student that keeps leaving the room is a stupid one and should not even be in the field of neuropsychology. I was a student once, everyone was, but I've never tested a patient without knowing instructions and without knowing what to do next. At first it's overwhelming because there are many things you have to keep in mind. But for the love of God, write checklist and have it with you with your patient. I don't understand why would you accept to be tested by such individual. Students are also supervised by board certified neuropsychologists. I am a clinical neuropsychologist and if any of my students would do that, I would kick them off my service. They don't belong in this field. Not everyone is competent enogh, please be careful when you chose your neuropsychologist for testing

Apr 17th, 2016 6:01am

I had a massive brain hemorrhage in 2013 leading to complete left homonymous hemianopsia (blindness to the left side in each eye) and left inattention, along with some other things. I have taken two neurophyscological exams, one referral from my neurologist and one given by the Division of Blind Services. The experiences were very different.

The person my neurologist referred me to had her assistant administer the test. Once I told her that I knew I had left inattention, she told the assistant to remind me to look to the left! Guess we weren't going to notice any inattention then. The test took a couple of hours. I had to take a break in the middle due to my problems with visual overload. They completely ignored this. The result of the test was that I cannot work due to depression (which is true), but said that I had few cognitive problems. This after a double craniotomy and damage to both my occipital and parietal lobes.

The second test went much better. It took most of a day. The doctor gave it himself and he was a specialist in both blindness and brain injury. The tests were more extensive and more detailed. The diagnosis was much more complete and accurate (reflected my own experiences).

I think a tremendous amount of the experience and results of this testing is based on the doctor who gives it. This renders it pretty much useless since there is no way to adjust the results for this.

Apr 15th, 2016 11:12pm

So many thoughts after reading this and all the comments. As a neuropsychology fellow there are some things that just infuriate me, some that sadden me, and some that just can't be helped. I'll break into two parts: 1. On the part of a person going through a neuropsychological evaluation, there is so little understanding of what such an evaluation really measures. So many of the comments here sadden me, not because they disagree with the results they received, but because no one mentions the recommendations that came from the evaluation. Look, many people disagree with diagnosis. That's fine, get a second opinion. For some, they don't understand the results and after thorough feedback they gain better insight into how their brain and psyche is functioning and the diagnosis is a relief. For others, they will not be satisfied unless they get the diagnosis they want. If you have made up your mind about the diagnosis before going to be tested, why go? If you know more than your doctors, then by all means, treat yourself. I have seen people visit some of the best neurologists and neuropsychologists in the country and reject all of their diagnosis(es) because it isn't the one they wanted, for whatever reason. Shouldn't it be good news to hear that your brain, organically, is in great shape, but psychological factors are influencing how you experience your daily life? Those things are far more easily treated than having to undergo invasive neurosurgical or medication based approaches. The psychological is just as real, just as based in neuroscience, and just as meaningful as organic injury. At the end of the day, it's not the doctors job to tell you what you want to hear, it's their job to diagnose properly to provide the correct treatment. 2. All that said, some of these examples reek of evaluations that infuriate me. Yes, there are good and bad providers out there, just like in any job. It is tragic to read cases where it looks like people have seen poorly trained, inexperienced, inept, unempathic, or otherwise unsatisfactory clinicians. The numbers on a test don't matter unless they are interpreted correctly, using the proper data, and integrated into the whole of the person. Beyond that, a good neuropsychology evaluation will provide not just an explanation of the results, but recommendations for treatment to improve quality of life, regardless of findings or diagnosis. Not one comment mentioned recommendations. Now, maybe they forgot, or maybe the clinician didn't do a good job explaining them - that's a major problem. Also, computerized screening, an MMPI... These are not neuropsychological tests. They can be helpful to creat a more full profile, but they are not assessing neuroanatomical correlates of cognitive function. A good neuropsychologist will make the evaluation meaningful, incorporate the persons experience, understand demographics and background history, evaluate current lifestyle and stressors, and THEN look at the data. It drives me mad that so many people seem to have received less-than adequate evaluations. If you take one thing away from this rambling post, let it be this. If you need a neuropsychological evaluation, come prepared with the information that is relevant to you - I can spend 20 hours with a patient and never happen to ask about the one critical thing that matters to this one person, so tell the evaluator what that important thing is for you! Brings a family member or a close friend that knows you well and has seen the changes in you, and consent to letting the evaluator ask them about what's going on because, let's face it, if you're having memory problems you just might forget in the heat of the moment. Then, find a board certified clinical neuropsychologist. An average psychologist is NOT qualified to perform a neuropsychological assessment. And clarify that you want a neuropsychological assessment, because it is not the same thing as a psychological evaluation.

Apr 15th, 2016 9:35pm

I have 2 test 2 years apart after a brain injury. Testing took 12 hours each time and I have no complaints. I think it was fair and done correctly. I was given the names of all test and my score. I had it done with by an independent neuropsychologist and her staff. I sought my own help after a brain injury.
I also think every neurologist I have ever seen is a jerk face but that is just me!

Apr 15th, 2016 5:37pm

My husband was not diagnosed with  a TBI until 3+ years after his accident. He left the hospital looking & sounding ok ... but was not.  He is not the same man I married- he is a "new normal" that does not fit in anymore. CAT/MRI's showed nada...until the neuropsychological testing.  He is very intelligent, still is just not as much as he used to be. He has cognitive & executive functioning deficits, behavior issues, reading, writing....etc. We struggle in our marriage, he struggles in everyday life and has been seeing a neuropsychologist going on 5 years now. Sometimes I think she helps, sometimes I think he is fooling her (he's good at deception).   His experience was middle of the road on the person doing the test (it IS very subjective) but it did show he had deficits and helped get him on disability. Take it at your worse time of day is one suggestion I have.

Apr 15th, 2016 4:30pm

I just received my results from my neuropsychological exam.  It turns out, that I am above average on most things with only 2 anomalies of which I was assured are of no major concern.  I have been exposed to the overpressure of over 200 explosions within a two year period.  I had the tests because I have serious memory issues.  When reading I now have to reread everything multiple times so I can understand what I have read.  I have trouble staying on task and the list goes on and on.  This has not always been the case.  I did not feel that the test covered the areas of concern that I had.  Oh well, I guess I am fine.  

Something is missing in these tests.  I have to assume that they work for many people, or they would not be used.  I just think that they do not cover every aspect of memory issues.  I had no problem remembering word pairs because, I created a small story to remember each word pair. I had explained that to the psychologist who had given me my results and he said that that showed a higher memory function.  I explained that I had been dong this trick for a while because I read it somewhere and seemed to help.  He repeated his original sentiment.  The bottom line is that the test did not address the issues that I am having.  I never had to read paragraphs 4-5 times to understand them.  I never used to lose track of what I was saying in mid sentence.  I never used to forget things within 5 minutes of being told.  It is possible that I do not have an issue, I guess.   

I see that many people have been called liars.  Is it possible that they made this series of tests so simple that nobody should do poorly, even with a TBI?  How else could they be so confident that anybody was lying?  I have to assume, based off the test that I took, that anybody scoring below average needs treatment (Lying or not).  I believe these tests are sham.

Mar 23rd, 2016 4:24pm

Okay.  I wasn't going to say anything here but it is beyond me to resist.  I have had no good Neuropsychology Testing experiences.  None.  I have had 2 a year apart and 2 IME's.  One IME lasted less than an hour and the second IME less than 5 I believe.  At any rate, the first one I was so hopped up on pain meds due to numerous orthopedic injuries and had a Student giving me the testing.  She had to keep leaving the room as she was lost as to what to do.  She had many inaccuracies and outright lies in her report.  We filed a rebuttal to this.  So maddening.  The second IME I ended up with a youngster who had not been doing it very long at all.  A few years and get this....NOW worked with the student who was now certified that I had gotten before.  He read her report and made judgments off that one and was completely unaware of me falling asleep due to cognitive fatigue during testing.  In IME I accidentally made a mistake knew I got it wrong, corrected it, and told him so.....he had to go back many times because he kept losing his papers, wasn't organized and couldn't remember my answers.  Many lies on his report as well.  Here I am looking for REAL answers to my deficits, my memory loss, my mental status changes and all I get is almost a duplicate and a direct redirection to that first report with the student....like they just relied on that information for their answers.  Everyone that knows me, my PCP, my family, my kids, my friends....they all see the difference in before and after.

I am not seeing the efficacy of this testing.  I was told also that I must be exaggerating or faking.  This is a punch in the gut when you are sincerely trying to get your life back.  I would love to have an independent study without them reviewing all the other stuff and see if it is more objectionable.  My spelling, grammar, processing is slower, confusion, lost when I drive. just lots of things that didn't exist before the wreck......it's maddening.  The tests would wipe me out for days to get recouped.  Cognitive fatigue enhanced greatly as I would put my all into each attempt.   How do we get help in a system set up not to actually do the work needed to get you the help you need???

Mar 7th, 2016 3:20am

We have all been through the lunacy of these useless tests. They make the doctors richer and us nowhere. You are basically on your own with your own recovery. God bless us all for we are alone in this.

Jan 28th, 2016 7:52am

Point blank, Nueropsychology is Hypothetical. I am a Veteran that has Cognitive Inpairment. I've actually had Head Trauma. I have PTSD. The Doctor said I was Faking the tests and that I shouldn't get any care. The Man doesn't even know me. Everyone that does know me is outraged. Neuropsychology is Fake in and of itself. Choke on that!

Jan 23rd, 2016 3:04pm

I will be taking neuropsychological testing in a couple days and I'm very curious about the entire thing so I was hoping someone could answer a few of these questions:

Is it common to take an IQ test at some point in relation to neuropsych testing?

How far back does the drug test go? (I like to take valerian root, but at max. dose, where as my doctor has asked me to take a lower dose).

How big of an impact will these tests make on my life?

Will I get to see images of my brain?

Jan 11th, 2016 10:52pm

I used to be a practicing general and vascular surgeon before I suffered a major stroke - at age 45.  I went through intensive inpatient and outpatient therapy and have regained most of my physical abilities.  However, I am struggling with the cognitive aspects of my recovery and have difficulty telling my evaluators what exactly I need to be able to do in order to function at a high level again (my goal is and always be to return to my work).  Herein lies the problem with these evaluations: they are very subjective and the person evaluating the patient has no frame of reference who the person was before the injury.  I have thus been very disillusioned by the entire process.

Jan 5th, 2016 12:45pm

I just read all of these comments and they make me so sad.  I am a neuropsychology examiner and would feel terrible if my patients had this experience.  

Jan 3rd, 2016 10:37pm

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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