A Guide to Neuropsychological Testing

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, although 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 from the interview and tests including diagnostic conclusions. Information will be provided on your strengths, weaknesses, and limitations and your emotional well-being. The report 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.

Posted on BrainLine October 27, 2011. Reviewed July 27, 2018.

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 (75)

8/1/2013 I passed out (vasovascular? Unknown origin) hit my head on a tile floor. This caused a subdural hematoma and I had an emergency craniotomy. My husband was told I had 30% chance of survival and 30% chance of full recovery. I have been working, walking, driving but have noticed more problems such as: saying words out of order, feeling overwhelmed when under stress and ask my family repetitive questions multiple times. After a long work day my eyes have difficulty focusing, I walk like I am drunk, and emotions can be difficult to control. I wonder if neuropsychology testing would be recommended as the neuro surgeon who did my surgery offers this in his office. Advice please

Yes, neuropsychological testing would be beneficial in your case. It would offer insight into which areas of your brain may have been affected by the fall, and how they relate to the symptoms you're experiencing.

Why are questions about sexual activity included in a neuropsychological exam? I'm wondering if the neuropsychologist was just a perv. He asked a LOT of questions.

People with TBI have lower inhibitions which may result in very risky and frequent sexual activities and being taken advantage of by others.

Hi, I'm doing a research paper on Alzheimer's Disease and I was curious about this test. My question is how do you score the test? I would like to use it for my research paper.

My doctor sent me for neuropsychological testing because I am demonstrating most symptoms of adult ADD. I suffered a loss in 1996 that I never recovered from, at least not emotionally. Soon afterwards I was diagnosed with PTSD that manifested in chronic depression and anxiety. I've been on antidepressants since 1997 but never felt "normal". I began to gain a lot of weight and asked my doctor if there was a prescription medication that would kill my appetite and he prescribed Phentermine. Within 20 min. of taking the first pill, I felt normal again. It was like magic. It didn't kill my appetite as much as I'd hoped but I didn't focus on the down side of the med. I was on it for 2 years then he cut off a 90 day refill and called me into his office, telling me that I couldn't stay on the med any longer. My depression was back and I considered suicide. For $11/month, I had my life back and he took it away. He said that if I tested out as ADD he could prescribe it again. The testing took about 6 hrs but I doubt it was accurate as I slept very little the night before. A week after the testing the doctor went over the results. They were not in any clinical or testing form- she had a chart similar to the food pyramid, with + or - for my scores but no numbers. She also had lost one of the tests and asked me to retake it. This was Nov. 9, 2018. I expected the full results about a month later. It is now 1/25/19 and I still don't have them. I think they lost them and I can't dispute the charge on my credit card. Is all this a waste of time? I just want my money back and to find a doctor who will truly listen to me.

Hi everyone,
I am due to meet with a clinical neuropsychologist at the end of the month. I had NMDAR encephalitis 3 years ago which left me in a coma for 5 weeks fighting for my life...(out of the 8 weeks I was in hospital I have no recollection of the first 6!) it’s been hard to get used to the ‘new’ me as I have changed a little (memory,balance,personality) but as a whole people just see me...they don’t see the tired me of not being able to sleep,or the emotional me when I feel low. I think it’s me battling the demons of feeling ‘different’. I’m struggling with the emotional side of it and also the pain side (this is also due to me having syringomyelia which has caused nerve damage to my left side) it can’t be cured and the pain will always be there. Am I going to find this meeting beneficial?! Would love to hear about how you thought your own meetings went etc.
Regards,
Anthea

I think you are an amazing woman! You're a true survivor and I'm in awe of your strength and perseverance.
You may find out that memory games and skills on the computer may be useful, especially if you do them for a short time each day. A physical or occupational therapist may be helpful in working with balance and muscles. I'm not sure what can safely be given for pain but you may want to speak with an acupuncturist if regular medications don't help. Find a support group, trusted therapist/counselor and write in a journal to get your feelings out. You may be able to discover your own solutions. Whatever you choose to do, don't stop until you find the help you need. Best of luck!

I am a 56 yr old female and had a neuro memory test, I had a motor cycle accident years ago and just recently took the 4 hr test and the results came back at 0.5%, what is normal.

I just had neuropsych testing done to determine deficits left from 2 strokes. I am 57 yrs and used to be a high functioning manager in the retail business. I used to live in Canada but now I live in the states. At first I was concerned with how the tests would be scored, how could these people know the me I was before my strokes? But after careful thinking I concluded that these tests would rate me on the average person. That's not so bad to be rated that way. They are not people with esp after all. It's not really rocket science either. The testing took 2&1/2 hours with a psychometrist and I have an appointment to go over the results with the neuropsychologist next week. At that time she will make the recommendations as to whether I need rehabilitation, can drive, or what job I am suited for. I pray for all the people I have read comments from but hope they find the understanding about what this testing serves. I will try to remember to post a reply to this comment and let everyone know how my follow up goes.

Work injury. Slowly getting better. My Neurologists said "progressing normally for 10% of the population" Special I am! Now WCB has arranged for testing ,eval and exams and I am scared sh**less! I want to talk to someone about how I feel. We have a hotline through benefits but I am afraid to in case that is read as a bad thing! I am pretty close to retirement and I read online that a concussion at a later stage in life greatly increases the risk of dementia. How the hell would anyone be able to prove that was related? I am still productive and valuable, just have to limit my hours due to the headache and ringing in the ears getting much worse when I m tired. I want to keep working at what I do because I am good at it and love it! I want the opportunity for my brain to heal. If it does it does if it doesnt well then it dosent, But after 3.5 months I dont think it is right to make any final decisions based on my being so special! lol
Sorry for rambling. It feels good to be open and honest.Thanx for letting me vent. And advice or suggestions or encouragement gratefully accepted.

Hi Charlene. I too sustained a concussion and contusion at work. I had to do the neuropsychological testing through workers comp. It is hard to read and I'm guessing my doctor will go over results with me. But I had to be 8 hours in this room with the doctor answering questions and it was so tiring! I didn't think I would make it through the test without falling asleep and I did fall asleep on her. She let me sleep until I woke up, which was like maybe 50-70 seconds. It was a long process and due to the head injury I have depression and some other emotional issues. If you ever want to talk offline I am available to talk. I'm home every day until, I don't know when. Just let me know or send me your email. I hope you are recovering and that is for everyone suffering. God bless you all.

Hello Charlene. In reading this, I feel as though we have been going through the same injury, symptoms and result. I suffered my concussion from being physically assaulted at my job, doing my job. I’ve been out since 12/30/17 and now still suffer same head pain, neck pain, ear pressure, etc...also had all the testing, still waiting on Nuero psych test results. Also had a surgery for a lipoma on upper back that appeared rapidly just after assault. It’sgoing into 10 months. I’ve been told concussions take a long time, a year for some. I’m very concerned that this is it forever. Any time I try to do my normal workload of daily tasks, symptoms worsen and I’m worse all over again. I too am concerned about future susceptibility to Alzheimer’s and even brain cancer as I’ve been told things and read things too. I go to acupuncture twice weekly on wc and I do think it helps but every time I do not go, I’m in pain again. Have you tried acupuncture? If not, investigate it. I’d love to hear back from you, how are you now all these months later?

The problem with TBI is there is no standard protocols in place for treatment. First evaluation, I was told to get a divorce and sweat when I feel stressed. The second was more explanatory yet, like most modern doctors, they want you to take pills regardless of the side effects.
Life changes in an instant. Because no one can see the injury, they assume it is your personality. My case is thanks to a drunk driver.

In response to this part of your comment
"Life changes in an instant. Because no one can see the injury, they assume it is your personality."
I Fully get what you're saying because my partner had a serious brain injury and because I live with him and did so before his accident I can see the changes in his behavior but these wouldn't be obvious to just anyone...maybe to a specialist such as a Neurologist through testing but not to any Joe Blow.
So I understand your frustration and hope live has improved for you.

I know it wont help but I want to offer my sympathy anyhow. Best wishes for a full recovery.

i sustained a concussion at work here in toronto ...., and since then i have headache, dizziness, blurry vision and more ... WSIB, recently, had ordered me to go through a Neuropsychology Assessment. Based on what what i read about all these comments made here by all these unfortunate people, I'm highly scared to go through it ..... Therefore, i wonder how will WSIB treat me, or handle my case, if i were to refuse WSIB's order not to subject myself to this testing ?? Are there any other alternatives acceptable for both WSIB and I ?? I would be sincerely grateful for all timely responses ... !

WSIB is clearly there to help you get back to work. I’ve been there and done it all. You should go to all the tests that they ask you to take. They ultimately will help get you back to work, retrain you for something you can do, or if you refuse to cooperate they can make your life miserable. Jump through the hoops and good luck!

Hi Ski, I'm also in the same situation here in Toronto ... I appreciated reading your comment .... Did WSIB had you take all those tests at CAM-H ...., or you were, instead, assessed & tested by some psychologists /psychiatrist somewhere else? You see, WSIB has just ordered me to be tested by CAM-H and i'm very nervous about it partly because the CAM-H program/testing is funded by WSIB ...., and partly because of some deeply traumatizing stories i heard about CAM-H ... If my family doctor were to arrange and have me assessed / tested by an independent psychiatrist, do you think that would satisfy WSIB? Or, you think WSIB will still insist that i take the CAM-H test/ assessment ? I mean, is there an alternative to CAM-H i can take and therefore comply with WSIB's demand for a neuropsycological test ?? Many thanks again, and i look forward to hearing from you (or from anybody else for that matter) sometime soon

I will be Anybody Else for today only. ;)

I get what you are saying, This last week has been one test after another mandated and done by WCB and traumatizing is exactly what it is. I think the only way to get them to agree to accept outside testing is to get your doctor to understand and help you. They will not go against direct medical advice. They are not stupid people and they know what a liability looks like.

That being said. It was nowhere nearly as bad as I feared it would be. Not even close. It was exhausting and headache inducing, but in a way quite a relief as well. A relief to have it done with and a relief to be able to try to explain what is going on with me. And they seemed to get it! The medical was pretty straightforward, family and personal history, questions about current symptoms (The Dr. didnt want to hear about how I WAS only how I am now, but I insisted in order for her to hear how I AM improving, because for me that is the key to my not giving up ) reflexes, range of motion. that sort of thing. The test for physical strength was very simple. ( I gave them a hard time about some of their tasks not fitting with OH&S guidelines, thankfully he had a sense of humour!) The Psych was actually really good. Started out with my parents and family but then moved to how I am dealing and he was actually complimentary and positive about how I am managing emotionally, Then there was the skills assesment I flat out told the tester that I considered it a waste of time as I have the perfect job for me already and I WILL get back to full time hours but go ahead and test away. It turns out that I am extremely well suited to the job I currently have, surprise surprise. :)

All in all my advice is to just be yourself and be completely frank. I was worried about things that didnt seem to matter. Like not remembering exact sequence of events and such. Thinking they would be suspicious. Instead they reassured me and accepted my limitations. Truly wishing you all the best, not just for the upcoming testing but for a full recovery!

Charlene, many thanks for taking your time to reply. I, indeed, feel much better now.

I wonder if that so-called "skill testing" was actually an IQ test you were subjected to?? As mentioned here on this forum, IQ tests are not scientific. And if (or when) I had to CAM-H assessment, can I ask to skip any given tests -- especially IQ tests?? Thank you so much, again!

It wasn't an IQ test, it was more of a cognitive reasoning thing. I also recommend signing the form necessary to receive copies of your assessment results. They should provide you with the paperwork for that. If not ask at the reception. I haven't gotten mine yet but when I do I should be able to see if there was any negative effect from my refusal to do some of the exercises. I hope not as one of the catch 22 type issues is that I don't have the strength to do any fighting with anyone. And there is no one but me to do whatever fighting might be needed. That is a very difficult place to be and I wish that it could be different. I wish there was an advocate that could help us, be on OUR side. That is why this forum is so important. We have at least got some support! Best of luck, sincerely!

-- Charlene, thank you so much again for taking your time to write -- AND write, you write so beautifully and precisely.
And the good news for me, is that i don't have to go to cam-h after all, as wsib had, finally, accepted an assessment report done for me previously by a psychologist.

Meanwhile, i clearly hear you as to how all alone, defenseless and vulnerable many of us here in the injured workers community are, and yes, this forum, indeed, is very supportive and ease our pain through beautiful, humble members like yourself. And i belive you can receive much more support, hence feel much more enpowered and positive if you were to attend weekley injured workers' gathering (refreshments served) hosted by http://injuredworkersonline.org/ which is located on danforth (just a walking-distance, two blocks east of Pape) where three lawyers and supporting staff members welcome us all and serve us like family members, while they do their best to respond to any legal questions or concerns we may have dealing with wsib issues, or related injury issues, and if necessary, literally advocate for us by their ever fearsome mighty pen and paper ...
Anyway, one more heartfelt thank you to you Charlene, and here's the adrs of Injured Workers’ Consultants Community Legal Clinic (IWC) :

815 Danforth Avenue, Suite 411
Toronto
(between Pape and Donlands subways)
Tel. (416) 461-2411

Thank you ! I am so glad you had success! I am certain that is an indicator of the future for you!

I have recently been diagnosed with significant brain injury.This has caused me to have various mental health problems and personality changes .I went to have the tests which took approx 7 hours.The person who carried out the tests introduced herself as a Neuropsychologist who is employed by the Health service here in the U.K.The tests were similar to the ones described in this forum.Once everything was completed a man came in and introduced himself as " my psychologist " it turns out the lady who carried out my assessment is actually a student who hasn't much experience. I Could not understand or believe it " I wonder what my test results and the report are going to say and who actually carries out the assessment of her findings. It should be good reading and then I will F.I.B (file in bin) my copy as it won't be correct. Now I'm more anxious than normal

After intensive neuropsychology testing I was so sick that I needed 2 weeks bed rest. It was brutal and I was re-traumatize and victimized. Brutality of assessment and wording I do not have words to describe it.
Good luck to all of you !!!

Thank you for the information!

I was rear ended at a red light as well, although I wasn’t knocked unconscious I have severe whiplash and moderate to sever concussion. I already had PTSD, but I have been able to cope until I was hit. Now I am a horrible mess and I am so angry that I struggle with everyday chores and I have children who need me!! I am struggling so bad and feel I am unable to get out what is in my head so I can get proper help! My psychologist has suggested EMDR for my PTSD which I agreed too but hasn’t happened yet. I am scared but your post made me feel less alone!! Thank you

Very helpful, thanks

i have had somewhere between 15-20 concussions and one complete knockout (out for 15 minutes) playing rugby league for about 10 years since i was 15 . Should i get a brain test ? 

I must say for myself, my neuropsych testing was very beneficial, however I will point out that I am not trying to prove I have issues (to insurance, disability, work or anyone else) I am just trying to determine how best to cope with the issues I have and work around them so that I may find a job which will suit my new normal. The neuropsychologist I work with does not take insurance cases, disability cases or any other case that is trying to prove something to someone (she calls them cases with a "legal" purpose). She only takes in cases that sincerely want help for their own reasons and want to learn how to cope with and maybe improve whatever their weaknesses are and capitalize on their strengths. My testing identified issues with executive control, visual memory and attention but strengths in many other areas. I am now in speech/cognition therapy to try and improve my weak areas and am looking into vocational rehab to try to retrain for a job which uses my strengths and makes minimal use of my weaknesses.

My suggestion to anyone with concerns about an IME or other forced neuropsych testing is get your OWN testing (you, or your insurance, pay the neuropsychologist) and that serves 2 purposes: 1) you get honest, worthwhile, trustworthy results in YOUR best interest and 2) When the IME comes you, or your attorney if that's the case, can argue effectively if their is an examiner, content or other bias built into the IME exam.

The problem you may run into with a wcb or insurance provider is that you are not their client and they will likely get more work in the future from the wcb or insurance company, a lot of work provide the give them good service. It’s just business and they make a lot of money. Insurance companies are not you friend, their profits increase proportionately to the amount of claims they deny.

Is Neuropsychology used for treatment for brain "issues" other than TBI's?  Can it be beneficial for a person who has Neurofibroma tumors in the brain?

I happened upon this site while looking for information on my husband's upcoming testing.  I'm not encouraged. HOWEVER, I find it immensely interesting to read some of your similar experiences (my husband's fall from 25 feet happened 10 years ago and regained good (not same as before) function/cognition, but in the past year or so there is a very definite decline in his emotional control, cognitive abilities, ability to focus, etc.  Before even reading all of your comments I was wondering how they could possibly evaluate the changes in his abilities since the testers do not know who he used to be or how he thought/processed/functioned.  It does feel so very, very lonely!

I see similarities between your husband's "case" and that of my boyfriend. He also had a tbi more than 10 years ago. He "recovered" (I highly doubt that he was anywhere near where he was before the accident but I didn't know him then) and he went back to work within one year.

Following that, his then wife said he had "changed" and was now angrier and they divorced. Poor guy didn't see that coming, but my research has shown that many realtionships break up post tbi. He went on with his life, not knowing really what had happened to him or that he was "different". Until he met me.

We have had a good, loving relationship but he has anger and mood swing issues that I would classify as moderate to severe. He started to decline and then became unable to work due to stress and increasing inability to manage tasks. Now he is trying to get his WSIB case re-opened as he CLEARLY is suffering from long term effects of his tbi (his GP says he has post-concussion syndrome) but WSIB basically says NO and now he's stuck having to prove that he can't function or cope like he used to. Even HE doesn't know how he got by in the last ten years!

There have been tests and doctors and.....it just goes round and round! This man had an industrial garage door come unhinged at work and fall on his head and he is permanently damaged and he has to PROVE that he has functioning issues?! That's crazy. I am helping him as best I can. And we are going to fight WSIB!

Good luck to everyone who is recovering from this debilitating type of injury!

Hi, I recently underwent a neuropsych test. I was told it was going to be 4-6 hours but the test was stopped after 1.5 hrs for reasons undisclosed. I have not yet seen the results of the test but am worried there are major issues because the test was stopped. Would anyone know why a test would be stopped so early?

What did you find out in your results?

I have been in three car accidents..8/2013, 12/1/2015 and 12/28/2015 .  I was told I have pcs/mtbi and will be seeing a neurologist on 12/9/17.  This is work Comp and I'm wondering how will doctor really be able to assess me?

My daughter was in car accident, suffered a TBI and went to testing in Portland Oregon. She never received any test scores and had to contact her attorney for a letter that was extremely uninformed and couldn't seem to answer the initial question at all. Why she had short term memory troubles and headaches since her accident. For the enormous price paid for the test, very disappointed with the company and how they treated my daughter

I was walking at a controlled intersection & was hit by a city bus going 20-30km per hour, thrown 10 feet, landed on my head on the road. I don't think I passed out but my confusion was documented by paramedics. I had these tests done by the insurance agency doctor. All the doctors & specialists I see are Neuro but insurance psychological testing, if it's by insurance company, they say psychological or psychiatric problems not mTBI PTSD & traffic anxiety. Results; can't work or function 25 months and trying to fight insurance for treatments. Disgrace! How can neuropsychologist destroy a persons health? How does a person heal with no guidance? I've never had brain problems before and now the basics are too much. Isolation, confusion, rage, vision, thinking, balance, noise, lights issues but no help $ for treatment. First time homeless in my life but it's quiet living in car compared to apartment I had for years but lost due to trying to find own treatments to try & get back to work. What options does a person with a mTBI have with no healthcare professionals with experience have but I'm denied mTBI PTSD diagnosis by insurance. Thanks so much. Any advice or help appreciated.

Canada Not Free healthcare if you can't access & forced to try & fund a trip to USA or ... To have guidance.

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 😂

My name is Amanda and I am a TBI survivor. I am scheduled for an 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.

what are the tests like? Is it difficult?

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, 

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.

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 can 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) can 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

This is extremely well said. I wish there were more people like you. I am a future Neuropsychologist (PsyD). Everything you said about training is very true. I started my practicums in Neurology, and will continue with Neurosurgery and hope to match for a Neuropsychology Internship and then residency. It makes such a difference to be in Neurology versus Psychiatry or Psychology when training to be a Neuropsychologist. The foundation needed to truly understand the application clinically of neuroanatomy see through EEG, MRI and CT and their relationships to patient's clinical presentations of their chief complains is necessary.

I am a neuropsychologist (PhD). I am so glad that you are training in Neurology and Neurosurgery, as these areas are critical for understanding the presentations and underlying causes of brain injury and neurologic illness. I will say that I have found a good understanding of psychology and psychiatry equally important in understanding patient concerns, informing diagnoses, and guiding treatment recommendations. I hope you are incorporating these areas into your training as well. Good luck!

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.

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.

3. Computerized screenings, MMPI... These are not neuropsychological tests. They can be helpful to create 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!
  • Bring 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.
  • 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.

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