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What is a neuropsychological assessment?

November 21, 2019

First of all a few words about what a neuropsychological assessment ISN’T

A neuropsychological assessment is not designed to assess your emotional functioning, if you are depressed or anxious or emotionally sensitive and emotionally intelligent.
It is not a test of personality.
It is not a test of sanity or craziness.

What a neuropsychological assessment IS

A neuropsychological assessment is a very detailed investigation of your thinking skills. It is very carefully constructed and has been proven to provide reliable and sensitive assessment of these thinking skills.

It is usual to separate these into domains:

Attention: Can you focus on something someone is saying or a picture for a short time and hold the information in a controlled way.

Memory: Can you attend to and focus on something like a proverb or saying and later repeat it back. Or remember a shape you’ve been shown and recognise it from amongst several similar things.

Planning: Given a simple practical task you’ve never done before can you demonstrate a methodical and organised way to complete it.

Mental Flexibility: Can you perform two simple tasks simultaneously? For how long can you keep that going?

Mental Switching: Can you swap between tasks. Can you also tell when you’ve made a mistake, stop yourself and see how to put it right?

When should it be given

When people are concerned that these thinking skills are not functioning as they should, it can be very hard to explain to others what it feels like. It can be very hard to get others to understand. Sometimes it is hard to get other people to believe what is going on.

Is my memory getting worse or am I imagining it?
Am I less patient and more abrupt that I used to be?

How is it different to an educational assessment?

Neuropsychological assessment is designed to try to demonstrate and measure the difficulties with thinking skills. Usually by comparing how you do the tasks compared to other people your own age. Some tests can take your educational level into account. It can be more difficult to account for cultural differences and if English is not your first language, but a skilled neuropsychologist can allow for this to a degree.

The test is tailored to focus on the skill sets required.
Unlike an educational assessment there is a focus on learning and remembering as well as planning, organising, being flexible. The test is sensitive to issues like impulsivity, anxiety and nervousness as well as whether or not a person is trying to “fake”a poor performance.

The assessment is conducted by a psychologist with specialised training in neuropsychology.

It comprises three steps;

Firstly an interview
This allows you to describe in your words the sorts of thinking skills that you have concerns about . Careful questions help narrow down whether the problem is in one domain of thinking or in many. You can bring a friend, family member or a support person with you. Some people find it helpful to bring some notes or even reports from doctors or others to help explain all your concerns.

If there have been accidents, illnesses or exposure to mind altering things like psychological trauma, drugs and alcohol this is all discussed with you in a supportive and non-judgemental way.

Secondly there are a series of table top tasks to complete.
Some of these are quite simple. They can be quite enjoyable like games.

But as you go on the tasks get challenging and you can see how far you can progress on each task.

The idea is to put in your personal best.

The tasks are decided by the neuropsychologist; often prior to your appointment if you’ve sent a referral in or as a result of your interview.

The tasks chosen do vary depending on what the concerns are: Obviously if you’re most worried about your construction skills and your visual processes there might be less focus on language skills and so on.

You cannot practice the tasks before the test. It is unethical for the psychologist or any other therapist to train you. That would invalidate the test. You cannot buy the tests they are only available for purchase and use by appropriately qualified psychologists.

The key is that you show how you approach novel tasks you’ve never seen before. This is important because it means that whatever specialised training you might have had you can still be compared against data from your age group.

Sometimes I have been asked why not simply test people on real life tasks? The difficulty with relying on that is that everyday tasks are influenced by things like practice and experience. Aslo real life tasks use multiple thinking skills in combination so if a task is difficult it can be really hard to work out exactly what thinking problem is causing the glitch.

It is also worth noting that because it is prudent to have a good look at skills across a few domains and compare them the testing session needs to be lengthy. A couple of hours are usually needed. That is broken up with rest breaks of course.

Thirdly The Data Analysis

This part is mostly done by the psychologist without you in the room. The tests you did are scored and your performance on that day is compared to how most people your age perform.

There are a range of factors taken into account. The tests are designed to allow for variation. For example: perhaps you were feeling mildly unwell or nervous. On another day you might perform better ; The tests are designed to take this into account. The psychologist will tend to think of your performance as within a range rather than a specific score.

Some mathematical modelling means the neuropsychologist can build up a picture of how they expect you should normally perform and compare how likely it is your current test performances match that. That means the neuropsychologist can be reasonably confident your test results are accurately showing either you’re fine or there appears to be a problem with some of your test performances.

Finally, what will you get out of a neuropsychological assessment?

The neuropsychologist will carefully consider if the test results might fit with a specific diagnosis. That is really important because getting the diagnosis correct helps work out what strategies will assist you in moving forwards.

Neuropsychological tests have been proven to pick up brain injuries and some diseases like dementia better than some medical tests like MRI scans and definitely much better than simple cognitive screens like the Mini Mental Status Examination.

This is discussed with you at a feedback session. You can ask questions about the implications and what to do next. A report is given to you usually by email. You get to keep that, and you can share it with people you choose.

If you think you or one of your family members could benefit from a neuropsychological assessment, contact our administration team here to arrange an assessment.

Catherine Cheetham,

Clinical Neuropsychologist


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