Neuropsychological Evaluation: Here's How It Works

I cannot listen to music and work at the same time. When I go out to dinner with friends, I find myself pining for a corner seat at the table because I have trouble following conversations that involve more than two people. The sight of Ikea furniture assembly directions makes me want to cry. I feel physically assaulted when I’m battered with questions from my overly inquisitive mother, who means well. I struggle to follow a recipe and when I do, I usually screw up at least one step. OK, two steps.

I’ve always wondered whether my “challenges,” as I like to refer to them, are simply little quirks or something more clinical in nature. So, I decided to undergo a neuropsychological evaluation to finally get some answers. Here’s what the process was like.

What is a neuropsychological evaluation?

According to the National Institutes of Health (NIH), a neuropsychological evaluation is a series of assessments that use standardized methods to assess cognitive functions, behavior, social-emotional functioning (like mood and personality), adaptive functioning, and academic achievement—in a nutshell, to see how the brain is working. The evaluations also include a thorough review of the patient’s medical history, a verbal interview, and depending on the situation, an interview with the patient’s family members and review of school records. NIH points to many situations in which a neuropsychological assessment may be utilized, including:

• Differential diagnosis, when brain-based impairment in cognitive function or behavior is suspected (e.g., memory complaints)
• Diagnosis of neurological disorders
• To establish possible lateralization or etiology of brain lesion
• To help with educational placement, interventions, and accommodations
• For determination of disability, return-to-work/school, driving ability, or for legal purposes
• To establish a neurological “baseline” if later changes are anticipated (for example, a pre-surgical vs post-surgical evaluation)
• To gauge an individual’s strengths and weaknesses to aid in treatment planning
• When memory impairment is suspected
• To track progress in rehabilitation and the effects of treatment and medication

How do you find a practitioner?

According to Paul Mattis, PhD, a psychologist who specializes in neuropsychology at Northwell Health, you should do your homework to find a neuropsychologist who is well trained. “While there are many fantastic neuropsychologists who are not board certified, finding a neuropsychologist who has obtained board certification through the American Board of Professional Psychology/American Board of Clinical Neuropsychology is one way to identify individuals well trained in clinical neuropsychology,” he advises. He also recommends asking for recommendations from friends, family, and doctors.

The golden ticket (aka, an appointment)

Getting an appointment for a neuropsychological evaluation wasn’t easy—and I work for a health system. Mattis explains that the neuropsychological evaluations take a substantial amount of time to complete—somewhere in the range of two to 10 hours, which can be spread over several days—and are administered by one person, so the number of patients that they can physically see is limited. Further, he says, “neuropsychology is a very specific subspecialty, and there are far fewer neuropsychologists than found in other specialties. Unfortunately, insurance coverage is also a frequent obstacle.” I got an appointment for several months out.

The neuropsychological evaluation

“A neuropsychological evaluation includes the use of standardized instruments to gain insight into an individual’s cognitive abilities,” says Mattis. A practitioner will measure things like attention, problem solving, language, and spatial and sensorimotor functions. And they will customize the evaluation for each individual, but each assessment will be administered in a standardized manner. So, the practitioner will choose among the measures available based on why the person is there, which means not every person will have the same experience.

I found my battery of measures to range from fun to frustrating, easy to impossible. Mattis explains, “The one thing all neuropsychological measures have in common is that they get challenging. It is not enough to assess if a function is present in a person; what must be identified is the individual’s level of function.” Basically, they need to push the patient to their “upper limits of functioning” to get an accurate assessment. I dropped a bunch of F-bombs throughout the evaluations.

The results

It takes a week or two for the practitioner to score the evaluation, which is interpreted by comparing the patient’s scores to an appropriate normative group. “We all have cognitive strengths and weaknesses, and the neuropsychological evaluation helps people to understand the unique way they process information,” says Mattis. Once the results are ready for you, your practitioner will meet with you or call you to discuss the results and make any necessary follow-up referrals.

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