GUIDE TO ADULT NEUROPSYCHOLOGICAL ASSESSMENT


What Is Neuropsychology?

Neuropsychology is a health-sciences specialty that studies the brain-behavior relationship.

Who Practices Neuropsychology?

A neuropsychologist is a Ph.D. fellowship–trained psychologist with expertise in how learning and behavior are associated with brain structure and function. 

A neuropsychologist employs standardized tests and observed behavior to define an individual’s cognitive status in order to compare his or her performance to that of other individuals of the same age, gender, racial and/or educational background.  

The neuropsychologist may work in many different settings and may have different roles in the care of the individual:  

  • May act as a case manager who follows the individual over time in order to adjust the recommended treatment to changing needs.
  • Can provide treatment, such as cognitive rehabilitation, behavior management, family therapy, or psychotherapy.
  • Usually works closely with other health care professionals involved in an individual’s management.

Which Individuals Are Referred for Neuropsychological Assessment?

An individual who suffers from a neurological or medical condition that affects brain functioning, such as (but not limited to):

  • Brain Injury, Concussion, Brain Tumor, Leukemia, Epilepsy, ADHD, Dementia, Parkinson’s, Multiple Sclerosis, Encephalopathies, and Neurodegenerative and Neurodevelopmental Conditions.
  • Acquired disorders as a result of teratogenic substances such as alcohol, illegal drugs, environmental toxins and radiation.
  • Other medical conditions that may affect brain functioning, such as diabetes, chronic heart and/or respiratory problems, certain genetic disorders, treatment of cancer.

Your physician may recommend a neuropsychological assessment to:

  • Assist in establishing a diagnosis.
  • Document your current skills prior to a planned medical intervention, such as surgery, or change in medication regimen prior to chemotherapy or radiotherapy. This initial testing is often referred as “baseline testing. After the medical intervention, testing is typically repeated to determine how the treatment affected physical and brain functioning.
  • Clinically evaluate and understand your cognitive pattern over time so that medical treatments, employment, and family expectations can be adjusted to your needs.
  • To scientifically investigate a hypothesis about the structure and function of cognition to be tested, or to provide information that allows experimental testing to be seen in the context of a wider cognitive profile.
  • To use in medico-legal proceedings, or in a court of law, as evidence in a legal claim or criminal investigation.

What Functions Are Assessed?

Usually a neuropsychological evaluation for an adult assesses the following areas:

  • Intellectual abilities
  • Achievement skills such as reading comprehension, mathematics, and spelling
  • Sensory and motor functioning
  • Attention
  • Learning and memory
  • Language
  • Visual-spatial skills
  • Executive skills such as problem-solving, planning, organization, mental and behavioral control, and cognitive flexibility
  • Behavioral and emotional functioning

How Does a Neuropsychological Assessment Differ from a Neurological Examination? 

Neurology is a medical specialty dealing with disorders of the nervous system. A neurologist diagnoses and treats a neurological condition. A neurological investigation focuses on structural networks or damage rather than functional processes involved in behavior and thinking.

A neuropsychologist focuses on assessing brain functioning, such as the way a person thinks, feels, and behaves.

How Can an Individual Be Referred for a Neuropsychological Assessment?

The following are the steps an individual must take in order to be referred for a neuropsychological evaluation:

  • If the individual does not intend to be reimbursed by insurance, no referral from the physician is necessary. In that case, the individual should call the neuropsychologist and discuss whether a neuropsychological evaluation is the right course of action.
  • For educational testing (learning disabilities), or when requesting testing accommodations, a referral is not necessary. Insurance does not pay for these types of evaluations. In that case, the individual should call the neuropsychologist and discuss how to proceed. 
  • If the individual expects to be reimbursed by insurance, the physician should complete the Referral Questionnaire, indicating on the script the reason for the referral and the specific areas of concern. A medical diagnosis is recommended and should be mentioned on the referral form. Referral questions that are medically relevant are approved by insurance companies more readily, so it is important that the primary medical condition suspected as being directly related to current symptomatology be mentioned on the referral form.
  • The provision of available medical records is crucial so that the neuropsychologist has a better understanding of all the factors that may affect brain functioning.
  • Provide the neuropsychologist with copies of previous assessments, if available.

Will the Neuropsychological Assessment Be Covered by Insurance?

  • Some insurance plans will require a letter from the referring physician, indicating the medical necessity of the assessment. Medical necessity means that the physician needs the assessment in order to proceed with providing care for the individual. For example, a neuropsychological assessment is typically considered to be medically beneficial if it assists in formulating a differential diagnosis, determining appropriate medication or titrating medication, or documenting side effects of medication, and if it assists in deciding between behavioral and psychopharmacological interventions.
  • Neuropsychological assessment used to establish, or confirm, a diagnosis as the basis for medical treatment is usually covered.
  • Most insurance plans will deny coverage for assessment used to establish an educational diagnosis (e.g. learning disability), testing for college accommodations, giftedness, or psychiatric diagnosis. However, when problems emerge in the context of a neurological disorder, traumatic brain injury, or a chronic medical condition, the assessment of academic functioning in the context of a complete neuropsychological evaluation may be reimbursed.
  • The option to pay “out of pocket, and to then apply for reimbursement by the insurance company, is always available. This process will allow the individual to receive services faster since insurance clearance for neuropsychological services may take up to several months.

What Information Will the Neuropsychologist Need Prior to the Appointment?

  • The individual will need to provide copies of previous medical records.
  • The individual will be asked to complete history forms and questionnaires mailed by our practice.
  • Since the neuropsychologist will ask questions about the individual’s medical history, early development, school history, family and social history, and employment, the individual needs to bring to the appointment any information that will help answer these questions.

What Should Be Expected?

  • A neuropsychological interview usually includes an interview with the individual, and if necessary with the spouse/parent(s) present. That will always be done before testing. At that time the neuropsychologist will determine how many hours and what kind of instruments need to be used in order to answer questions relating to the individual’s condition.
  • Testing involves paper and pencil, hands-on activities, and sometimes the use of a computer.
  • Family members are not present during testing.
  • The time required for testing will depend on the individual’s problem and level of functioning. Testing sessions can last from 2 to 6 hours at a time and up to 10 hours total.
  • If the individual wears glasses and/or a hearing aid, those implements should be brought to the assessment.
  • If the individual has special language needs, please alert the neuropsychologist prior to the appointment.
  • Neuropsychological evaluation reports are permanent medical records, so the neuropsychologist will need to have as much information as possible before a final report is issued. Usually reports can take anywhere from 2 to 4 weeks to be completed, depending on the available information. However, preliminary results can be released within two weeks after the completion of the neuropsychological evaluation.

If the above information does not provide answers to your questions please do not hesitate to contact our practice.

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