What is a neuropsychological examination?

The neuropsychological examination is one of the methods of diagnosing neurodevelopmental, neurodegenerative and acquired disorders of brain function. It is frequently a part of the overall neurodiagnostic assessment which includes other neurodiagnostic techniques such as CT, MRI, EEG, SPECT. The purpose of the neuropsychological examination is to assess the clinical relationship between the brain/central nervous system and behavioral dysfunction, as well as to participate in differential diagnosis. It is a neurodiagnostic, consultative service and NOT a mental health evaluation or treatment service.

The Social Security Administration defines neuropsychological testing as the "administration of standardized tests that are reliable and valid with respect to assessing impairment in brain functioning." The examination is performed by a qualified neuropsychologist who has undergone specialized education and intensive training in the clinical neurosciences, including the relationship between behavioral functioning and neuroanatomy, neurology, and neurophysiology. The neuropsychologist works closely with primary or consultant physicians in assessing patient cerebral status. Neuropsychological services are designated as "medicine, diagnostic" by the Federal Health Care and Financing Administration (HCFA), are subsumed under "Central Nervous System Assessments" in the 1996 CPT Code Book, and have corresponding ICD diagnoses.

Neuropsychological examinations are clinically indicated and medically necessary when patients display signs and symptoms of intellectual compromise, cognitive and/or neurobehavioral dysfunction that involve, but are not restricted to, memory deficits, language disorders, learning disabilities, developmental disabilities, pervasive developmental disorders, impairment of organization and planning, difficulty with cognition, and perceptual abnormalities. Frequent etiologies include: head trauma, stroke, tumor, infectious disease, toxic exposure, metabolic abnormalities, autoimmune disease, genetic defects, prenatal/perinatal/neonatal complications, and neurodegenerative disease.

The examination entails the taking of an extensive history (including review of medical records) and the administration of a screening assessment or a comprehensive evaluation that can take many hours and require intensive data analysis. Consultation with other medical professionals such as neurologists, neurosurgeons, pediatricians, psychiatrists, and radiologists is common. The sensitivity of neuropsychological tests is such that they often reveal abnormality in the absence of positive findings on CT and MRI scans. Moreover, they can identify patterns of impairment that are not determinable through other procedures, leading to appropriate treatment recommendations.

*Document created by the Neuropsychology Division of the New York State Psychological Association (NYSPA-NPD)