C. Munro Cullum, Ph.D. Answers Questions On: Neuropsychology

Neuropsychology is the field dedicated to understanding and assessing high-level cognitive abilities such as memory, attention and concentration, reasoning, the ability to attend to stimuli, and the ability to learn and retain new information.

While neuroimaging studies such as CT and MRI show us how a patient’s brain looks structurally, and cerebral blood-flow studies let us see how blood is flowing to the brain, those tests don’t tell us how the brain is actually working.

Neurologists generally examine basic aspects of memory and other cognitive abilities as part of their exam, but refer patients for neuropsychological assessment when there’s a known or suspected diagnosis of some kind of brain disorder and they want a very thorough assessment. Our tests provide more detailed snapshots of areas of cognitive strength and weakness.

For example, the three-word recall is a quick, simple memory test a physician might do in clinic as part of a mental status examination. Neuropsychological testing does similar types of tasks, but in much more detail. Instead of having a patient recall three words, the neuropsychological examination might include longer word lists, stories, and figures to learn and remember to more thoroughly assess memory abilities.

A neuropsychological evaluation evaluates and measures how well the brain is working from a functional cognitive perspective. It is currently the most sensitive means we have of measuring human brain function, and it is the only way to really document the level of proficiency in someone’s cognitive abilities.

Neuropsychological testing enables us to quantify cognitive behaviors and brain functions across a variety of cognitive skills, including memory, language, attention, and concentration.

The fact that a problem exists doesn’t necessarily mean there’s a disorder. We have to assess it to determine how bad a problem is and what other cognitive abilities might be involved. We then assist the referring physician with a diagnosis and treatment plan.

One clinician might say a patient has a “mild” cognitive problem, but our definitions of “mild” might not be the same.

Quantification of cognitive abilities helps us to standardize and measure that – and to establish a baseline that we can look at over time. For instance, I might find that a patient’s IQ and language skills are superior but memory is only average, which may represent a decline for that person in that area. We can use neuropsychological test scores to actually measure recovery or decline over time and to help patients and families understand what is going on.

Because there’s not just one test of brain function – the brain is too complex – a neuropsychological evaluation includes a combination of tests in different formats. Some are question and answer, others involve performing specific tasks, some use drawings, and others are administered via computer.

We also tailor the evaluations to fit each patient’s presenting complaints, background, and suspected or diagnosed disorder. Some tests may be the same from patient to patient, but others are not. Evaluations can take one to six hours, depending upon the referral question and what needs to be learned from the exam.

By evaluating a wide range of cognitive functions, we get a picture of how someone is functioning overall from a cognitive standpoint, including strengths as well as weaknesses.

For example, we see a lot of people who think their memory is impaired. While they may indeed have memory impairment, if we administer only memory tests, we won’t know about the rest of their cognitive functions, and might inaccurately pinpoint a deficit. Problems with attention or language can masquerade as memory problems.

After we complete a neuropsychological evaluation, we compile the results from the different tests into a profile that helps us determine what’s normal and what’s not. If we detect a problem, we also assess its severity. We consider all of the test results in light of the patient’s background and presentation, outline their cognitive strengths and weaknesses, and then discuss these findings in relation to known or suspected diagnoses.

We work closely with neurologists, psychiatrists, neurosurgeons, and other physicians to help diagnose and treat patients with cognitive disorders.

For instance, if we see something abnormal in the neuropsychological profile of someone with memory impairment and suspected Alzheimer’s disease, we determine whether the profile looks like what we typically see in Alzheimer’s or if it looks like something else.

We also talk with patients about our diagnostic impressions and recommendations. When we review their cognitive strengths and weaknesses, this allows us to provide them with suggestions and strategies to help with their adaptive functioning, in addition to providing information that helps patients and families better understand their condition.