Neuropsychological examination

Foreword
Because of the fact that the most reliable possible picture of cognitive functioning must be obtained, on this page only one example of an image used during the neuropsychological examination, is displayed.

 

A neuropsychological examination can reveal hidden damage to the brain. It examines psychological symptoms and functions with an assumed neurological background. It can sometimes identify the consequences of brain injury that an MRI or CT scan cannot.

 

A neuropsychological examination is requested when there are complaints in the areas of:

  • cognitive functioning, such as changes in attention, memory, perception, language, thinking, pace and execution of actions;
  • behavior and emotions, such as loss of initiative, reduced social skills, aggressiveness, anxiety, depression, hostile behavior and personality changes.

 

What does the neuropsychological examination entail?

During the investigation, the complaints are identified through an interview. The conversation attempts to gain insight into functioning as it was before the brain injury occurred.

In addition, a number of tests and sometimes questionnaires are given. The tests are usually some kind of puzzles and quiz questions. The tests measure, among other things, intelligence, short- and long-term memory, concentration, work pace, perception, language skills, spatial insight and planning.

 

The neuropsychologic test also tests whether the patient has vision damage. Is visibility limited or partially limited?

It is also tested whether the person in question has a good overview by, among other things, checking whether he/she can do two things at the same time and can keep track of time.
Specific areas of the brain cause specific damage and there are specific tests and puzzles for that.

That is why some tests are easy for one person, but difficult for another. The questionnaires clearly identify complaints about anxiety or sadness. The examination can also provide information about the nature of changes in thinking, as well as the location of the lesion in the brain.

 

A neuropsychological report is created from the neuropsychological test. This report consists of the following parts:

  • Additional information / anamnesis / history: how the patient suffered the brain injury, including the most recent brain imaging, the current complaints that the patient experiences, the care provider's history including any previous (neuropsychological) examination, the personal, family and social situation and the medication currently being used.
  • Observations made during the (neuropsychological) examination
  • The results: Discussion of the test results found
  • Conclusion: summary of the above parts with a conclusion

 

Peak performance

It must be realized that an NPO must take place under optimal conditions, i.e. without distracting factors. In such a situation, a peak performance can sometimes be achieved that may not be achieved in daily life.

  • The test room must be well lit and low-noise
  • Feasibility of the test for the patient, i.e.: being able to hear or see well, understanding instructions
  • The patient must be able to complete the test

 

Disharmonic intelligence profile

A neuropsychological examination can reveal a disharmonic intelligence profile, something that occurs in many people with brain damage. A person may be verbally strong but score very poorly on executive tasks, such as being unable to plan or oversee things.

 

Cognition is measured with an intelligence test.
Read more about cognitive problems after brain injury.

Read more about having difficulty with executive tasks or executive dysfunctioning. 

The phenomenon of a disharmonic profile can also occur in people who do not have a brain injury, for example people who are gifted or people with an autistic disorder or even in people with anxiety disorders. Note that it does not have to lead to problems.

 

There can be huge differences between the VIQ and the PIQ. In that case we talk about a disharmonic intelligence profile or the Verbal Performal gap. This gap can be caused by brain injury, but it may also be that the gap was already there before the brain injury and that it was aggravated by the brain injury. More information: Verbal Performal gap. 

 

Memory
Memory tests are performed during the neuropsychological examination. The purpose of each of these tests is primarily to examine the capacity of working memory, short-term memory and long-term memory. Sometimes a distinction is made between visual memory and memory for words/sentences.

 

Vocabulary knowledge, understanding
Does the patient understand social situations, word concepts and general principles? Does the patient have general knowledge and can that knowledge still be applied? There are various tests for this.

 

Being able to divide attention
A neuropsychological test usually also includes a Stroop color test, named after Mr. Stroop who invented this test. This test is intended to measure divided attention.
In this task, color words are printed in conflicting ink colors. For example, the word RED is printed with yellow ink. The assignment is to name the color of the ink in a whole series of such words. We must therefore suppress the tendency to read the word itself. Below, we show an example.

 

 

Executive functions (control functions)
The executive functions are tested: planning, taking initiative, working concentrated under time pressure, making rational decisions, not acting impulsively, etc. There are several tests in a neuropsychological test that test these functions. For example, by using colored cards that must be sorted according to a different criterion each time, the flexibility of the brain when switching between tasks can be clearly determined.
Because executive functions are the 'higher cognitive processes' (higher in the pyramid, see image), they regulate, as it were, the underlying lower cognitive functions (information processing speed, attention and memory).
That is to say: the functioning of one of the lower cognitive functions determines how the executive functions proceed. A person who has difficulty with his/her attention may have underlying difficulty with his/her information processing and concentration. So there does not necessarily have to be a disturbance in attention.

 

image from https://goshope.one/products.aspx?cname=hierarchy+of+cognitive+functions&cid=60

 

Some executive functions:

  • Planning
  • Organization
  • Cognitive flexibility
  • Goal-oriented behavior
  • Time management

See more on our executive functions page.

 

Symptom Validity Tests (SVTs)

SVT's are neuropsychological tests that can be used to determine whether patients have cognitive underperformance. 
This test can be questionnaires as well as reasoning or memory tasks.
The tests investigate whether, for example, a patient exaggerates his complaints or deliberately underperforms.
The cause of this can be very different. For example, there may be factors that make someone want to perform worse or aggravate certain complaints, but it can of course also be due to the brain injury.
Of course, someone can also complete the questionnaires blindly or not understand the questions.
That is why the total test is valuable. Which brain areas are affected? Does that agree with the test results?

More information on this can be found here.