NEUROPSYCHOLOGY SERVICES

Dr Ilana Hepner, Clinical Neuropsychologist, Sydney

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Neuropsychological assessment

Neuropsychological assessment provides an objective way to measure brain-behaviour relationships. The assessment is conducted by a neuropsychologist; a psychologist who has completed advanced training in the assessment and evaluation of brain-behaviour relationships.

A neuropsychologist has specific expertise in the assessment of cognition, emotion and behaviour in individuals with (or who are suspected to have) brain dysfunction arising from various neurological, psychiatric or other medical conditions.

The findings of neuropsychological assessment can play an important role in establishing a diagnosis, in helping to differentiate between conditions (eg. dementia and depression), in treatment, rehabilitation and care planning.

If brain dysfunction is confirmed or suspected, if there are concerns about memory and thinking, or if there are difficulties with work, study or with going about new or familiar tasks, then neuropsychological assessment may be warranted.
Neuropsychological assessment can be useful in the diagnosis and management of:
  • Neurodegenerative disorder (eg. Alzheimer's disease, Vascular dementia)
  • Traumatic or acquired brain injury
  • Cerebrovascular accident (stroke)
  • Neurological disorders (eg. epilepsy, brain tumour)
  • Neuropsychiatric disorders, other mental health conditions and substance abuse (e.g., alcohol or drug use)
  • Developmental and Learning disorders (eg. dyslexia, ADHD)
  • Other medical illnesses that can affect cognitive function (eg. autoimmune disorders or endocrine dysfunction).
The findings and recommendations may help to:
  • Confirm or clarify the diagnosis
  • Monitor for change over time (eg. following a change in medication, treatment or surgery)
  • Increase understanding of the impact of a condition on a person's level of function
  • Guide return to work, study or rehabilitation planning
  • Identify strategies that may assist performance and help improve quality of life
  • Evaluate capacity (eg. testamentary capacity, capacity to confer or revoke a Power of Attorney) and the ability to make decisions regarding self-care, medical treatment and accommodation.
In the medicolegal or forensic context, a neuropsychological assessment may be requested to:
  • Confirm or clarify the diagnosis
  • Help establish whether a brain injury has occurred
  • Help determine the impact of any brain injury on cognition, emotion and behaviour, or on current or future social, educational or occupational function
  • Help determine capacity to participate in legal proceedings.
The assessment process
An interview forms the first part of the assessment, where the client's current concerns and background history are discussed. It is often helpful to also interview a family member, carer or close friend to obtain their perspective on the issues at hand.

The second part of the assessment involves objective evaluation of cognition, emotion, academic achievement and/or personality using valid and reliable measures. Cognitive functions include abilities such as attention, speed of information processing, intellect, learning and memory, language, planning, organisation and problem solving.

Most assessments require about two to three hours (including interview and breaks). Medicolegal assessments are more detailed and some may take four to five hours.

Once the assessment is complete, the client's results are compared with normative data obtained from healthy persons of a similar age and background to the client. The findings are then interpreted in the context of the client's educational, occupational, social and medical history. A detailed report is then sent to the referrer. For self funded clients, a feedback session is often organised to discuss the findings and recommendations.