Understanding Neuropsychological Testing: An Insight into Brain Function and Behavior

By: Kirsten Moran 

Abstract

Neuropsychological testing is a tool used by neuropsychologists, licensed experts with specializations in disorder diagnosis, to evaluate a person’s cognitive abilities and emotional state to facilitate diagnoses, plan treatments, and be used as context for forensic psychologists. The assessment can be done within a few hours, and can include writing (digitally or manually) or drawing, solving puzzles, and answering verbal questions. Post-test, the neuropsychologist will follow up with the individual with a written report limited to recommendations and referrals, as well as sharing the gained information with the patient's health care team. 

Applications and Conductors

Neuropsychological testing, often employed in forensic contexts, is a valuable tool for assessing an individual's cognitive abilities and emotional well-being. Conducted by neuropsychologists—licensed professionals with specialized training in identifying and diagnosing cognitive, emotional, and behavioral disorders related to brain function. Whether in personal injury cases, mental health evaluations, civil competency matters, criminal proceedings, or workers' compensation claims, neuropsychological testing offers insightful evaluations of a person's memory, attention, language skills, problem-solving abilities, executive functioning, and emotional regulation. This multifaceted approach enables a comprehensive understanding of an individual's mental capabilities and emotional state, ultimately facilitating diagnoses and planning treatments for conditions such as autism and dementia, strokes, substance disorders, and traumatic brain injuries. 

The Testing Process 

Prior to the test, patients are prepared through given explanations by their doctor and care team, as well as reviewing medications and health history. Doctors will often advise the following actions to ensure accurate test results: alcohol and drug avoidance, thorough sleep, relaxation practice, and preparing necessary supplies for the test, such as glasses, before the assessment. Along with the mentioned neuropsychologist, a specialized technician, and a psychometrist are used during neuropsychology testing to supply and score the test, while the neuropsychologist will evaluate your entire case. Testing often takes thirty minutes to three hours, depending on the cooperation and severity of the patient. Typically, the assessment will involve writing (digitally or manually) or drawing, solving puzzles, and answering questions. Neuropsychologists will interpret results using norm-referencing of factors, including age and educational background. Within a couple of weeks following the procedure, the neuropsychologist informs the patient of their results through a written in-depth report, identifying their strengths and weaknesses. The report includes recommendations and interventions to improve these skills, and occasionally, referrals to other experts. While they can not diagnose, with patient permission, they can share results with a patient’s healthcare team.

Standard Tests 

The following tests are commonly used for each specialization and are completed by neuropsychologists. They are valued in the overall assessment of an individual's cognitive abilities and mental state, to prove a diagnosis, plan treatment, and be used as evidence in forensic settings. 

Memory-  The Rey-Osterrieth Complex Figure Test (ROCF) is a prevalent neuropsychological assessment involving the copying and subsequent recall (immediate and delayed) of a geometric figure. It serves in helping diagnose brain damage, neurological diseases, psychological conditions like schizophrenia and ADHD, and assess cognitive impairments.

Executive Function- The Wisconsin Card Sorting Test (WCST) is a widely employed neuropsychological examination tool designed to evaluate executive functions, particularly cognitive flexibility (or set-shifting) and abstract reasoning. The WCST requires individuals to sort stimulus cards based on principles of color, form, or number, adapting their approach as the sorting rule changes unexpectedly.

Motor Function- The Purdue Pegboard Test is a manipulative dexterity examination consisting of twenty-five holes, partnered by matching pegs with a key along one side that must be rotated to match the hole before they can be inserted, requiring complex visual-motor coordination. Professionals utilize the participants' results in terms of accuracy and speed to localize brain lesions, assess motor deficits, and evaluate the impact of neurological disorders on daily functioning.

Language- The Controlled Oral Word Association Test (COWAT) measures spontaneous production of words belonging to the same category or beginning with some designated letter. The participant is usually asked to name words beginning with a letter (usually in sets of F, A, and S, or C, F, and L), excluding proper nouns, for one minute. Neuropsychologists will evaluate the individual based on the total number of accepted words for all three letters, and can then provide insights into potential conditions like Alzheimer's disease, brain injuries, and other cognitive deficits. 

Visuospatial-  The Judgment of Line Orientation Test is frequently used in clinical settings to assess neurological conditions that affect spatial processing, like stroke, traumatic brain injury, and neurodegenerative diseases. During the assessment, neuropsychologists present participants with a set of two angled lines and task them with matching these lines to a reference set of 11 lines arranged in a semicircle. Results are interpreted alongside other tests to understand an individual's visuospatial abilities and guide interventions.

Citations 

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Zhang, Xiaonan, et al. “Overview of the Complex Figure Test and Its Clinical Application in Neuropsychiatric Disorders, Including Copying and Recall.” Frontiers in Neurology, vol. 12, no. 680474, Aug. 2021, https://doi.org/10.3389/fneur.2021.680474. 

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