Neuro-Psych Tests

Neuropsychological testing is an important component of the assessment and treatment of brain injury, dementia, neurological conditions, and psychological and psychiatric disorders. Neuropsychological testing is also an important tool for examining the effects of toxic substances and medical conditions on brain functioning.

The historical origins of neuropsychology and neuropsychological testing are in both psychology and neurology. The primary activity of a neuropsychologist is the assessment of brain functioning through structured and systematic behavioral observation.

The following has been adapted from the Encyclopedia of Mental Disorders website.

Neuropsychological tests are designed to examine a variety of cognitive abilities, including speed of information processing, attention, memory, language, and executive functions, which are necessary for goal-directed behavior. By testing a range of cognitive abilities and examining patterns of performance in different cognitive areas, a neuropsychologist can make inferences about underlying brain function.

The modern field of neuropsychology emerged in the twentieth century, combining theories based on anatomical observations of neurology with the techniques of psychology, including objective observation of behavior and the use of statistical analysis to differentiate functional abilities and define impairment. The famous Soviet neuropsychologist Alexander Luria played a major role in defining neuropsychology as it is practiced today. Luria formulated two principle goals of neuropsychology: to localize brain lesions and analyze psychological activities arising from brain function through behavioral observation. American neuropsychologist Ralph Reitan emphasized the importance of using standardized psychometric tests to guide systematic observations of brain-behavior relationships.

Before the introduction of neuroimaging techniques like the computed tomography (CAT scan) and magnetic resonance imaging (MRI), the primary focus of neuropsychology was diagnosis. Since clinicians lacked non-surgical methods for directly observing brain lesions or structural abnormalities in living patients, neuropsychological testing was the only way to determine which part of the brain was affected in a given patient. Neuropsychological tests can identify syndromes associated with problems in a particular area of the brain. Neuropsychological screening of elderly people complaining of memory problems can help identify those at risk for dementia versus those experiencing normal age-related memory loss.

As neuropsychological testing came to play a less vital role in localization of brain dysfunction, clinical neuropsychologists found new uses for their skills and knowledge. By clarifying which cognitive abilities are impaired or preserved in patients with brain injury or illness, neuropsychologists can predict how well individuals will respond to different forms of treatment or rehabilitation. Although patterns of test scores illustrate profiles of cognitive strength and weakness, neuropsychologists can also learn a great deal about patients by observing how they approach a particular test.

Performance on neuropsychological tests is usually evaluated through comparison to the average performance of large samples of normal individuals. Most tests include tables of these normal scores, often divided into groups based on demographic variables like age and education that appear to affect cognitive functioning. This allows individuals to be compared to appropriate peers.

The typical neuropsychological examination evaluates sensation and perception, gross and fine motor skills, basic and complex attention, visual spatial skills, receptive and productive language abilities, recall and recognition memory, and executive functions such as cognitive flexibility and abstraction. Motivation and personality are often assessed as well, particularly when clients are seeking financial compensation for injuries, or cognitive complaints are not typical of the associated injury or illness.

Neuropsychological tests are specifically designed tasks used to measure a psychological function known to be linked to a particular brain structure or pathway.  During the past decade neuropsychological testing has become very sophisticated.  Tests that are currently available are standardized, highly accurate, and possess a high degree of predictive accuracy.  

Psychologists and neuropsychologists create batteries of standardized tests to answer specific referral questions. A typical battery consists of more than a dozen standardized tests and provides very specific data on a patient's cognitive functioning.

While neurological examination and CT, MRI, EEG, and PET scans look at the structural, physical, and metabolic condition of the brain, the neuropsychological examination is the only way to formally assess brain function. Neuropsychological tests cover the range of mental processes from simple motor performance to complex reasoning and problem solving. 

Neuropsychological testing is time-consuming, ranging from 3 to 12 hours, and requires that the psychologist be attentive to the patient's energy and motivation. Most neuropsychologists select a unique combination of tests focused on the diagnostic and examination questions of interest for an individual.

The following has been adapted from the bapta website.

Neuropsychological testing provides diagnostic clarification and grading of clinical severity for patients with subtle or obvious cognitive disorders. These include:

Children who are not achieving appropriate developmental milestones
Infants exposed to drugs, alcohol or illness in-utero
Patients with head injuries
Patients with Parkinson's Disease, or other neurological diseases
Patients exposed to chemicals or toxins
Substance abusing patients
Stroke victims
Patients with dementia
Wouldn't I be providing better care by referring my patient to a neurologist?

The function of a neuro-psychologist is significantly different from that of a neurologist. The neurologist's expertise lies in diagnosing and treating the structural and physiological consequences of brain injuries and neurological illnesses. In contrast, neuropsychologists assess the effects of brain injuries and illnesses on cognition and behavior; they are experts in assessing functional capacities. Many patients need both neurological and neuro-psychological work-ups.

Neuropsychological testing provides quantifiable data about the following aspects of cognition:

Short-term and long-term memory
Ability to learn new skills and solve problems
Attention, concentration, and distractibility
Logical and abstract reasoning functions
Ability to understand and express language
Visual-spatial organization Visual-motor coordination
Planning, synthesizing and organizing abilities
This data results in accurate clinical diagnosis and a grading of clinical severity.

The Encyclopedia of Mental Disorders points out that some neuropsychologists prefer to use fixed test batteries like the Halstead-Reitan Battery or the Luria-Nebraska Battery for all patients. These batteries include tests of a wide range of cognitive functions, and those who advocate their use believe that all functions must be assessed in each patient in order to avoid diagnostic bias or failure to detect subtle problems.

The more common approach today, however, is to use a flexible battery based on hypotheses generated through a clinical interview, observation of the patient, and review of medical records. While this approach is more prone to bias, it has the advantage of preventing unnecessary testing. Since patients often find neuropsychological testing stressful and fatiguing, and these factors can negatively influence performance, advocates of the flexible battery approach argue that tailoring test batteries to particular patients can provide more accurate information.

The following alphabetical listing (adapted from the Brainsource website) includes some of the more frequently used tests employed in a neuro-psychological assessment. Brief descriptions indicate the intent of each test . Some tests are included here that are not, strictly speaking, neuropsychological tests, but that may be used in a comprehensive examination.

The items below include the Test Name and then the Purpose of the Test:

Ammons Quick Test This test has been used for many years to help assess premorbid intelligence. It is a passive response picture-vocabulary test.

Aphasia Tests (various) Several aphasia and language tests examine level of competency in receptive and expressive language skills. (e.g., Reitan-Indiana Aphasia Screening Test)

Beck Depression or Anxiety Scales These scales provide quick assessment of subjective experience of symptoms related to depression or anxiety.

Bender Visual Motor Gestalt Test This test evaluates visual-perceptual and visual-motor functioning, yielding possible signs of brain dysfunction, emotional problems, and developmental maturity.

Boston Diagnostic Aphasia Examination Broad diagnosis of language impairment in adults.

Boston Naming Test Assessing the ability to name pictures of objects through spontaneous responses and need for various types of cueing. Inferences can be drawn regarding language facility and possible localization of cerebral damage.

California Verbal Learning Test This procedure examines several aspects of verbal learning, organization, and memory. Forms for adults and children.

Cognitive Symptom Checklists Self-evaluation of areas of cognitive impairment for adolescents and adults.

Continuous Performance Test Tests that require intense attention to a visual-motor task are used in assessing sustained attention and freedom from distractibility. (e.g., Vigil; Connors Continuous Performance Test)

Controlled Oral Word Association Test Different forms of this procedure exist. Most frequently used for assessing verbal fluency and the ease with which a person can think of words that begin with a specific letter.

Cognistat (The Neurobehavioral Cognitive Status Examination) This screening test examines language, memory, arithmetic, attention, judgment, and reasoning. It is typically used in screening individuals who cannot tolerate more complicated or lengthier neuropsychological tests.

d2 Test of Attention This procedure measures selective attention and mental concentration.

Delis-Kaplan Executive Function System Assesses key areas of executive function (problem-solving, thinking flexibility, fluency, planning, deductive reasoning) in both spatial and verbal modalities, normed for ages 8-89.

Dementia Rating Scale Provides measurement of attention, initiation, construction, conceptualization, and memory to assess cognitive status in older adults with cortical impairment.

Digit Vigilance Test A commonly used test of attention, alertness, and mental processing capacity using a rapid visual tracking task.

Figural Fluency Test Different forms of this procedure exist, evaluating nonverbal mental flexibility. Often compared with tests of verbal fluency.

Finger Tapping (Oscillation) Test This procedure measures motor speed. By examining performance on both sides of the body, inferences may be drawn regarding possible lateral brain damage.

Grooved Pegboard This procedure measures performance speed in a fine motor task. By examining both sides of the body, inferences may be drawn regarding possible lateral brain damage.

Halstead Category Test This test measures concept learning. It examines flexibility of thinking and openness to learning. It is considered a good measure of overall brain function. Various forms of this test exist.

Halstead-Reitan Neuropsychological Battery A set of tests that examines language, attention, motor speed, abstract thinking, memory, and spatial reasoning is often used to produce an overall assessment of brain function. Some neuropsychologists use some or all of the original set of tests in this battery.

Hooper Visual Organization Test This procedure examines ability to visually integrate information into whole perceptions. It is a sensitive measure of moderate to severe brain injury.

Kaplan Baycrest Neurocognitive Assessment Assesses cognitive abilities in adults, including attention, memory, verbal fluency, spatial processing, and reasoning/conceptual shifting.

Kaufman Functional Academic Skills Test A brief, individually administered test designed to determine performance in reading and mathematics as applied to daily life situations.

Kaufman Short Neuropsychological Assessment Measures broad cognitive functions in adolescents and adults with mental retardation or dementia.

Luria-Nebraska Neuropsychological Battery This is a set of several tests designed to cover a broad range of functional domains and to provide a pattern analyses of strengths and weakness across areas of brain function. The tests reflect a quantitative model of A. R. Luria's qualitative assessment scheme.

MMPI-2 (Minnesota Multiphasic Personality Inventory) This well-known and well-respected personality assessment is often used to accompany neuropsychological tests to assess personality and emotional status that might lend understanding to reactions to neurofunctional impairment.
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Memory Assessment Scales This is a comprehensive battery of tests assessing short-term, verbal, and visual memory.

MicroCog This computerized assessment measures nine functional cognitive areas sensitive to brain injury.

Millon Clinical Multiaxial Inventory A self-report assessment of personality disorders and clinical syndromes. This is sometimes used as an adjunct instrument in comprehensive neuropsychological assessment.

Mooney Problem Checklist This instrument helps individuals express their personal problems. It covers health and physical development; home and family; morals and religion; courtship, sex, and marriage.

Multilingual Aphasia Examination This set of subtests provides comprehensive assessment of a wide range of language disorders.

North American Reading Test This reading test is often used to help assess premorbid intelligence, for comparison with current intelligence as measured by more comprehensive tests.

Quick Neurological Screening Test This is a rapid assessment to identify possible neurological signs, primarily in motor, sensory, and perceptual areas.

Paced Auditory Serial Attention Test Tests for attention deficits including concentration, speed of processing, mental calculation, and mental tracking. Sensitive for diagnosing cognitive impairment in individuals 16 and up.

Paulhus Deception Scales This instrument measures the tendency to give socially desirable responses, useful for identifying individuals who distort their responses.

Personality Adjective Checklist This self-report measure evaluate several personality patterns, primarily focusing on personality disorders.

Repeatable Battery for the Assessment of Neuropsychological Status Designed as a brief, repeatable measure of cognitive decline or stability over time, appropriate for trauma, disease, or stroke.

Rey Auditory Verbal Learning Test This procedure evaluates the ability to learn word lists. It is the forerunner of other tests of verbal learning using lists of words.

Rey Complex Figure Test This drawing and visual memory test examines ability to construct a complex figure and remember it for later recall. It measures memory as well as visual-motor organization.

Rey 15-item Memory Test This test is used to evaluate potential for malingering in memory.

Rey-Osterrieth Complex Figure Test Analyzes aspects of visuospatial ability and memory in all ages.

Rivermead Behavioural Memory Test Evaluates impairments in everyday memory related to real life situations.

Rogers Criminal Responsibility Scale This instrument is designed to assess the impairment of an individual at the time a crime was committed.

Rorschach Projective Technique This familiar inkblot test is used to evaluate complex psychological dynamics. Persons with brain injury have been shown to produce certain kinds of responses that can complement other tests and help to understand personality changes associated with brain injury.

Ruff Figural Fluency Test This visual procedure complements verbal fluency tests in assessing ability to think flexibly but using visual stimuli rather than words.

Sensory Screening Test Various procedures include the assessment of tactile sensitivity to various objects, the ability to recognize objects by touch, and the ability to detect numbers written on the hands by touch alone. By examining both sides of the body, inferences may be drawn regarding possible lateral brain damage.

SCL-90 (Symptom Checklist 90) This checklist evaluates the individual's subjective complaints.

Shipley Institute of Living Scale Comparison of vocabulary knowledge and ability to figure out abstract sequential patterns has been established as a sensitive measure of general brain functioning.

Stroop Test This brief procedure examines attention, mental speed, and mental control.

Symbol Digit Modalities Test Screening test for children and adults to detect cognitive impairment.

Tactual Performance Test Assesses speed of motor performance, tactile perception, spatial problem-solving, and spatial memory in all ages.

Test of Memory Malingering This test is used to evaluate potential for malingering in memory.

Test of Memory and Learning (TOMAL) This test for children and adolescents measures numerous aspects of memory, assessing learning, attention, and recall.

Test of Memory Malingering For ages 16-84, this visual recognition test helps discriminate malingered from true memory impairments.

Thematic Apperception Test This projective test is most commonly used to examine personality characteristics that may aid in understanding psychological or emotional adjustment to brain injury.

Tower of London A test for all ages, assessing higher-level problem-solving, valuable for examining executive functions and strategy planning.

Trail Making Tests A and B These tests measure attention, visual searching, mental processing speed, and the ability to mentally control simultaneous stimulus patterns. These tests are sensitive to global brain status but are not too sensitive to minor brain injuries.

Validity Indicator Profile A complex, computer-analyzed test for evaluating effort and motivation in test taking.

Verbal (Word) Fluency Tests (various) There are a variety of verbal fluency tests in use. Each is designed to measure the speed and flexibility of verbal thought processes. (e.g., Controlled Oral Word Association Test; Thurstone Verbal Fluency)

Wechsler Adult Intelligence Scale--III  Wechsler Adult Intelligence Scale—III This set of 13 separate "subtests" produces measures of memory, knowledge, problem solving, calculation, abstract thinking, spatial orientation, planning, and speed of mental processing. In addition to summary measures of intelligence, performance on each subtest yields implications for different neurofunctional domains. The set of tests takes about an hour or more to administer. The WAIS-III is often the foundation for a comprehensive neuropsychological assessment.

Wechsler Intelligence Scale for Children--III Intelligence Scale for Children—III Comparable to the Wechsler Adult Intelligence Scale, this procedure contains subtests that measure similar domains in children.

Wechsler Memory Scale—III This set of 18 separate "subtests" yields information about various kinds of memory and learning processes. Summary memory indices are provided in addition to the individual scores of the subtests. The whole set of tests takes about an hour to administer. The WMS-III provides a comprehensive assessment of memory. It is co-normed with the WAIS-III and is usually used in conjunction with it.

Wechsler Test of Adult Reading Provides estimate of pre-morbid intellectual functioning in persons 18-89, normed with the WAIS-III and WMS-III.

Wide Range Achievement Test Provides level of performance in reading, spelling, and written arithmetic. The reading and spelling tests are often used in estimating premorbid intellectual functioning.

Wisconsin Card Sort Test Similar in concept to the Category Test, this procedure also measures the ability to learn concepts. It is considered a good measure of frontal lobe functioning.

Wonderlic Personnel Test This personnel test is not a neuropsychological instrument per se, but is used to help evaluate vocational abilities and potential for comparison with other neuropsychological tests in making practical prognostic decisions.

Word Memory Test A validity procedure designed to detect response bias that might indicate exaggeration of impairment or symptom feigning.

For more information about neuro-psychological tests, please click on the linked websites listed below.  Please remember that it may be considered a breach of ethics for a professional to administer neuro-psychological or other psychological tests without the person taking the test fully understanding the nature and purpose of the test and without providing feedback or assuring that feedback and/or follow-up by a qualified practitioner will take place.

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