Neuropsychological Evaluations in Adults

 

Am Fam Physician. 2019 Jan 15;99(2):101-108.

Author disclosure: No relevant financial affiliations.

Neuropsychologists provide detailed assessments of cognitive and emotional functioning that often cannot be obtained through other diagnostic means. They use standardized assessment tools and integrate the findings with other data to determine whether cognitive decline has occurred, to differentiate neurologic from psychiatric conditions, to identify neurocognitive etiologies, and to determine the relationship between neurologic factors and difficulties in daily functioning. Family physicians should consider referring patients when there are questions about diagnostic decision making or planning of individualized management strategies for patients with mild cognitive impairment, dementia, traumatic brain injury, and other clinical conditions that affect cognitive functioning. Neuropsychological testing can differentiate Alzheimer dementia from nondementia with nearly 90% accuracy. The addition of neuropsychological testing to injury severity variables (e.g., posttraumatic amnesia) increases predicted accuracy in functional outcomes. A neuropsychological evaluation can be helpful in addressing concerns about functional capacities (e.g., ability to drive or live independently) and in determining a patient's capacity to make decisions about health care or finances. Most patients who underwent neuropsychological evaluation and their significant others reported that they found the evaluation helpful in understanding and coping with cognitive problems.

Family physicians are often the first health care professionals to evaluate patients with memory loss and cognitive dysfunction. Although many patients can be readily diagnosed and treated, some present significant challenges. A neuropsychological consultation can help characterize cognitive deficits, clarify diagnoses, and develop optimal management plans for patients with cognitive issues.1  Common goals of neuropsychological evaluations are provided in Table 1.2

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Neuropsychological evaluation can identify the onset and type of mild cognitive impairment and dementia so that early intervention can occur.

B

15, 16, 20, 22, 23

Neuropsychological evaluation can be useful in predicting the degree of driving risk in persons with dementia.

B

25

Neuropsychological evaluation can be useful in determining decision-making capacity in persons with cognitive impairment.

C

26

Neuropsychological evaluation can identify cognitive deficits, predict functional outcomes, and monitor patient recovery after traumatic brain injury.

B

20, 3138


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Neuropsychological evaluation can identify the onset and type of mild cognitive impairment and dementia so that early intervention can occur.

B

15, 16, 20, 22, 23

Neuropsychological evaluation can be useful in predicting the degree of driving risk in persons with dementia.

B

25

Neuropsychological evaluation can be useful in determining decision-making capacity in persons with cognitive impairment.

C

26

Neuropsychological evaluation can identify cognitive deficits, predict functional outcomes, and monitor patient recovery after traumatic brain injury.

B

20, 3138


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

 Enlarge     Print

TABLE 1.

Common Goals of Neuropsychological Evaluations

GoalExamples

Characterize cognitive and behavioral function

Establish cognitive baseline before or after illness, injury, or treatment

Evaluate the impact of a medical issue on cognitive, behavioral, or emotional function

Identify cognitive strengths and weaknesses to predict ability to perform daily living activities

Identify subtle cognitive deficits

Prioritize differential diagnoses

Assess for psychological contributions to symptom presentations (e.g., depression, somatoform features)

Differentiate “worried well” patients from those with cognitive impairment

Establish, confirm, or differentiate between diagnoses that affect cognition

Evaluate for dementia and differentiate between potential etiologies

Plan and monitor treatment

Help determine candidacy for neurosurgical procedures (e.g., deep brain stimulation, epilepsy surgery, ventricular shunting)

Identify cognitive strengths and weaknesses to

The Authors

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RYAN W. SCHROEDER, PsyD, is an associate professor in the Department of Psychiatry and Behavioral Sciences at the University of Kansas School of Medicine–Wichita....

PHILLIP K. MARTIN, PhD, is an assistant professor in the Department of Psychiatry and Behavioral Sciences at the University of Kansas School of Medicine–Wichita.

ANNE WALLING, MB, ChB, is a professor emerita in the Department of Family and Community Medicine at the University of Kansas School of Medicine–Wichita.

Address correspondence to Ryan W. Schroeder, PsyD, University of Kansas School of Medicine, 1010 N. Kansas St., Wichita, KS 67214 (e-mail: rschroeder2@kumc.edu). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

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