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Neuropsychological Assessment

What are Neuropsychological Tests and how do they work?

Neuropsychology is the study of an individual's cognitive and behavioral symptoms linked to neurological conditions. Clinical Neuropsychology assesses how and to what extent a condition (ex. ADHD, or Parkinson) impacts daily functioning. At the same time, neuropsychological tests provide detailed information on the level of impairment of the nervous system and the feasible interventions to treat the symptoms. Neuropsychological tests can provide objective measures, with results helping in diagnosis and rehabilitation planning.

There are several types of neuropsychological tests, and each tries to assess different parts of your brain and how they work together. Generally speaking, neuropsychological tests attempt to evaluate the following mental functions: mood and personality, processing speed, memory, learning, critical thinking, reasoning, attention, intellect, reading, motor speed, and agility.
Neuropsychological tests measure these abilities and indicate impairments in mental functioning, suggesting overt or covert abnormalities.

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Components of a Standard Neuro-Psychological Test

When your provider refers you for a neuropsychological examination, our psychologist uses one or more procedures to assess any abnormality's extent identifying the most likely area(s) of the brain involved.

The first step in the evaluation is the careful exploration of your medical history: it is one of the most important aspects of any examination. It shows what conditions you've had previously, any relevant family history, if you're under any medical care and how the medications affect your brain's functioning (ex, antidepressant, high blood pressure), your general attitude, and much more. Your medical history guides the doctor in the right direction. For example, if you've had a stroke, expect to see an impairment in one or more cognitive functions, such as memory, mobility, personality, and more (depending on which region of the brain the stroke happened). 

Then, we schedule you for one or more tests: this can be a paper-and-pencil test (classical way) or a digital test (current and, in some cases, a state-of-the-art procedure). The tests contain questions and tasks that measure your neuropsychological functioning (how your brain's functioning affects your thoughts and behavior). The way you complete the test (whether alone or needing help, the time required, details recalled, ... ) is also important, as that evaluates your coordination, memory, comprehension, and other skills. Remember that these tests are standardized, meaning that your results will be scaled and compared against a sample of peers. 

When To Get Tested? Who can refer me?

Your doctor, your therapist or yourself, can request a neuropsychological evaluation when impairments in any one of the cognitive functions listed above are possible.

Additionally, there are various reasons to obtain a neuropsychological evaluation. For example, if you were diagnosed with Dementia, your neurologist can request a comprehensive neuropsychological evaluation to measure movement coordination, memory, personality, and other aspects. Other common reasons are:

  • Helping your provider with a differential diagnosis. A differential diagnosis is a list of conditions most likely caused by the symptoms you are experiencing. A differential diagnosis points your doctor, or team of doctors, in the right direction, both for treatment planning and medication management.
  • As an aid before and after functional neurosurgical procedures. For example, if your doctor has recommended that you get surgical treatment for, let's say, a brain tumor, neuropsychological testing will evaluate your performance before and after the surgery to determine if it has had any adverse effects on nearby areas and your general cognitive functions.
  • Can provide a personal baseline for follow-up neuropsychological assessments. Suppose you've been recently diagnosed with a neurodegenerative disorder, such as Alzheimer's or Parkinson's. In that case, the baseline shows how your disease is progressing and becomes an important consideration that your medical team will use to discuss any potential and upcoming treatment. For example, if your disease progresses slower or faster than average, this may affect your treatment plan. 
  • It will provide valuable insight into any care you require for your condition. For example, if the test has shown that you have a significant impairment in manual dexterity, then your doctor may recommend a carer to come in once a day to make sure that you are alright.
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Testing For Parkinson's

Neuropsychological tests are the gold standard in assessing the progression of Parkinson's disease and providing guidance for the initial diagnosis of Parkinson's disease. 

A classic assessment for Parkinson's disease firstly involves taking a medical history. Questions such as previous brain injury or if any family member of yours has Parkinson's or any other movement disorder are essentials. Then, we administer a series of tests to analyze your movement, manual dexterity, and mental functioning. Since Parkinson's affects the brain's basal ganglia (a deep part of the brain responsible for the planning of movements), the test aims to assess this part of the brain's integrity. 

Other tests assess your memory, spatial awareness, critical thinking, and more. This sequence helps in ruling out any other conditions that may affect you. 

Bring any current medications that you're taking or a list of them; include each name, dosage, and frequency; also indicate if you've had any previous imaging done (for example, if you've had an MRI or a CT scan). If you have trouble providing this information, you can ask a family member to help you.

Testing For Dementia

Like any neuropsychological assessment, the first step is to examine your medical history, if you are currently taking any medication, and any other bits of information relevant to your health condition. 

Following that, you complete a series of tests that help determine your neuropsychological functioning. Such tests are similar to that of Parkinson's, but some are more specific and help confirm or rule out a diagnosis of Dementia. Tests verge on measurement of visuospatial tasks, comprehension, auditory short- and long-term memory, visual memory, and motor-coordination. 

Due to the nature of Dementia, a diagnosis in the early stages of the disease is sometimes difficult. A diagnosis is confirmed, more often than not, when the disease progresses into very noticeable symptoms, such as impaired memory, reduced critical thinking, and lack of spatial awareness.

Therefore, neuropsychological tests are essential as they provide a baseline from which doctors and psychologists can determine a disease's progress. In many cases, it helps to arrive at a diagnosis quicker or change your treatment plan to fit your condition better. 

Anatomy of the Frontal Lobe

Common neuropsychological conditions involve directly or indirectly the frontal lobe, one of the most complex areas of the brain. It is the location where thinking, language, personality, judgment, inhibition, to name a few, generate or are processed. 

As you can see, the frontal lobe is responsible for many functions that make us human, such as creativity, emotional expression, planning, and judgment. Many mental conditions, such as Multiple Sclerosis, Autism Spectrum Disorder, and Frontotemporal Dementia, to name a few, affect the frontal lobe in particular. 

Your eyes, ears, nose, and skin provide sensory information and are relayed to your frontal lobe so you can process your surroundings and act upon them.

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Anatomy of the Basal Ganglia (Parkinson's Disease)

The basal ganglia are a group of nuclei located deep in the brain and is responsible for several core functions of the human body. For simplicity, you can think of the basal ganglia as a feedback mechanism that receives, processes, and sends back information from the cerebral cortex (the superior layer of the brain) to other parts of the brain. In short, these nuclei are essential in the regulation of movement, such as walking.

In Parkinson's disease, it is this part of the brain that undergoes progressive degeneration. Neurons that form the basal ganglia start to lose their integrity and eventually become dysfunctional. 

Another critical function of the basal ganglia is modulating emotional responses. It receives inputs from other parts of the brain and relays a response to the rest of the brain. Dysregulation in this area, such as in the case of Parkinson's disease, involves a change in the mood caused by a degeneration of neurons responsible for processing emotions. 

Anatomy of the Hippocampus 

The hippocampus is another vital part of the brain involved in learning, memory, aggression, rage, and hormone regulation. The most crucial function is memory. 

The hippocampus receives inputs from other parts of the brain and body, such as the frontal lobe and the brain's premammillary region, and other complex areas. These connections enable the hippocampus to participate in sensory changes in the environment, adding further complexity to its functionality. 

As you can see, the brain's structure and function are complex, and when something minimal goes wrong, it can have a significant impact on your mental health. 

To summarize: the types of neuropsychological tests, and their functions, are diverse and vary depending on what conditions your doctor wants to rule out or confirm. Neuropsychological tests aid in diagnosing or rule out any neurological conditions and help create a baseline. Conditions such as Parkinson's disease, Dementia, and Wernicke's disease, to name a few, often require a comprehensive neuropsychological evaluation. 

Neuropsychological tests themselves are complex, with many components that attempt to evaluate your brain's multiple aspects and how it functions. As the brain is a complex organ, neuropsychological tests are specific, as they need to assess your brain's functioning. Likely, you have questions about your upcoming tests: please do not hesitate to ask our doctors all the things you want to explore or understand. We are here for you.

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