An Adult Assessment is geared specifically to meet the diagnostic needs of individuals age 18 to 54 who are exhibiting cognitive changes. It is the most in-depth and comprehensive form of evaluation that is specifically aimed at exploring the behavioral manifestations of brain dysfunctions across various neurocognitive domains. This assessment is a crucial tool in specifying whether an individual has actually suffered a brain injury, especially when the effects of the injury are subtle and may be mistaken by other factors such as stress, depression, lack of motivation, or undesirable “personality flaws”. While imaging studies such as CAT-Scan or MRI’s may not detect slight structural abnormalities in the brain when the insult is minor or diffuse, neuropsychological testing will show ways in which the individual is able or not able to perform certain tasks that are dependent on healthy brain activity, and can, therefore, diagnose brain dysfunction in the absence of identifiable structural brain abnormalities.
Thus, a thorough Neuropsychological Assessment will allow for early intervention and can answer simple but very crucial real-life questions such as:
◦ Can my parent continue to live independently without supervision?
◦ Is my spouse able to continue to take care of our finances?
◦ What medical conditions are contributing to the cognitive changes?
◦ What medications could be helpful?
◦ Are there any psychological/emotional factors contributing to the cognitive decline?
◦ What would be the best academic environment for my child’s specific learning style?
◦ Will my child be able to have an independent and productive life despite of his/her disability?
◦ Will my child do best in a community college rather than a 4-year university program?
◦ Is there anything that I can do at home that would be helpful to my child?
◦ Has my child reached their highest potential or is there still room for further improvement?
◦ What kind of work will be more suitable for me after my brain injury?
◦ How will the effects of the stroke interfere with how I used to function at home and at work?
◦ Will I be able to learn new skills after my brain injury?
◦ Can anything be done to improve my ability to organize and plan effectively in my work place?
The evaluation will be able to answer these real-life questions by providing specific information about the functioning of the following cognitive realms and how the deficits interfere with daily activities:
◦ Attention and Concentration which includes working memory, capacity for registration and mental manipulation of simple and complex bits of information, focused and sustained attention.
◦ Executive Functioning which includes processing speed, abstract thinking, mental shifting, organization, planning, sequencing, inhibition and impulse control.
◦ Memory and learning which includes immediate and delayed recall, recognition, storage and consolidation of new information into long-term memory, learning rate, storage capacity.
◦ Language which includes oral and written expression, auditory and reading comprehension, word retrieval, and verbal fluency.
◦ Sensory-Motor functioning which includes gross and fine motor skills, balance and postural stability, eye-hand coordination.
◦ Visual Spatial Abilities which includes figure-ground differentiation, visual scanning, attention to essential visual detail, visual analysis and synthesis.
◦ Auditory Processing which includes auditory functioning under various compromised auditory environments at different frequencies.
In addition, to providing relevant data on the “status” of these mental functions, a Neuropsychological Assessment provides an objective measure of the individual’s global intellectual potential or intelligence (IQ), and how their functioning in the various neurocognitive domains described above differ from the estimate of their true potential. An understanding of the individual’s psychological and emotional well-being and the extent to which unresolved issues or untreated clinical symptoms may contribute to the cognitive impairment is also derived from this evaluation.
A Neuropsychological Assessment will often involve not only the administration and interpretation of standardized psychometric measures, but also a thorough clinical interview to attain an in-depth understanding of the problems at hand, consultation with other relevant professionals and/or family members, observation of the individual in his/her natural environment such as school, nursing home etc., and a careful review of school, psychiatric, and medical records. The outcome of the evaluation is often very helpful in providing diagnostic clarification, assisting in educational and vocational planning, making disability and forensic determination, and establishing the guidelines for the development of an effective and comprehensive individualized Cognitive Rehabilitation Program. This type of assessment is often recommended for: 1) baseline testing before a treatment or intervention is implemented, 2) to follow the progression of cognitive development especially during significant transition times when a new level of demands are necessary and services may need to be redefined, 3) cases in which a brain-based impairment in cognitive and behavioral functioning is suspected and is believed to be due to:
◦ Traumatic Brain Injury
◦ Vascular Conditions such as CVA’s and TIA’s
◦ Brain Tumor, Aneurysm
◦ Neurodegenerative Disorders such as Alzheimer’s and Parkinson’s Disease
◦ Seizure Disorder or Epilepsy
◦ Central Nervous System Infections/Inflammation such as Meningitis, Encephalopathy, Multiple Sclerosis
◦ Toxic Exposure
◦ Chronic Substance Abuse such as Korsakoff’’s Syndrome
◦ Metabolic or Endocrine conditions such as Diabetes Mellitus, Kidney or Liver Disorders
◦ Genetic Disorders such as Fragile X
◦ Environmental Conditions such as in-utero exposure to illicit drugs, Fetal Alcohol Syndrome
◦ Neurodevelopmental Conditions such as ADHD, Pervasive Developmental Disorders
Symptoms and behavioral presentations that may warrant a visit to your Primary Care Physician and a referral for a Neuropsychological Assessment include:
◦ Memory Loss (i.e. forgetting conversations, forgetting names of familiar people, frequently losing or “misplacing” belongings around the house).
◦ Attention and Concentration (i.e. difficulty focusing on goal-directed tasks, being easily distractible, unable to filter out interfering stimuli, difficulty sustaining attention overtime, or dividing attention between multiple sources of information).
◦ Poor Organization and Planning (i.e. not knowing how to prioritize, poor time management, poor sequencing ability, knowing how to do parts of a task but being unable to bring it to completion).
◦ Difficulty Multitasking (i.e. unable to do several tasks at once such as answering the phone while trying to finish an email).
◦ Difficulties With Language (i.e. difficulties recalling the words for familiar objects, decreased fluency in speech, using the wrong word).
◦ Problems With Visual Spatial Skills (i.e. unable to read maps, difficulty finding objects in a busy visual field, having difficulty making sense of what you see while driving).
◦ Problems With Writing or Reading (i.e. not being able to read as well as before, not being able to read what you have written).
◦ Changes In Thinking and Increased Confusion (i.e. having illogical thoughts, increased suspiciousness, not recognizing familiar places, not remembering day or time)
◦ Changes in Impulse Control (i.e. doing or saying things you wouldn’t normally do, increased irritability or impatience, increased social disinhibition).
The San Mateo Memory Center