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Professional Affairs and Information Office
2121 South Oneida Street, Suite 550
Denver, Colorado 80224-2594
TEL /FAX (512) 454-9429
E-mail: PAIO@NANonline.org
NATIONAL ACADEMY OF NEUROPSYCHOLOGY
The neuropsychological examination is one of the methods of diagnosing neurodevel-
opmental, neurodegenerative, and acquired disorders of brain function. It is frequently
a part of the overall neurodiagnostic assessment, which includes other neurodiagnost-
ic techniques such as CT, MRI, EEG, and SPECT. The purpose of the neuropsycholog-
ical examination is to assess the clinical relationship between the brain/central nervous
system and cognitive/behavioral dysfunction, as well as to participate in differential
diagnosis. It is a neurodiagnostic, consultative service, and not a mental health eval-
uation or treatment service.
The Social Security Administration states that comprehensive neuropsychological
examinations may be used to establish the existence and extent of compromise of
brain function (SSA, 2002). They also describe “acceptable medical sources” for disab-
ility examinations to include licensed or certified psychologists. The evaluation is per-
formed by a qualified neuropsychologist who has undergone specialized education
and intensive training in the clinical neurosciences, including the relationship between
behavioral functioning and neuroanatomy, neurology, and neurophysiology.
Neuropsychological services are subsumed in the Medicine Chapter under "Central
Nervous System Assessments/ Tests" in the CPT 2002 (AMA Press, page 368), and
have ICD diagnoses. The American Academy of Neurology has rated neuropsychol-
ogical testing as “Established” with Class II evidence and a Type A recommendation.
Neuropsychological examinations are clinically indicated and medically necessary
when patients display signs and symptoms of intellectual compromise, and cognitive
and/or neurobehavioral dysfunction that involve, but are not restricted to, memory
deficits, language disorders, learning disorders, developmental disabilities, pervasive
developmental disorders, impairment of organization and planning, and perceptual
abnormalities. Neuropsychological evaluations are important in determining and out-
lining both subtle and more severe neurocognitive deficits among patients with cere-
brovascular conditions, traumatic brain injury, epilepsy, multiple sclerosis, and HIV
(AAN, Neurology, 47, 592-599), as well as hydrocephalus, neurotoxic exposure, brain
tumors, and other common medical conditions such as thyroid and collagen-vascular
disorders among others. Neuropsychological evaluations also provide critical
adjunctive information for the diagnosis of conditions such as dementia (National
Institute of Neurological Communicative Disorders and Stroke-Association Internat-
ionale pour la Recherche’ et l’Enseignement en Nourosciences: NINCDS-AIREN,
Roman et al., 1993, Neurology, 43, 250-260; and the NINCDS-Alzheimers Disease and
Related Disorders Association, McKhann et al., 1984, Neurology, 34, 939-944).
Neuropsychologists work closely with primary or consultant physicians assessing
patients’ cerebral status. Outlining strengths and weaknesses is important in guiding
rehabilitation and clinical patient management, as well as in monitoring treatment
response and progression. Diagnosis of dementia is critical in the management of
patients as well as in assisting caregivers in long term planning. Physicians and
organizations such the Pediatric Oncology Group regularly request baseline and follow-
up neuropsychological evaluations to monitor the central nervous system effects of
radiation, neurosurgery, and chemotherapy.
A typical neuropsychological evaluation entails the taking of an extensive history
(including review of medical records), and the administration of a comprehensive
evaluation that can take 8 or more hours and requires intensive data analysis. Con-
sultation with other medical professionals such as neurologists, neurosurgeons,
pediatricians, psychiatrists, and radiologists is common.
The sensitivity of neuropsychological tests is such that they often reveal abnormality in
the absence of positive findings in CT and MRI scans. Moreover, they can identify
patterns of impairment that are not determinable through other procedures, leading to
appropriate treatment recommendations. In their paper “Psychological testing and
psychological assessment: A review of evidence and issues,” Meyer et al. (2001) high-
light the finding that neuropsychological testing has been found to be as good as med-
ical tests in detecting neurological conditions such as dementia.
In summary, neuropsychological evaluations are often medically indicated for diag-
nosis and/or rehabilitation planning. Consistent with the opinions of our medical
colleagues as outlined above, such evaluations are neurodiagnostic, consultative
services, and not mental health evaluations or treatment services.
Respectfully,
Leslie D. Rosenstein, Ph.D., ABPP-CN
Director of Professional Affairs and Information
Professional Affairs and Information Office
National Academy of Neuropsychology
References
American Medical Association (2002). 2002 CPT: Current Procedural Terminology.
AMA Press: Chicago.
McKhann et al. (1984). Clinical diagnosis of Alzheimer’s disease: Report of the National
Institute of Neurological Communicative Disorders and Stroke-Association-Alzheimers
Disease and Related Disorders Association. Neurology, 34, 939-944.
Meyer et al. (2001). Psychological testing and psychological assessment: A review of
evidence and issues. American Psychologist, 56(2), 128-165.
Roman et al. (1993) Vascular dementia: diagnostic criteria for research studies. Report
of the National Institute of Neurological Communicative Disorders and Stroke-
Association Internationale pour la Recherche’ et l’Enseignement en Nourosciences
(NINCDS-AIREN) International Workshop. Neurology, 43, 250-260.
Social Security Administration (2002). Disability evaluation under Social Security. SSA
Publication Number 64-039. www.ssa.gov/disability/profesionals/bluebook/
AdultListings.htm
Therapeutics and Technology Subcommittee of the American Academy of Neurology
(1996). Assessment: Neuropsychological testing of adults. Consideration for
neurologists. Neurology, 47, 592-599.
Acknowledgement
This document was based upon “The Neuropsychological Neurodiagnostic
Examination: Statement” developed by Stephen Honor, Ph.D., ABPP-CN, FP, CP and
The New York State Psychological Association's Neuropsychology Division, published
in the NYSPA Notebook, July 1996, 6 Executive Park Drive, Albany, New York 12203.
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