Cognitive / Behavioral / Neuropsychological Testing (2023)

Overview and Description

Brain injuries and various neurocognitive disorders often cause impairments in cognition, emotional control, and behavior that vary in severity and presentation. Physicians can often detect these deficits by using standard screening tools such as the Mini-Mental Status Examination or other bedside evaluation tools. However, in certain situations, it may be necessary to refer patients for a thorough neuropsychological evaluation.1

Formal neuropsychological testing using a battery of instruments detects a wider range of cognitive impairments, some of which may be subtler and not readily detectable using brief screening instruments. Furthermore, variables such as language, education, cultural backgrounds, and age may complicate the interpretation of results from bedside evaluations. Many neurologic and psychiatric disorders can present with specific patterns of cognitive (e.g. attention, concentration, immediate and remote memory, learning, language, perception, executive processing, psychomotor speed, and sensory-motor functions) and behavioral (e.g. speech, agitation, emotional control) dysfunction, which could make diagnosis and subsequently treatment easier.2

Other uses of neuropsychological and behavioral testing include:

  • Providing baseline and prognostic information
  • Identifying potential barriers to community reintegration
  • Assessing decisional capacity
  • Assessing socio-emotional control
  • Monitoring progress from specific interventions or therapies
  • Assessing ability to return to sports, employment, or schooling and need for accommodations
  • Assessing driving ability
  • Legal considerations and determining disability1-3

Formal neuropsychological assessments initially involve obtaining a medical and psychiatric history, pertinent neuroimaging results, and previous clinical interviews and evaluations. Once completed, several specific neuropsychological or behavioral tests are administered, which are tailored to the specific question being addressed. Depending on what is being tested, the evaluation may last several hours and are therefore typically performed in the outpatient setting. Each test is administered in accordance to a specific testing manual, which standardizes the results, and the scores are then compared to those of an appropriate matched group of people (i.e. age, gender, cultural backgrounds, education, etc.). These comparisons in addition to specific test results help to estimate pre-morbid cognitive abilities, which provides clinicians important information on potential changes caused by disease or injury.1,4

Cognitive Domains and Testing

Brief cognitive assessments can be performed by multiple practitioners in rehabilitation settings and can help tailor treatments to meet individual patient needs and abilities. Some cognitive tests are designed to be used serially to assess changes over time, while other tests cannot be due to test/retest validity issues. Multiple domains may be tested, including commonly impaired skills listed below, noting less frequently tested domains may be investigated as indicated by specific circumstances.

(Video) Cognitive Disorders: Assessment and Testing – Psychiatry | Lecturio

  • Alertness describes one’s arousal to stimuli. This can be spontaneous, reactive to verbal or noxious stimulation, or non-alert. Deficits in alertness may arise from brain injury or specific medical interventions. The timing and fluctuations in alertness may also indicate infection or delirium if rapid or indicate disorders of consciousness if more chronic. Impairments in alertness and orientation can significantly impair cognitive testing, thus some specific testing should be done during periods of improved alertness. Current research on stroke attention deficits suggests that although there is an immediate effect of cognitive rehabilitation on attentional and alertness cognitive domains, future studies may be necessary to determine whether this benefit persists or is generalizable to activities of daily living.5
  • Attention is the ability to focus on a task or object and is necessary for participation in cognitive testing. Focused or selective attention describe one’s ability to focus on a specific aspect of the environment. Sustained attention or vigilance is the length of time one can focus on a task in the setting of distracting stimuli. Divided attention or cognitive flexibility is the ability to shift back and forth between tasks smoothly. As mentioned above, research is ongoing to determine whether cognitive rehabilitation has long-lasting benefits on attention.5
  • Orientation describes a patient’s awareness of their current environment, typically in terms of person, place, time, and situation. Significant alterations in orientation are more common during the immediate post-injury phase. In cases of traumatic brain injury, the time until consistent orientation to these variables, known as post-traumatic amnesia, is a strong predictor of recovery.6
  • Memory is a broad term that encompasses to one’s ability to recall events and information and apply previously learned knowledge or skills to current situations. Various memory impairments are common after brain injury, and can be examined using appropriate tests.7
    • Retrograde amnesia describes loss of memory preceding an injury.
    • Anterograde amnesia describes loss of memory for events after an injury.
    • Registration of information occurs immediately after being provided information. If registration fails, there will be no recall of the information.
    • Semantic memory involves conceptual and factual knowledge.
    • Procedural memory is the ability to learn behaviors and cognitive skills at an automatic, unconscious level.
    • Working memory involves retaining information while concentrating on another task, and then utilizing that information in a functional environment.
    • Remote memory or memory of one’s distant past is typically well-preserved following brain injury.2,7
  • Executive functioning is the ability to engage in problem-solving or task planning from initiation to completion. Executive functioning consists of judgment, reasoning, concept formation, abstraction, initiation, fluency, planning, organization, mental flexibility, and impulse control.2,8
  • Language encompasses fluency, repetition, naming, verbal comprehension, reading, and writing. Language disorders, known as aphasias, can impact other cognitive domains and complicate the interpretation of results obtained from cognitive testing. Some studies suggest that non-language domains such as attention and executive functioning can even impact people with chronic aphasia. Offering choices and using nonverbal means of testing may help determine whether cognitive deficits exist in the setting of aphasia.2,9

Neuropsychological Testing

As previously described, neuropsychological testing assesses cognitive skills and is better suited to detect impairments not easily identified through bedside examination or brief screening tools. Neuropsychological testing ideally includes a thorough diagnostic interview, review of medical records, obtaining a social, developmental, and psychiatric history, and identifying a person’s perceived level of function. Neuropsychological testing typically focuses on several domains, noting there can be overlap with both cognitive and behavioral testing.1

Some of the more commonly tested neuropsychological domains include:

  • Motivation
  • Emotional wellbeing and adjustment
  • Attention and concentration
  • Generalized intelligence and fund of knowledge
  • Executive functioning
  • Language
  • Visuospatial reasoning
  • Psychomotor speed
  • Memory

Results of neuropsychological testing provide information on brain lesion location and correlate results to the person’s symptoms. For example, focal lesions usually target specific cognitive domains whereas diffuse brain injuries have more global impacts on cognition and affect multiple domains. Additionally, visual memory can be impaired in patients with oculomotor dysfunction or occipital lesions, and executive functioning deficits can be found in those with frontal lobe injuries. It is important to consider that a person’s performance on neuropsychological testing should reflect their best effort. Testing may need to be performed over multiple sessions to minimize fatigue which could potentially cause inappropriately poor results. In addition to detecting impairments, neuropsychological testing also provides important information regarding areas of relative strength, which can be utilized to compensate for areas of identified weaknesses. Research has also demonstrated the predictive ability of neuropsychological screening to identify people with mild TBI who are at increased risk for poor rehabilitation outcomes.10 As a result, testing can help direct therapeutic interventions across several disciplines and help providers develop accommodations in school or work environments that enhance successful community reintegration.

Behavioral Domains and Testing

Behavior is a complex manifestation of one’s emotional state, conception of the environment, and understanding of societal norms. Agitation, disinhibition, and confusion are commonly observed during early recovery from brain injury, necessitating a multimodal approach to management that includes but is not limited to environmental and behavioral modification, the judicious use of medications, and constant observation. Structured behavioral assessments are usually accomplished by employing observational tools.11, 12

There are multiple treatment strategies for behavioral impairments related to neurocognitive dysfunction. As an example, extinction of an undesirable or maladaptive behavior occurs when a behavior is performed less frequently coupled with positive reinforcement of more desirable alternative behaviors. In the acute rehabilitation setting, reinforcement strategies may not be possible or convenient. Instead, care teams may implement “delirium precautions” to reassure patients. This includes maintaining a consistent sleep-wake cycle, reducing noxious environmental stimuli, staffing with consistent caretakers, and enforcing calm communication. Staff education and environmental modifications to remove stimuli not well tolerated by the person with brain injury need to be quickly and consistently implemented. If non-pharmacological strategies are ineffective, providers can trial medication changes.11, 12

(Video) Intro to Neuropsychological Assessment

Relevance to Clinical Practice

Formal neuropsychological testing is an important part of defining cognitive strengths and weaknesses following brain injury or disease. It allows for standardization and comparison to those of a similar age and education. The information gathered helps guide the rehabilitation team in optimizing functional recovery, and depending on the tool used, serial testing allows the clinician to formally monitor recovery. When conducted early in the rehabilitation process, neuropsychological testing can help identify factors such as resiliency or emotional disorders that may significantly impact engagement and treatment outcomes. Interventions can then be aimed at building resiliency or addressing psychiatric comorbidities to maximize success.Formal testing has also been shown to potentially offer information on prognosis and future productivity when conducted in the early weeks to months following brain injury.1,13,14

Cognitive assessment

Some individuals are not well suited for formal neuropsychological assessment for various reasons, such as intolerance to lengthy and comprehensive testing batteries. A more concise battery of cognitive tests may be an acceptable alternative while still providing predictive value regarding functional outcome up to one year after traumatic brain injury.Even a simple test of recall of three words following a 24-hour delay has been shown to have predictive value for psychosocial distress and return to productivity following brain injury.15,16

Behavioral assessment

Agitation, aggression, disinhibition, and impulsivity can pose challenges for care providers and for the patient’s loved ones. These behaviors interfere with treatment compliance, meaningful engagement in therapy, and consequently with outcomes. Effective behavioral assessment involves ongoing monitoring of intervention efficacy and collaboration among rehabilitation team members. It also helps family members identify triggers of problematic behaviors which can guide feedback and education on how to respond effectively.11, 12

Evidence for specific standardized tests

Neurocognitive disorders result from multiple etiologies and disease processes.There is a growing body of research comparing the utility of various standardized tests to detect deficits and assess function in people with a variety of brain injuries.The O-Log and Cog-Log tests are brief bedside instruments that have demonstrated utility as serial tools to track cognitive recovery or decline in the neurologic rehabilitation setting. They are both reliable measures to assess orientation and track recovery from post-traumatic amnesia.17

Additionally, numerous studies have compared the Mini-Mental State Examination (MMSE) with the Montreal Cognitive Assessment (MoCA) in assessing the neurologic rehabilitation population.While results have varied, some studies suggest the MoCA is more effective than the MMSE in identifying cognitive deficits in the first month post-stroke. However, other studies have found them roughly equivalent in the same population 3-6 months post-stroke. Following subarachnoid hemorrhage, the MoCA was found to be more sensitive in detecting cognitive impairment and to more strongly correlated with lengthier neurocognitive testing findings than the MMSE. In terms of predicting functional outcomes, the portion of the MoCA specifically assessing the visuo-executive domain has also been shown to have greater association with functional outcomes post-stroke than the total scores of either the MMSE or MoCA.18-20

(Video) What can I expect when going for my neuropsychological evaluation?

Additional Considerations

Concomitant disorders can create challenges for neuropsychological testing.For example, in people with stroke and early dementia, it may be difficult to decipher which disease process is contributing to a specific deficit.Please refer to the “Dementia and Delirium” chapter for more details on testing for these conditions. Pediatric brain injury poses unique challenges because cerebral function at this age is in a rapid phase of change. Many factors play a role in cognitive development, such as biological age, developmental age, and environment.Children injured at an early age may have more challenges acquiring new cognitive skills, in spite of neuroplasticity. Therefore, it is important that tests are appropriate for biological as well as developmental age and that interpretation of results is based on age-matched norms.Repeat testing is warranted at times of transition, particularly when there is an increase in cognitive expectation in school and during early teenage years when abstract reasoning and executive functions normally develop.21

Cutting Edge/ Unique Concepts/ Emerging Issues

Computerized neuropsychological tests are widely available to assess cognitive skills in multiple disease states and are increasingly being used to assess cognition post-concussion. For example, ImPACT, Concussion Sentinel, and Headminder Concussion Resolution Index tests are just some of the instruments available to detect changes in cognition following a concussion if pre-injury test results are available for comparison. These can be administered anywhere there is access to a computer, mouse, and a quiet testing environment. Furthermore, research investigating the validity of computerized (CogState Brief Battery) vs paper-pencil (MOCA) cognitive assessments revealed the CogState Brief Battery is a valid alternative for clinicians who wish to measure cognitive skills following acute ischemic stroke.22 Lastly, in the field of primary care, there has been positive experiences with the Computer Assessment of Mild Cognitive Impairment (CAMCI) in identifying early signs of dementia. Overall, these results suggest primary care providers can consider computerized cognitive testing in their offices for their patients.23

Questions of validity have been raised related to potential inadequate effort provided during baseline testing, the environment in which the test is administered, and other confounding factors.24 The addition of validity tests have been used to improve detection of insufficient effort.25 Overall, the advantages of computerized testing include lower cost, easier access to both baseline and subsequent testing, standardized administration, and less learning effect than traditional pen-and-paper testing. Disadvantages include decreased breadth of scope of cognition assessed, inability to tailor the testing environment based on performance, possible validity concerns, and the lack of information regarding the process a testing subject goes through in reaching an answer. Although promising, computerized testing provides useful but incomplete information about recovery from concussion, thus decisions regarding return to participation in sports needs to be multifactorial.26,27

Lastly, teleconferencing is another emerging concept for neuropsychological and cognitive testing. Evidence suggests neuropsychological testing by video teleconference is a feasible and reliable means of conducting assessment with populations that would otherwise lack access due to remote location or difficulties with traveling. Implemented widely during the Covid-19 pandemic, teleconferencing has changed the practice of medicine. However, while there is evidence to support virtual cognitive assessments, there are gaps in diagnostic certainty. A systematic review of 121 studies revealed only two demonstrated good reliability compared with in-person cognitive assessment of dementia. With time, the methodology and test accuracy will hopefully improve.28,29

Gaps in Knowledge/ Evidence Base

Limited evidence exists regarding the accuracy of the MMSE and other standardized cognitive assessment tests in non-white ethnic populations, with some indication they may underestimate cognitive abilities in these groups.30 Future studies are also needed to further clarify the utility of the various standardized cognitive tests in predicting functional outcomes as well as correlating performance on brief assessments with formal neuropsychological batteries following brain injury.While neuropsychological testing can supplement medical evaluations after brain injury, there are rarely pre-morbid results available to serve for comparison. Most deficits related to brain injury are detected only when there is decreased performance based on estimated pre-morbid abilities or in selected areas when compared with others.

(Video) What Is Neuropsychological (Neurocognitive) Testing?

In addition, testing gives a snapshot of current cognitive functioning, but it does not show cause, requiring a synthesis of medical evaluation with the results of neuropsychological testing to get a true picture of current cognitive functioning. Lastly, the role of computerized neuropsychological testing in concussion management is still being defined, and further research is needed to determine the efficacy of teleconferencing and virtual cognitive testing.

References

  1. Schaefer LA, Thakur T, Meager MR. Neuropsychological Assessment. 2021 May 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 30020682.
  2. Harvey PD. Domains of cognition and their assessment. Dialogues Clin Neurosci. 2019;21(3):227-237. doi:10.31887/DCNS.2019.21.3/pharvey
  3. Pastorek NJ, Proto DA, Sander AM, Clark AN. Psychological assessment and intervention in rehabilitation. In: Cifu DX, Kaelin DL, Kowalske KJ, Lew HL, Miller MA, Ragnarsson KT, Worsowicz GM, eds. Braddom’s Physical Medicine and Rehabilitation. 5thPhiladelphia, PA: Elsevier; 2016: 71-83.
  4. Zucchella C, Federico A, Martini A, Tinazzi M, Bartolo M, Tamburin S. Neuropsychological testing. Pract Neurol. 2018 Jun;18(3):227-237. doi: 10.1136/practneurol-2017-001743. Epub 2018 Feb 22. PMID: 29472384.
  5. Loetscher T, Potter KJ, Wong D, das Nair R. Cognitive rehabilitation for attention deficits following stroke. Cochrane Database Syst Rev. 2019 Nov 10;2019(11):CD002842. doi: 10.1002/14651858.CD002842.pub3. PMID: 31706263; PMCID: PMC6953353.
  6. Ponsford JL, Spitz G, McKenzie D. Using Post-Traumatic Amnesia To Predict Outcome after Traumatic Brain Injury. J Neurotrauma. 2016 Jun 1;33(11):997-1004. doi: 10.1089/neu.2015.4025. Epub 2015 Oct 13. PMID: 26234939.
  7. Budson AE, Price BH. Memory dysfunction. New England Journal of Medicine. 2005; 352: 692-699.
  8. Rabinovici GD, Stephens ML, Possin KL. Executive dysfunction. Continuum (Minneap Minn). 2015 Jun;21(3 Behavioral Neurology and Neuropsychiatry):646-59. doi: 10.1212/01.CON.0000466658.05156.54. PMID: 26039846; PMCID: PMC4455841.
  9. Schumacher R, Halai AD, Lambon Ralph MA. Assessing and mapping language, attention and executive multidimensional deficits in stroke aphasia. Brain. 2019 Oct 1;142(10):3202-3216. doi: 10.1093/brain/awz258. PMID: 31504247; PMCID: PMC6794940.
  10. Walker WC, Stromberg KA, Marwitz JH, et al. Predicting Long-Term Global Outcome after Traumatic Brain Injury: Development of a Practical Prognostic Tool Using the Traumatic Brain Injury Model Systems National Database [published correction appears in J Neurotrauma. 2020 Mar 15;37(6):905]. J Neurotrauma. 2018;35(14):1587-1595. doi:10.1089/neu.2017.5359
  11. McCauley SR, Wilde EA, Miller ER, Frisby ML, Garza HM, Varghese R, Levin HS, Robertson CS, McCarthy JJ. Preinjury Resilience and Mood as Predictors of Early Outcome Following Mild Traumatic Brain Injury. Journal of Neurotrauma. 2013; 30: 642-652.
  12. Karol RL. Principles of behavioral analysis and modification. In: Zasler ND, Katz DI, Zafonte RD, eds. Brain Injury Medicine, Principles and Practice. 1st New York, NY: Demos; 2007:818.
  13. Hüsser A, Fourdain S, Gallagher A. Neuropsychologic assessment. Handb Clin Neurol. 2020;174:239-249. doi: 10.1016/B978-0-444-64148-9.00017-X. PMID: 32977881.
  14. Sherer M, Novack TA, Sander AM, et al. Neuropsychological assessment and employment outcome after traumatic brain injury: a review. The Clinical Neuropsychologist. 2002; 16(2): 157-178
  15. Hanks RA, Millis SR, Ricker JH, et al. The predictive validity of a brief inpatient neuropsychologic battery for persons with traumatic brain injury. Archives of Physical Medicine and Rehabilitation. 2008; 89: 950-957
  16. Dawson DR, Levine B, Schwartz ML, Stuss DT. Acute predictors of real-world outcomes following traumatic brain injury: a prospective study. Brain Inj. 2004 Mar;18(3):221-38. doi: 10.1080/02699050310001617406. PMID: 14726283.
  17. Penna S, and Novack TA. Further validation of the orientation and cognitive logs: their relationship to the mini-mental state examination. Archives of Physical Medicine and Rehabilitation, 2007; 88: 1360-1361
  18. Van Heugten, CM, Walton L, Hentschel U. Can we forget the Mini-Mental State Examination? A systematic review of the validity of cognitive screening instruments within one month after stroke. Clinical Rehabilitation. 2015; 29(7): 694-704.
  19. Schwizer, TA, Al-Khindi T, Macdonald RL. Mini-Mental State Examination versus Montreal Cognitive Assessment: Rapid assessment tools for cognitive and functional outcome after aneurysm subarachnoid hemorrhage. Journal of the Neurological Sciences. 2012; 316: 137-140.
  20. Toglia J, Fitzgerald KA, O’Dell MW, Mastrogiovanni AR, Lin CD. The Mini-Mental State Examination and Montreal Cognitive Assessment in Persons with mild subacute stroke: Relationship to functional outcome. Archives of Physical Medicine and Rehabilitation. 2011; 92: 792-798.
  21. Hüsser A, Fourdain S, Gallagher A. Neuropsychologic assessment. Handb Clin Neurol. 2020;174:239-249. doi: 10.1016/B978-0-444-64148-9.00017-X. PMID: 32977881.
  22. Gagnon MM, Laforce R Jr. Computerized vs. Paper-Pencil Assessment of Cognitive Change following Acute Ischemic Stroke. J Neurol Disord. 2016 Dec 1;4(8):317. doi: 10.4172/2329-6895.1000317. PMID: 28649579; PMCID: PMC5482710.
  23. Millett G, Naglie G, Upshur R, Jaakkimainen L, Charles J, Tierney MC. Computerized Cognitive Testing in Primary Care: A Qualitative Study. Alzheimer Dis Assoc Disord. 2018 Apr-Jun;32(2):114-119. doi: 10.1097/WAD.0000000000000219. PMID: 29140858.
  24. Abeare CA, Messa I, Zuccato BG, Merker B, Erdodi L. Prevalence of Invalid Performance on Baseline Testing for Sport-Related Concussion by Age and Validity Indicator. JAMA Neurol. 2018;75(6):697–703. doi:10.1001/jamaneurol.2018.0031
  25. Erdodi L, Korcsog K, Considine C, Casey J, Scoboria A, Abeare C. Introducing the ImPACT-5: An Empirically Derived Multivariate Validity Composite. J Head Trauma Rehabil. 2021 Mar-Apr 01;36(2):103-113. doi: 10.1097/HTR.0000000000000576. PMID: 32472832.
  26. Broglio SP, Ferrara MS, Maccioccci SN, Baumgartner TA, Elliot R. Test-retest reliability of computerized concussion assessment programs. Journal of Athletic Training. 2007; 42: 509-514.
  27. Moser RS, Iverson GL, Echemendia RJ, et al. Neuropsychological evaluation in the diagnosis and management of sports-related concussion. Archives of Clinical Neuropsychology. 2007; 22: 909-916.
  28. Wadsworth, HE, Galusha-Glasscock JM, Womack KB, Quiceno M, Weiner MF, Hynan LS, Shore J, Cullum CM. Remote neuropsychological assessment in rural American Indians with and without cognitive impairment. Archives of Clinical Neuropsychology. 2016; 31: 420-425.
  29. Watt JA, Lane NE, Veroniki AA, Vyas MV, Williams C, Ramkissoon N, Thompson Y, Tricco AC, Straus SE, Goodarzi Z. Diagnostic accuracy of virtual cognitive assessment and testing: Systematic review and meta-analysis. J Am Geriatr Soc. 2021 Jun;69(6):1429-1440. doi: 10.1111/jgs.17190. Epub 2021 May 4. PMID: 33948937.
  30. Khan, F and Tandros G. Complexity in cognitive assessment of elderly British minority ethnic groups: Cultural perspective. Dementia. 2014; 13(4): 467-482.

Original Version of the Topic

Brian T. Kucer, MD, Todd Lewis, PhD. Cognitive / behavioral / neuropsychological testing. 9/20/2013

Previous Revision(s) of the Topic

Kimberly Hartman, MD, Allison Blough, MD. Cognitive / behavioral / neuropsychological testing. 7/3/2018

Author Disclosure

Steven Flanagan, MD
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Jason Kessler, MD
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(Video) Montreal Cognitive Assessment (MoCA): Administration

Julia Tsinberg, MD
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Danni Lu, MD
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FAQs

How accurate are cognitive tests? ›

Conclusions— Commonly used cognitive screening tools have similar accuracy for detection of dementia/multidomain impairment with no clearly superior test and no evidence that screening tools with longer administration times perform better.

What is the biggest issue with neuropsychological tests? ›

The biggest problem is that neuropsychological assessments require doctors to make inferences, or educated guesses, about what is happening in the brain and the mind.

What is the most widely used cognitive assessment tool? ›

Mini-Mental State Examination (MMSE)

This test is currently the most widely used cognitive assessment tool.

What does cognitive testing determine? ›

Cognitive ability tests assess abilities involved in thinking (e.g., reasoning, perception, memory, verbal and mathematical ability, and problem solving). Such tests pose questions designed to estimate applicants' potential to use mental processes to solve work-related problems or to acquire new job knowledge.

What is a good score on a cognitive test? ›

25-30 points: normal cognition. 21-24 points: mild dementia. 10-20 points: moderate dementia.

Can you fail a cognitive test? ›

If your test results were not normal, it means you have some problem with memory or other mental function. But it won't diagnose the cause. Your health care provider may need to do more tests to find out the reason. Some types of cognitive impairment are caused by treatable medical conditions.

What happens if you fail a neuropsychological test? ›

If you fail the validity or effort testing, the neuropsychologist and the insurance company may deem some or all of the results “invalid.” Failure to pass validity testing can also lead to questions of your credibility.

What are the limitations of neuropsychological testing? ›

An impressive number and variety of neuropsychological tests are in use but some have one or more deficiencies: problems with reliability or validity, inadequate normative data, lack of alternative forms, take too long to administer, lack ecological validity, or have become too familiar to the public.

Do neuropsychologists diagnose mental illness? ›

A neuropsychological evaluation can assess an existing condition to gauge its stage of development or provide a new diagnosis. It is often used to help those with physical disorders, including TBI or stroke. A neuropsych can also identify mental health disorders, such as bipolar disorder.

What is the 30 question cognitive test? ›

he Mini Mental State Examination (MMSE) or Folstein test is a 30-point questionnaire that is used extensively in clinical and research settings to measure cognitive impairment. It is commonly used in medicine and allied health to screen for dementia.

How do you know if you have cognitive decline? ›

Signs of cognitive decline
  1. Forgetting appointments and dates.
  2. Forgetting recent conversations and events.
  3. Feeling increasingly overwhelmed by making decisions and plans.
  4. Having a hard time understanding directions or instructions.
  5. Losing your sense of direction.
  6. Losing the ability to organize tasks.
  7. Becoming more impulsive.
6 Sept 2020

What questions are asked on a cognitive test? ›

The questions featured in these tests tend to include verbal analogies, arithmetic calculations, spatial relations number series puzzles, comprehension, and reading comprehension. Cognitive ability tests are notoriously tricky, as they often come with harsh time-limits and specific question types.

What does a low cognitive score mean? ›

What do poor and good scores on a cognitive test mean? Poor (low) scores provide more information than good (high) scores. A very low score usually means there's some brain impairment. But a good score doesn't necessarily mean there's no brain impairment. There still could be brain functioning issues.

Is a cognitive test an IQ test? ›

Cognitive Test. The primary difference between the IQ test and the cognitive test is its purpose. The cognitive test is designed to gauge a test taker's knowledge on a particular subject. The IQ test sets out to assign a number or rank to the individual's overall intelligence.

Do neurologists do cognitive testing? ›

At Progressive Neurology, we perform one of the standardized computer-based test, called MindStreams®. The program offers several various tests that assess different cognitive functions. The physician usually selects which test is appropriate based on the patient's condition.

How do you pass a cognitive ability test? ›

10 Ways To Prepare For Cognitive Ability Tests
  1. Practice with a range of tests. ...
  2. Make mistakes, and learn from them. ...
  3. Practice under exam conditions. ...
  4. Focus on your weaknesses. ...
  5. Create a study plan. ...
  6. Answer all the questions. ...
  7. Check your technology and extras. ...
  8. Learn which test you are taking.
27 Oct 2021

What does a cognitive score of 12 mean? ›

The following ranges may be used to grade severity: 18-25 = mild cognitive impairment, 10-17= moderate cognitive impairment and less than 10= severe cognitive impairment.

What is considered mild cognitive impairment? ›

Mild cognitive impairment (MCI) is the stage between the expected cognitive decline of normal aging and the more serious decline of dementia. It's characterized by problems with memory, language, thinking or judgment.

What are the 4 levels of cognitive impairment? ›

The four cognitive severity stages spanning normal aging to dementia are:
  • No Cognitive Impairment (NCI)
  • Subjective Cognitive Impairment (SCI)
  • Mild Cognitive Impairment (MCI)
  • Dementia.

What is the 5 word memory test? ›

The 5-Word test is a bedside memory test with free and cued selective recollection. Here, we evaluated its reliability Belgian French speakers. Five groups were studied : normal subjects, depressive patients, patients with AD, patients with vascular dementia and 47 patients for a validation of a logistic model.

Can anxiety cause dementia like symptoms? ›

The symptoms of severe anxiety can be like those of dementia. They include restlessness and difficulties sleeping and concentrating. For more information, see our section: Conditions that may be mistaken for dementia.

How accurate is Neuropsych testing? ›

What is neuropsychological testing? During the past decade neuropsychological testing has become a very sophisticated science. Currently available tests are highly accurate, standardized instruments with predictive accuracy in the 80-95% range.

How accurate is a neuropsychological evaluation? ›

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.

What does a Neuropsych evaluation tell you? ›

A neuropsychological evaluation is a test to measure how well a person's brain is working. The abilities tested include reading, language usage, attention, learning, processing speed, reasoning, remembering, problem-solving, mood and personality and more.

What are neuropsychological tests examples? ›

List of neuropsychological tests
  • Ammons Quick Test.
  • Beck Depression Inventory, Anxiety Inventory, and Hopelessness Scale.
  • Bender Visual Motor Gestalt (BVMG) Test.
  • Boston Diagnostic Aphasia Examination.
  • Boston Naming Test.
  • California Verbal Learning Test.
  • CANTAB (Cambridge Neuropsychological Test Automated Battery)

What is a flexible battery in neuropsychological assessment? ›

A flexible battery involves the selection and administration of an array of tests (i.e., the “battery”) that are based on the neuropsychologist's perception of the patient's presenting complaints. There is no one flexible battery shared by all neuropsychologists.

What is the fixed battery approach to neuropsychological assessment? ›

A fixed battery is a set of neuropsychological tests defined within a structure or conceptual framework. The battery of tests is given as a whole unit. The battery of tests usually has an understood and defined relationship of test scores and a standardized interpretation approach.

How often should neuropsychological testing be done? ›

How often should evaluations be repeated? In general, evaluations should be repeated every 2 to 3 years to provide an update on the individual's progress in treatment and determine whether treatment should be modified.

What kind of questions does a neuropsychologist ask? ›

Your neuropsychologist will ask you a number of questions about your current mood to better understand how your feelings and emotions may be affecting your scores on measures of thinking and to see if counseling might be a helpful next step. 5. Who will I meet with during my appointment?

Can a neuropsychologist diagnose depression? ›

Neuropsychological assessments are an invaluable diagnostic tool for psychiatric, developmental, and neurocognitive conditions like ADHD, depression, autism, and dementia.

What does a MoCA score of 22 mean? ›

Scores on the MoCA range from zero to 30. A score of 26 and higher is considered normal. In the initial study data, normal controls had an average score of 27.4. People with mild cognitive impairment (MCI) scored an average of 22.1. People with Alzheimer's disease had an average score of 16.2.

What does a MoCA score of 17 mean? ›

A MoCA score of 26 or higher is generally considered normal, while a score of 18 to 25 can indicate mild cognitive impairment, and 10 to 17 can indicate moderate impairment. A score of less than 10 indicates severe impairment.

What does a MoCA score of 11 mean? ›

A score of 19 to 25 indicates mild cognitive impairment. Scores of between 11 and 21 suggest mild Alzheimer's disease.

What is the most common cognitive impairment? ›

Alzheimer's disease, one of the most common cognitive disorders, affects approximately 5.1 million Americans.

How long can a person live with mild cognitive impairment? ›

Life expectancy for individuals with MCI

The life expectancy for participants with MCI ranged from 21.3 years (95% CI: 19.0–23.6) at age 60 to 2.6 years (1.6–3.6) at age 95.

What triggers cognitive decline? ›

While age is the primary risk factor for cognitive impairment, other risk factors include family history, education level, brain injury, exposure to pesticides or toxins, physical inactivity, and chronic conditions such as Parkinson's disease, heart disease and stroke, and diabetes.

How do you answer cognitive assessment questions? ›

How to Pass Cognitive Assessment Test: Questions and Answers

What are 4 common cognitive assessment tools? ›

Functional Activities Questionnaire. IQCODE. Lawton-Brody IADL. Mini MoCA Self Screen.

How many questions are on a cognitive test? ›

Fast Facts: The CCAT® has 50 questions. You'll have 15 minutes to answer as many questions as you can. There are 3 different kinds of questions: verbal, math and logic, and spatial reasoning.

What is the average cognitive score? ›

What is the average cognitive score? The average cognitive Scaled Score is 250, which translates to a raw score of 20. This average score was established during assessment development, using what's called a “Reference Group.” That group, on average, scored 19.8 points out of a possible 50, which translates to 250.

Is cognitive ability the same as IQ? ›

Intelligence refers to one's cognitive abilities, including memory, comprehension, understanding, reasoning, and abstract thought. Intelligence is not quite the same as IQ, although people use the terms interchangeably. IQ, which stands for "Intelligence Quotient," is a score determined by an IQ test.

What is a good aptitude score? ›

If a perfect aptitude test score is 100% or 100 points, and your score is 80% or above, it is considered a good score. A minimum acceptable score is considered to be from 70% to 80%.

Are cognitive ability tests reliable? ›

Are cognitive ability tests reliable? Cognitive ability tests are widely considered to be reliable in understanding how well a candidate will perform on the job. They are assessing corresponding skills and can predict job performance of candidates with a high degree of reliability.

What is cognitive testing for ADHD? ›

Cognitive testing in ADHD is used to identify a variety of symptoms and deficits, including selective attention, poor working memory, altered time perception, difficulties in maintaining attention and impulsive behavior.

What are the 8 cognitive skills? ›

The 8 Core Cognitive Capacities
  • Sustained Attention.
  • Response Inhibition.
  • Speed of Information Processing.
  • Cognitive Flexibility.
  • Multiple Simultaneous Attention.
  • Working Memory.
  • Category Formation.
  • Pattern Recognition.
26 Nov 2020

What is a good score on a cognitive test? ›

25-30 points: normal cognition. 21-24 points: mild dementia. 10-20 points: moderate dementia.

What is the most widely used cognitive assessment tool? ›

Mini-Mental State Examination (MMSE)

This test is currently the most widely used cognitive assessment tool.

Can a neuropsychologist diagnose dementia? ›

Abstract. Neuropsychology contributes greatly to the diagnosis of dementia. Cognitive deficits can be detected several years before the clinical diagnosis of dementia.

Is a cognitive test an IQ test? ›

Cognitive Test. The primary difference between the IQ test and the cognitive test is its purpose. The cognitive test is designed to gauge a test taker's knowledge on a particular subject. The IQ test sets out to assign a number or rank to the individual's overall intelligence.

Can anxiety cause dementia like symptoms? ›

The symptoms of severe anxiety can be like those of dementia. They include restlessness and difficulties sleeping and concentrating. For more information, see our section: Conditions that may be mistaken for dementia.

What does a low cognitive score mean? ›

What do poor and good scores on a cognitive test mean? Poor (low) scores provide more information than good (high) scores. A very low score usually means there's some brain impairment. But a good score doesn't necessarily mean there's no brain impairment. There still could be brain functioning issues.

How do I know if I have cognitive impairment? ›

You forget things more often. You forget important events such as appointments or social engagements. You lose your train of thought or the thread of conversations, books or movies. You feel increasingly overwhelmed by making decisions, planning steps to accomplish a task or understanding instructions.

What is the 30 question cognitive test? ›

he Mini Mental State Examination (MMSE) or Folstein test is a 30-point questionnaire that is used extensively in clinical and research settings to measure cognitive impairment. It is commonly used in medicine and allied health to screen for dementia.

What is cognitive testing for ADHD? ›

Cognitive testing in ADHD is used to identify a variety of symptoms and deficits, including selective attention, poor working memory, altered time perception, difficulties in maintaining attention and impulsive behavior.

What are the 8 cognitive skills? ›

The 8 Core Cognitive Capacities
  • Sustained Attention.
  • Response Inhibition.
  • Speed of Information Processing.
  • Cognitive Flexibility.
  • Multiple Simultaneous Attention.
  • Working Memory.
  • Category Formation.
  • Pattern Recognition.
26 Nov 2020

What disorder is most often misdiagnosed as dementia? ›

Lewy body dementia (LBD) is the most misdiagnosed form of dementia, taking on average more than 18 months and three doctors to receive a correct diagnosis.

What 3 illness can have similar symptoms to dementia but is not? ›

Thyroid, kidney, liver, heart and lung problems, urinary and chest infections and strokes are among the many medical conditions that can produce dementia-like symptoms.

What reversible condition could be mistaken for dementia? ›

Depression. Depression, especially major depressive disorder, can cause confusion, lethargy and even memory problems.

What is the average cognitive score? ›

What is the average cognitive score? The average cognitive Scaled Score is 250, which translates to a raw score of 20. This average score was established during assessment development, using what's called a “Reference Group.” That group, on average, scored 19.8 points out of a possible 50, which translates to 250.

How do you pass a cognitive ability test? ›

10 Ways To Prepare For Cognitive Ability Tests
  1. Practice with a range of tests. ...
  2. Make mistakes, and learn from them. ...
  3. Practice under exam conditions. ...
  4. Focus on your weaknesses. ...
  5. Create a study plan. ...
  6. Answer all the questions. ...
  7. Check your technology and extras. ...
  8. Learn which test you are taking.
27 Oct 2021

How can I improve my cognitive score? ›

Top 10 Tips To Pass Your Cognitive Ability Test
  1. Know which publisher is used. ...
  2. Don't get stuck. ...
  3. Practice different reasoning tests to build your confidence. ...
  4. Sharpen your numeracy. ...
  5. Get comfortable with spotting patterns. ...
  6. Repeat hard questions. ...
  7. Have a strategy. ...
  8. Skip or guess?
22 Jul 2021

What is the most common cognitive impairment? ›

Alzheimer's disease, one of the most common cognitive disorders, affects approximately 5.1 million Americans.

What are the 4 levels of cognitive impairment? ›

The four cognitive severity stages spanning normal aging to dementia are:
  • No Cognitive Impairment (NCI)
  • Subjective Cognitive Impairment (SCI)
  • Mild Cognitive Impairment (MCI)
  • Dementia.

How long can a person live with mild cognitive impairment? ›

Life expectancy for individuals with MCI

The life expectancy for participants with MCI ranged from 21.3 years (95% CI: 19.0–23.6) at age 60 to 2.6 years (1.6–3.6) at age 95.

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