The Neuropsychology Referral and Answering the Referral Question



Neuropsychological evaluations provide a wealth of information to the referring clinician and patient, offering a host of answers to important diagnostic and treatment-related questions. The range of questions a neuropsychological evaluation can answer are broad, but generally fall under six broad categories (e.g., Lezak et al., Neuropsychological assessment, 4th edn. Oxford University Press, New York, 2004):
  1. 1.
    Diagnoses: Identifying the existence of brain dysfunction [and differentiating brain dysfunction from non-lesional psychiatric diagnosis or otherwise reversible causes of cognitive dysfunction (e.g., depression)].
    • Example: Distinguishing dementia from depression or identifying the presence of mild cognitive impairment (MCI).

  2. 2.
    Describing neuropsychological status: Detailing how a disease or lesion(s) is expressed from cognitive, behavioral and affective perspectives.
    • Example: Describing how a traumatic brain injury (TBI) has affected a patient’s cognitive and emotional functioning, including the severity and extent of neuropsychological deficits.

  3. 3.
    Treatment planning, treatment facility placement or evaluating for resource utilization.
    • Example: Identifying if a patient meets inclusion/exclusion criteria for placement in a rehabilitation facility. An increasing emphasis within neuropsychology is predicting neuropsychological outcome from proposed medical treatment (e.g., temporal lobectomy for intractable epilepsy or DBS for Parkinson’s disease).

  4. 4.
    Identifying the effects of treatment (often includes measuring change in function over time).
    • Example: Evaluation of effects of a speech/language therapy program for a patient.

  5. 5.
    Research evaluation tool: Identifying basic and central nervous system processes and/or the effects of other agents on the central nervous system.
    • Example: Evaluating the neuropsychological effects of a medication to treat epilepsy in a randomized controlled trial.

  6. 6.

    Forensic applications: Neuropsychological evaluations are increasingly being used to assist fact-finding bodies to determine if, or the extent to which, an alleged event resulted in damage to the CNS. Another use is to assist courts in evaluating if a defendant is capable of managing his/her affairs independently. Also used forensically to evaluate mental state/competence/decision making capacity of individuals, particularly those alleged to be involved in ­criminal activities



Mild Cognitive Impairment Neuropsychological Assessment Brain Dysfunction Neuropsychological Functioning Comparison Standard 
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© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.University of South Florida College of MedicineTampaUSA

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