The Neuropsychology Referral and Answering the Referral Question

  • Mike R. Schoenberg
  • James G. Scott


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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  1. Achiron, A., Polliack, M., Rao, S. M., Barak, Y., Lavie, M., Appelboim, N., et al. (2005). Cognitive patterns and progression in multiple sclerosis: Construction and validation of percentile curves. Journal of Neurology, Neurosurgery, and Psychiatry, 76, 744–749.PubMedCrossRefGoogle Scholar
  2. American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Text Revision (DSM-IV-TR). Washington DC, Author.Google Scholar
  3. Busch, R. M., Frazier, T. W., Haggerty, K. A., & Kubu, C. S. (2005). Utility of the Boston Naming Test in predicting ultimate side of surgery in patients with medically intractable temporal lobe epilepsy. Epilepsia, 46, 1773–1779.PubMedCrossRefGoogle Scholar
  4. Chelune, G. J. (1995). Hippocampal adequacy versus functional reserve: Predicting memory functions following temporal lobectomy. Archives of Clinical Neuropsychology, 10, 413–432.PubMedGoogle Scholar
  5. Chelune, G. J. (2010). Evidenced-based research and practice in clinical neuropsychology. The Clinical Neuropsychologist, 24, 454–467.Google Scholar
  6. Chelune, G. J., & Najm, I. (2001). Risk factors associated with postsurgical decrements in memory. In H. O. Luders & Y. Comair (Eds.), Epilepsy surgery (2nd ed., pp. 497–504). New York: Lippincott Williams & Wilkins.Google Scholar
  7. Chelune, G. J., & Stone, L. (2005). Risk of processing speed deficits among patients with relapsing and remitting and secondary progressive multiple sclerosis. Journal of Clinical and Experimental Neuropsychology, 11, 52.Google Scholar
  8. Drane, D. L., Lee, G. P., Cech, H., Huthwaite, J. S., Ojemann, G. A., Ojemann, J. G., et al. (2006). Structured cueing on a semantic fluency task differentiates patients with temporal versus frontal lobe seizure onset. Epilepsy and Behavior, 9, 339–344.PubMedCrossRefGoogle Scholar
  9. Dujardin, K., Defbvre, L., Duhamel, A., Lecouffe, P., Rogelet, P., Steinling, M., et al. (2004). Cognitive and SPECT characteristics predict progression of parkinson’s disease in newly diagnosed patients. Journal of Neurology, 251, 1432–1459.CrossRefGoogle Scholar
  10. Fleisher, A. S., Sun, S., Taylor, C., Ward, C. P., Gamst, A. C., Petersen, R. C., et al. (2008). Volumetric MRI vs clinical predictors of Alzheimer disease in mild cognitive impairment. Neurology, 70, 191–199.PubMedCrossRefGoogle Scholar
  11. Heilman, K. M., & Valenstein, E. (2003). Clinical Neuropsychology(4th ed.). New York: Oxford University Press.Google Scholar
  12. Hermann, B., Davies, K., Foley, K., & Bell, B. (1999). Visual confrontation naming outcome after standard left anterior temporal lobectomy with sparing versus resection of the superior temporal gyrus: A randomized prospective clinical trial. Epilepsia, 40(8), 1070–1076.PubMedCrossRefGoogle Scholar
  13. Individuals with Disabilities Act (IDEA) (1990). Pub. L. No 101–336, S2, 104 Stat. 328.Google Scholar
  14. Individuals with Disabilities Act (IDEA) (2004). Pub. L. No 108–446, S2, 647 Stat. 118.Google Scholar
  15. Lezak, M. D., Howieson, D. B., & Loring, D. W. (2004). Neuropsychological assessment (4th ed.). New York: Oxford University Press.Google Scholar
  16. Lineweaver, T. T., Morris, H. H., Naugle, R. I., Najm, I. M., Diehl, B., & Bingaman, W. (2006). Evaluating the contributions of state-of-the-art assessment techniques to predicting memory outcome after unilateral anterior temporal lobectomy. Epilepsia, 47(11), 1895–1903.PubMedCrossRefGoogle Scholar
  17. Mesulam, M. (2000). Principals of behavioral and cognitive neurology (2nd ed.). New York: Oxford University Press.PubMedCrossRefGoogle Scholar
  18. Ponsford, J., Draper, K., & Schonberger, M. (2008). Functional outcome 10 years after traumatic brain injury: Its relationship with demographic, injury severity, and cognitive and emotional status. Journal of the International Neuropsychological Society, 14, 233–242.Google Scholar
  19. Ropper, A., & Samuels, M. (2009). Adams and victor’s principles of neurology (9th ed.). NY: McGraw Hill.Google Scholar
  20. Sawrie, S. M., Martin, R. C., Gilliam, F. G., Roth, D. L., Faught, E., & Kuzniecyk, R. (1999). Contribution of neuropsychological data to the prediction of temporal lobe epilepsy surgery outcome. Epilepsia, 39, 319–325.CrossRefGoogle Scholar
  21. Seidenberg, M., Pulsipher, D. T., & Hermann, B. (2007). Cognitive progression in epilepsy. Neuropsychology Review, 17(4), 445–454.PubMedCrossRefGoogle Scholar
  22. Sherer, M., Novack, T. A., Sander, A. M., Struchen, M. A., Alderson, A., & Thompson, R. N. (2002). Neuropsychological assessment and employment outcome after traumatic brain injury: A review. The Clinical Neuropsychologist, 16, 157–178.PubMedCrossRefGoogle Scholar
  23. Stroup, E., Langfitt, J., Berg, M., et al. (2003). Predicting verbal memory decline following anterior temporal lobectomy (ATL). Neurology, 60, 1266–1273.Google Scholar
  24. Whyte, J., Cifu, D., Dikmen, S., & Temkin, N. (2001). Prediction of functional outcomes after traumatic brain injury: A comparison of 2 measures of duration of unconsciousness. Archives of Physical Medicine and Rehabilitation, 82, 1355–1359.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.University of South Florida College of MedicineTampaUSA

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