PROCESS OF NEUROPSYCHOLOGICAL EVALUATION:
1. Doctor's Order
Neuropsychological evaluation typically begins with a physician's order, although this is not absolutely required, other than for purposes of insurance reimbursement.
If you are considering a neuropsychological evaluation, you may want to discuss these concerns with a trusted physician. This helps to keep that provider informed of any concerns you may have, and there may be some general medical work-up that may help to address any underlying medical conditions that may be contributing to symptoms (e.g. thyroid disorder may contribute to fatigue or cognitive symptoms). Another reason would be that your physician can write an order for neuropsychological evaluation, which is important if you want to seek reimbursement from your health insurance (i.e. most insurance companies will require a doctor's order for this).
Some doctors are not as familiar with these types of evaluations, so you may need to explain why you are seeking one (e.g. “We have wondered if Dad may be struggling with early dementia” or "I just don't know if I'm ready to go back to work since my stroke", etc.). If meeting with a physician is not an option in your situation, or if your doctor is not familiar with this type of evaluation, you do not absolutely need a doctor’s order, and you can be self-referred, or request an evaluation for a family member.
If at any time you are unsure about whether or not an evaluation is appropriate for your situation, you can call our offices and request a brief phone consultation to answer any questions.
2. Schedule an appointment:
Next, an appointment will be scheduled.
If you are ready to schedule an appointment, and you would like to see insurance reimbursement for this, please see our insurance reimbursement page.
Once you are ready to schedule the appointment, the next step would be to call our offices to request an appointment.
Once the office is contacted, some preliminary details will be gathered and reviewed by the neuropsychologist, and then an appointment will be offered.
3. Fill out some paperwork.
Some paperwork will be required prior to the appointment.
You will receive a packet in the mail with some important forms prior to the appointment. These forms will help gather some background information that will help focus on important concerns during the appointment. These will need to be completed and brought to the appointment.
4. Try to get your medical records specific to this concern.
It is recommended to obtain any important medical records prior to the appointment. This will speed up the process of evaluation.
If the person to be evaluated has seen any medical providers or had medical tests related to the problem (e.g. blood tests, MRI or CT of the head), it will be helpful to get copies of these records ahead of time so they can be reviewed. Any recent visits to a general provider are also helpful for general medical history. This process is fairly simple - you just need to call the offices and request the doctor's office notes or test results, and you may need to fill out a release form. If this process is unclear or difficult, medical records can also be requested after the neuropsychological evaluation has started, although this may delay the process a little (e.g. we may need to wait a week or two for records, which may delay the final report).
5. Plan on most of the day for your evaluation.
Unlike most doctor’s appointments, neuropsychological evaluations typically require one half to three quarters of a day to complete. The evaluation will typically start in the morning with an interview with the neuropsychologist. The interview will cover a discussion of the reason for the evaluation, including any symptoms the person is experiencing, and ways that these things are impacting the person’s life. There will also be gathering of some basic information about the person’s functioning in general (e.g. family history, educational experiences, work history, etc.), to assist in fully understanding the context of a person’s life, which will later make tailored recommendations possible. This interview typically includes the person to be evaluated, as well as at least one close family member, who may be able to contribute important information or context, and also provide support. It is not strictly necessary to have a family member present, but it is encouraged. The interview will last typically about an hour, although in some complex cases, it may last a little longer.
Following the interview, the person will accompany the neuropsychologist into the testing area, and the testing will begin. It is notable that some neuropsychologists use testing technicians to administer the tests. The testing will consist of a wide variety of tasks, many involving questions that are asked, some involving problem-solving tasks or puzzles, and others involving questionnaires that are completed by the person. Testing typically takes several hours (ranging from 2-4 for an older adult, to 4-6 for a younger person). Having a variety of tasks to complete, and rest breaks as needed, typically makes the time pass quickly. It is important to note that this testing is not educational in nature, and although the tests may be challenging, no one is expected to do well on all of the items. All tests are carefully selected to address the needs of each individual. When the testing is completed, the follow-up appointment will be scheduled, so that the results can be reviewed.
6. Find out your results in your follow-up appointment.
Your follow-up appointment will be scheduled about two weeks after your initial evaluation.
Following the testing, the neuropsychologist will score tests and compile all results, and complete a careful review of the testing data, as well as review of any relevant medical records and other supporting information to assist with the evaluation. The time taken to compile and review the test findings and carefully document the diagnosis and treatment recommendations can range from three to five hours. This will result in a final report that is typically five to six pages in length, also including an appendix of detailed testing results when that is needed.
On the day of the follow-up appointment, the neuropsychologist will meet with the person and any accompanying family members for about an hour. During this time, there will be a careful review of the findings of the evaluation, and a detailed discussion of any specific recommendations that will be offered. There will be time to ask questions, and in fact, this will be encouraged. Following this appointment, the report will be given to the person and/or family members (both paper and electronic copies), for their own future use for reference, or to provide to other doctors or healthcare providers. With your authorization, the report will also be sent to the referring physician and other specialists, etc.
7. An optional consultation period will be available following your last appointment.
After the evaluation and follow-up are complete, the person and/or family members will be able to call with any further questions or concerns during “telephone visits” that will be provided. Up to 4 telephone visits will be available over the next 6 weeks. Telephone visits are 15 minutes in length. If matters arise that are more involved and not able to be addressed in this way, the person will be encouraged to schedule an extended follow-up session at an additional cost. During this time, the patient and his or her family may also access materials in our Neuropsychology Lending Library.
8. If repeat evaluation is needed, this can be scheduled in the future.
For some conditions that include significant changes over time (e.g. dementia, which may show gradual decline, or severe stroke or head injury, when some important over time may occur), it may be helpful to pursue repeat neuropsychological evaluation. Typically, repeat testing is not pursued in less than 12 months, although shorter intervals may be considered in the case of rapidly changing presentations.