Neuropsychological Impairment: Screening and Assessing

A neuropsychological examination investigates an individual's performance in various functional areas. However, there are times in the early stages of a diagnostic investigation when the presence of a brain injury or disease is not compelling, but a reasonable suspicion exists. In such circumstances, a neuropsychological screening examination may be used with other diagnostic methods.

Neuropsychological Assessment

A neuropsychological screening test is a much shorter form of comprehensive neuropsychological evaluation, focusing mainly on important sensitive areas of function. A neuropsychological screening examination is designed to establish whether there is sufficient evidence for a diagnosis of brain damage or brain illness beyond the initial clinical impression.

Even though it is "screening," the examination must be conclusive. Missing a neurological diagnosis because of a screening exam might be disastrous. Once a screening indicates a fair possibility of a neurological problem, a complete neuropsychological assessment is recommended to get more diagnostic, prognosis, and treatment planning information. At this stage, a referral for a neurological check would also be warranted.

Goals of Neuropsychological Assessment

Specific brain regions and related brain structures constitute functional networks that mediate psychological domains/processes/components. Disruptions in certain psychological components/processes/domains suggest injury to the brain structures/networks that mediate these activities. As a result, neuropsychological testing has two objectives.

  • The primary purpose is to identify an individual patient's disturbed psychological components/processes/domains and develop a profile of psychological function adequacies and deficiencies.

  • The second purpose is to use the previously obtained neuropsychological profile to identify brain structures/functional networks that are malfunctioning or damaged. Finally, this data is utilized to lateralize and localize the brain lesion.

Nature of Neuropsychological Tests

Neuropsychological tests are tools for conducting a neuropsychological evaluation. The exams assess certain psychological processes as well as their fundamental components. The difficulty level could be better since the assessment aims to discover a functional impairment rather than test peak performance limits. These include that the test has acceptable reliability and validity, that the scoring is objective, and that the test has adequate normative data.

Identifications of a Deficit by Neuropsychological Tests

The two methodologies used in detecting deficiencies using neuropsychological testing are the ideometric and psychometric approaches. The ideometric technique is appropriate for individual patient clinical assessments, and the psychometric technique is appropriate for assessing abilities/ aptitudes using numeric ratings. While the first is used in a clinical examination that considers the patient's past, the second is utilized to evaluate the patient's talents and aptitudes regardless of the patient's background.

In neuropsychological testing, the ideometric method emphasizes the patient's premorbid functioning concerning education, occupation, social and occupational functioning, and performance on other neuropsychological tests. The patient's present sensory/motor limitations, motivational deficits, and exhaustion level are all considered.

The Luria-Nebraska Neuropsychological Battery

This approach was initially disclosed in two preliminary validity investigations in 1978. Historically, Christensen, a student of A. R. Luria, a distinguished Russian neurologist, and neuropsychologist, published Luria's neuropsychological examination. The book came with a handbook and a kit, including test items from Luria and his colleagues. The battery has 269 objects that may be evaluated on a 2- or 3-point scale.

A score of 0 denotes average performance. Some items may be assigned a score of 1, signifying poor performance. A score of 2 shows that the performance is anomalous. The elements are organized into the Christensen kit's categories; however, unlike Christensen, who organized the items to reflect how Luria utilized them, the Luria-Nebraska version is presented as a collection of quantitative scales.

Each scale's raw score is the sum of the 0, 1, and 2 item ratings. As a result, the greater the score, the worse the performance. Individual item ratings may be based on speed, accuracy, or quality of response. In certain circumstances, the same assignment may be awarded two scores: speed and accuracy. These two scores are counted as separate items.

The 269 items are organized into 11 content scales, each of which can be given separately. Because the number of items on these scales varies, raw scale scores are transformed to T scores with a mean of 50 and a standard deviation of 10. These T scores are shown as a profile on a specially designed form. The names of the content scales have been replaced with acronyms in the alternative version of the battery. Thus, there are scales for Motor, Rhythm, Tactile, Visual, Receptive Speech, Expressive Speech, Writing, Reading, Arithmetic, Memory, and Intellectual Processes, which are known as the C1 through C11 scales in the alternative version.

The Halstead-Reitan Neuropsychological Battery

The battery's origins may be traced back to Halstead's special laboratory, created in 1935 to study neurosurgical patients. The first significant report on the findings of this laboratory was published in a book titled Brain and intelligence: A Quantitative study of the frontal lobes), implying that Halstead's test was originally intended to describe frontal lobe function. Although there are multiple variations of the Halsted Reitan battery, the changes are slight. There is a core set of procedures that practically all battery versions must be administered in a laboratory with particular equipment. It is advisable to budget 6 to 8 hours of patient time.

Each test in the battery is self-contained and may be administered independently of the others. However, it is often thought that a particular number of tests must be performed to compute an impairment index. Individual scores for the Halsted Reitan vary according to the test, with individual results indicated in time to completion, mistakes, number correct, or another sort of derived score.

These scores are frequently converted to conventional scores or ratings to be profiled. All the tests contribute to the impairment index on a 6-point scale, with the results as a rating profile. They have also developed quantitative scoring methods for the Reitan Aphasia Test and the drawing of a Greek cross, both of which are part of the test.

Validity and Reliability

In most situations, the criteria utilized for concurrent validity is the objective detection of any central nervous system damage obtained independently of the neuropsychological test findings. As a result, neurologists or neurosurgeons typically give confirmation.

Identifying brain lesions has historically been difficult since, unlike many other parts of the body, the brain cannot normally be seen directly in a living human. The main exception is when a patient has brain surgery or a brain biopsy. These treatments are necessary for validation to rely on autopsy data or different brain imaging techniques.

Because several changes may have occurred in the patient's brain between testing and brain inspection, autopsy data are not always relevant for validation purposes. Currently, new neuroimaging methods and intensive studies connected with them have made significant headway toward resolving this issue.

Magnetic resonance imaging (MRI) is now the most extensively utilized imaging method. Cooperation among neuroradiologists, neurologists, and neuropsychologists has already resulted in the completion of numerous significant research that correlates MRI data with neuropsychological test findings. Most neuropsychological tests and batteries used today have demonstrated reliability and validity.


Adult neuropsychological assessments generally include general intellectual capacity, memory, speed and accuracy of psychomotor activity, visual-spatial skills, visual, auditory, and tactile perception, language, and attention. As a result, a complete neuropsychological examination may be characterized as a technique that, at the very least, covers all of these bases.

Updated on: 13-Feb-2023


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