Normally, a neuropsychological examination explores in depth an individual's performance in a wide range of functional domains. There are instances, however, in the early phases of diagnostic exploration when the presence of a brain injury or disease is not compelling but when a suspicion reasonably might be considered. In such cases, along with other diagnostic procedures, a neuropsychological screening examination may be employed. A neuropsychological screening examination is a considerably abbreviated version of a full neuropsychological assessment, looking only at key sensitive areas of function.
The purpose of a neuropsychological screening examination is to determine if there is reasonable evidence, beyond initial clinical impression, for a diagnosis of brain injury or brain disease. Even though it is "screening," the examination must be definitive in this regard. To miss a neurological diagnosis on the basis of a screening examination could be quite unfortunate. Once a screening points to reasonable probability that a neurological condition exists, a full neuropsychological examination would be indicated to attain further diagnostic, prognostic, and treatment planning information. A referral for neurological examination would also be appropriate at this point.
Both screening and full neuropsychological examinations offer the opportunity for diagnosis of probability of brain dysfunction (as opposed to diagnosis of psychodynamic, personality, and/or emotional disorder not associated with neurological causes). For a screening examination, assessing probability of brain dysfunction is about as far as the diagnosis goes. A full neuropsychological examination, on the other hand, is necessary to delineate the wide variety of functional manifestations of brain damage or disease. Such detail is necessary to understand the life consequences of functional impairment (e.g., work, school, relationships, driving potentials, competency, and so forth).
Ability to understand personality, mental health, and behavioral characteristics of the individual when there is a brain injury requires a full neuropsychological examination. A broad range of functional domains must be evaluated. Also, designing a cognitive, rehabilitative, or psychological treatment program for a person with brain injury or disease requires comprehensive understanding of broad neuropsychological characteristics.
Formal neuropsychological testing is typically a relatively minimal component of a screening examination. The psychologist performing a screening examination may rely as much on history, behavioral observations, patterns of subjective complaints, and other history to establish a reasonable suspicion of an organic pathological state of the brain.
Screening neuropsychological examination is indicated when:
situational explanation for changes in emotions or cognitive functioning cannot be readily identified;
a medical or injury condition is suspected to have impacted brain health (for example, compromised circulation, chronically poor nutrition, or drug toxicity);
any relatively sudden, unexpected, and unaccounted for changes appear in mental or cognitive performance that impacts work or daily functioning;
gradual or sudden onset of unusual physical, sensory, or motor changes (an examination by a physician is always indicated in these instances, as well);
an individual fails to improve with special educational or therapeutic interventions designed to address a specific mental or cognitive problem.
Full neuropsychological examination is indicated when:
screening examination is positive for likelihood of brain disorder;
a brain injury or disease is already known and comprehensive understanding of functional impact is desired;
a brain injury or disease is highly suspect and comprehensive neurofunctional characteristics are desired to complement neurological examination and diagnostic understanding;
comprehensive diagnostic and functional nature of brain injury or disease is necessary for rehabilitation and life-long planning;
comprehensive diagnostic, functional, and causative nature of brain injury or disease is necessary for forensic application;
complex diagnostic efforts require careful, objective, and often serial measurement of neurofunctional performance across cognitive domains.
Copyright ©1999, 2000, 2001 Dennis P. Swiercinsky, Ph.D.