Overview of Assessment & Treatment

A neuropsychological assessment comprehensively evaluates cognition (i.e., thinking skills) and psychological functions using standardized testing materials. Areas of assessment include the following (but is not limited to):

• Intellectual functioning
• Academic skills
  
• Attention
• Language
• Memory (& Learning)
• Executive Functions (e.g., reasoning, problem solving, planning, organizing)
• Visuospatial abilities
• Processing speed
• Motor abilities
• Psychological functioning (E.g., behaviour, emotions, social skills, and general mental health)

The assessment will be useful for individuals with possible disorders that affect brain functioning. Furthermore, the assessment can be conducted for individuals of all age groups (i.e., from children to older adults). Individuals with the following medical conditions (but not limited to) may benefit from an assessment:

• Neurodevelopmental disorders (e.g., intellectual disability, autism spectrum disorder, attention deficit hyperactivity disorder, foetal alcohol spectrum disorder, and learning disorders)
• Neurological disorders (e.g., epilepsy, hydrocephalus, ruptured aneurysm, migraine, Parkinson's disease, Huntington's disease, multiple sclerosis, early onset dementia and Alzheimer's disease and other dementias)
• Acquired brain injury (e.g., concussion, mild to severe head injury, stroke, brain infections, toxicity due to substance overuse, brain tumour, and injury due to lack of oxygen)
• Other medical conditions that affect brain functioning (e.g., heart disease, chronic kidney disease, long-term diabetes, breathing issues and autoimmune diseases)
• Chronic or persistent psychological difficulties (e.g., recurrent depression, anxiety and bipolar disorder)
• Changes in thinking abilities, memory and behaviours without any known cause or due to age.

The assessment usually aims to answer a referral question. This may include referrals from a medical and/or allied health professional (e.g., GP, psychiatrist, neurologist, neurosurgeon, paediatrician, occupational therapist, speech therapist, physiotherapist), individuals can self-refer themselves as well as caregivers/family members can refer their loved ones. Some examples of questions would include:

• What is the cause of decline in memory or changes in behavior?
• How am I going to get back to working or studying life after my brain injury?
• How am I going to get back to working or studying life after my brain injury?
• How am I going to care for my loved one who has dementia?
• What strategies can be used to improve my child’s learning skills?

Hence, the assessment could be useful for the following purposes:

To obtain an individual's cognitive profile (i.e., thinking skills that are preserved and impaired) for:

• Diagnosis of neurodevelopmental disorders
• Differential diagnosis (to determine if observed cognition and behavioural changes are due to depression, movement disorder, another brain disease, medication or medical treatment)
• Diagnostic clarification (i.e., type of dementia)
• Evaluating changes in cognitive functioning before and after a medical treatment or brain surgery (e.g., deep brain stimulation, epilepsy surgery)
• Revealing areas of daily functioning (e.g., financial management, socializing, and complex decision making) that may benefit from rehabilitation from cognitive or behavioural treatment, occupational therapy and/or pharmacotherapy
• Providing strategies to re-integrate into daily life (e.g., ability to work, study and care for family) following a brain injury
• Identifying brain functions that may benefit from targeted intensive cognitive training (e.g., Goal management training, and cognitive rehabilitation software such as HappyNeuron Pro)

To obtain an individual's cognitive strengths and weaknesses for:

• Developing individualized ways to adapt learning methods for children with neurodevelopmental disorders
• Identifying cognitive abilities to plan career pathways for teenagers or adults with neurodevelopmental disorders
• Identifying cognitive areas that can be utilized to enhance effectiveness of psychological therapy or rehabilitation (e.g., occupational therapy, speech therapy and physiotherapy)
• Improving patient's self-perception and planning a possible future pathway following a brain injury
• Helping patients and caregivers to understand and adapt activities of daily living based on cognitive strengths.

Although the assessment would involve standardized test materials, no formal preparation or reading will be required. The assessment hopes to see that individuals are trying their best to perform in the tasks given on the assessment day. Some preparations that can be done include the following:

• Please have sufficient sleep the day before.
• Please eat before the appointment. You can also bring some snacks to munch during break time.
• Please bring in the completed questionnaires that may have been given to you by the assessor prior to your appointment day.
• Please remember to take your prescribed medications (if any) before the appointment. Do try to avoid taking any medications that may cause drowsiness.
• Please bring a list of your current medications and their dosages.
• Please bring your reading glasses or hearing aids (if any).
• Please bring your radiology (e.g., brain CT or MRI scans) reports (if any).
• Please bring reports from medical and/or allied health professionals (e.g., speech therapist, occupational therapist, physiotherapist, psychologist) if requested by the assessor.

The overall assessment may be conducted over 1 – 3 sessions. Depending on the number of sessions, each session may last between 1 – 5 hours. The sessions will usually begin with a clinical interview followed by cognitive testing.

1. Clinical interview: Gathering relevant information regarding changes in thinking skills, childhood, education, family, work, social life, medical illness, and psychological functioning. Collateral information is also gathered from familymembers/caregivers, treating clinician and other people (e.g., teachers for child patients) as necessary. Radiology findings are sometimes required and included in the assessment. Medications used by individuals are also taken into consideration.
2. Cognitive tests: For objectively quantifying an individuals' thinking skills (i.e., memory, attention, and executive functioning).

The neuropsychologist will score and interpret the individual’s test results together with the information obtained during the clinical interview. The aim would be to understand the individual’s strengths and limitations while answering the referral question. A follow-up appointment for feedback regarding the assessment findings and recommendations for treatment will be scheduled (1 session, 1-2 hours). A comprehensive report will also be provided.

Intervention/rehabilitation will be provided as requested by the individual and/or family members (number and length of sessions will vary according to individuals). The treatment plan may comprise of (but not limited to):

1. Providing psychological and behavioural services (to the individual and/or to family members).
2. Cognitive rehabilitation (e.g., suggesting compensatory strategies, working with family members to implement strategies, and/or providing intensive cognitive training).
3. Collaboratively working with other allied health professionals (e.g., occupational therapist, speech therapist, and physiotherapist): To integrate the practice of cognitive or psychological strategies within the individual's daily life.
4. Referring to required services (e.g., occupational therapy, physiotherapy, early childhood intervention, psychiatry, and medical investigation).
5. A re-evaluation of cognitive functioning following implementation of suggested treatment (if required). This follow-up assessment is also necessary to establish diagnosis of degenerative disorders (e.g., dementia).