Neurocognitive Testing is an assessment used to evaluate various aspects of cognitive functioning. A Neurocognitive exam is longer than other measures and must be tailored to the presenting questions and challenge. We administer many neurocognitive tests that can be given virtually, though in some cases, you may need to see someone local to you to fill in some gaps. This post provides an overview of our services and information to help you decide if we can help you or a loved one. You can also contact us or schedule a consultation anytime.
Neurocognitive Testing Overview
The following is an overview of a typical neurocognitive exam we offer; later in this post, we provide a fictional example and more details about the contexts in which these assessments are used.
Neurocognitive Testing Uses
Neurocognitive testing can be used to assess aspects of:
- Memory: Short-term, long-term, and working memory.
- Attention and Concentration: Ability to maintain focus and process information.
- Executive Functioning: Skills such as problem-solving, planning, organization, and decision-making.
- Language Skills: Understanding and using language, including naming objects, following commands, and speech fluency.
- Visuospatial Abilities: Understanding spatial relationships and visual perception.
- Motor Skills: Coordination and fine motor control (if these are a major concern, you likely need to see someone in person)
- Emotional and Psychological Functioning: Assessing your mood, personality aspects, and psychological well-being.
Neurocognitive Testing Methods
A neurocognitive exam may include a combination of:
- Standardized measures that show specific neurological and cognitive functioning aspects are the cornerstone of neurocognitive testing.
- Questionnaires that help describe your abilities in everyday situations and may trace changes in your skills and capabilities over time.
- Interviews with you and sometimes caretakers help us gather more data, which may include information from your physician.
We also collect any prior records you have from school, medical providers, and therapists when they have information that may help us assess your current functioning and how any challenges have evolved.
Neurocognitive Testing Results
The results of a neurocognitive exam help identify specific cognitive deficits, determine the impact of neurological conditions, guide treatment plans, and monitor changes in cognitive functioning over time.
Neurocognitive Tests 
The neurocognitive tests we use are a set of standardized assessments used to measure various aspects of cognitive functioning. Here are some of the commonly used neurocognitive tests in a full psych evaluation:
Neurocognitive Tests for Memory
- Wechsler Memory Scale (WMS): This scale assesses different types of memory, including immediate, delayed, and working memory.
- Rey Auditory Verbal Learning Test (RAVLT): Measures verbal learning and memory, including recalling a list of words over several trials.
- California Verbal Learning Test (CVLT): Similar to RAVLT, but more comprehensive, assessing verbal memory and learning.
2. Attention and Concentration
- Digit Span (from the Wechsler Adult Intelligence Scale – WAIS): Measures attention and working memory by asking the individual to repeat sequences of numbers forward and backward.
- Continuous Performance (CPT): Measures sustained attention and impulsivity by requiring the individual to respond to certain stimuli while ignoring others.
3. Neurocognitive Tests for Executive Functioning
- Wisconsin Card Sorting (WCST): Assesses the ability to form abstract concepts, shift cognitive strategies, and problem-solve.
- Trail-making (TMT): Measures cognitive flexibility and task switching by having the individual connect numbered and lettered circles in order.
- Stroop Test: Evaluates cognitive control and the ability to inhibit cognitive interference (e.g., naming the ink color in which a word is printed rather than the word itself).
4. Language Tests
- Boston Naming (BNT): Assesses the ability to name pictures of objects, testing for language and word retrieval skills.
- Controlled Oral Word Association (COWAT): Measures verbal fluency by asking the individual to produce as many words as possible from a given category or starting letter within a set time.
5. Neurocognitive Testing for Visuospatial Abilities
- Rey-Osterrieth Complex Figure: Assesses visuospatial constructional ability and visual memory by having the individual reproduce a complex geometric figure.
- Block Design (from WAIS): Tests spatial visualization and problem-solving skills by requiring the individual to replicate patterns using colored blocks.
6. Neurocognitive Tests for Motor Skills
- Grooved Pegboard: Measures fine motor speed and coordination by asking the individual to place pegs into a board with grooves.
- Finger-tapping test: Assesses motor speed by measuring how quickly an individual can tap a button with their finger.
7. Emotional and Psychological Functioning
- Beck Depression Inventory (BDI): A self-report measure used to assess the severity of depression.
- Minnesota Multiphasic Personality Inventory (MMPI): A comprehensive psychological measure that evaluates personality structure and psychopathology.
8. Intelligence and General Cognitive Ability
- Wechsler Adult Intelligence Scale (WAIS): This scale measures overall cognitive ability and provides scores in areas such as verbal comprehension, perceptual reasoning, working memory, and processing speed.
- Mini-Mental State Examination (MMSE): A brief screening tool for cognitive impairment, often used to assess dementia.
Depending on the specific cognitive concerns being evaluated, these neurocognitive tests can be used individually or as part of a battery. Neurocognitive exam results provide detailed information about an individual’s cognitive strengths and weaknesses, which can be used for diagnosis, treatment planning, and tracking changes over time, often through follow-up neurocognitive testing.
Neurocognitive Exam Example
Brian was self-referred to us for neurocognitive testing with problems and difficulty with concentration. He wants to determine whether these issues are due to normal aging or related to a neurological condition. He is 68 years old and reports frequent forgetfulness, such as misplacing items, forgetting appointments, and difficulty following conversations. Additionally, he has noticed increased difficulty focusing on tasks and organizing daily activities. He is also experiencing depressive symptoms.
Neurocognitive Testing Process
The neurocognitive exam process is as follows:
- Initial Interview
- We conduct a detailed interview to gather Brian’s medical history, symptoms, daily functioning, and relevant psychological or emotional factors. The patient’s wife provides additional information.
- Assessment Battery Selection
- Based on the concerns about memory and attention, we choose a battery of neurocognitive tests to evaluate these domains.
- Memory Measures
- Wechsler Memory Scale (WMS): Brian is asked to recall a list of words immediately after hearing them and again after a delay, testing both immediate and delayed memory.
- Rey Auditory Verbal Learning (RAVLT): Brian is presented with a list of words over multiple trials and asked to recall as many as possible. This assesses verbal learning and memory retention.
- Attention and Concentration
- Digit Span (WAIS subtest): Brian is asked to repeat a sequence of numbers in the same order (forward span) and in reverse order (backward span). This assesses working memory and attention.
- Continuous Performance (CPT): Brian responds to specific letters or symbols on a screen while ignoring others, measuring sustained attention and vigilance.
- Executive Functioning Tests
- Trail Making (TMT) Parts A & B: In Part A, Brian connects numbered circles in order, testing processing speed. In Part B, Brian alternates between numbers and letters (e.g., 1-A-2-B), assessing cognitive flexibility and task-switching ability.
- Stroop Test: Brian is shown words printed in different colors and asked to name the color of the ink rather than the word itself, assessing cognitive control and inhibitory processing.
- Language Tests
- Boston Naming (BNT): Brian is shown pictures of common objects and asked to name them, assessing language abilities and word retrieval.
- Controlled Oral Word Association (COWAT): Brian is asked to generate as many words as possible starting with a specific letter within a set time, testing verbal fluency.
- Visuospatial Abilities
- Rey-Osterrieth Complex Figure: Brian is asked to copy a complex geometric figure and reproduce it from memory, assessing visuospatial construction and visual memory.
- Emotional and Psychological Functioning
- Beck Depression Inventory (BDI): Brian completes a self-report questionnaire to assess the presence and severity of depressive symptoms, which could impact cognitive functioning.
Neurocognitive Exam Results and Interpretation
The results of Brian’s Neurocognitive exam can be explained based on the aspects we assessed:
- Memory: Brian shows moderate difficulty with delayed recall, suggesting potential early memory impairment, which could be indicative of mild cognitive impairment (MCI).
- Attention and Concentration: Performance on the CPT and Digit Span indicate a reduced ability to maintain attention and focus, aligning with Brian’s complaints.
- Executive Functioning: Brian has some difficulty with the Trail Making Part B and the Stroop, indicating mild impairment in cognitive flexibility and inhibitory control.
- Language: Brian performs within the normal range on Boston Naming and COWAT, suggesting that language abilities are preserved.
- Visuospatial Abilities: Brian’s performance on the Rey-Osterrieth Complex Figure shows adequate visuospatial skills but some difficulty with visual memory.
- Emotional and Psychological Functioning: The BDI scores suggest mild depressive symptoms, which could contribute to cognitive difficulties.
Diagnosis and Recommendations
The results may suggest mild cognitive impairment (MCI) with some early signs of memory and attention difficulties. The mild depressive symptoms could also be contributing to these cognitive issues, so we do not rule out that the difficulties may be transient and psychological.
We recommend therapy with a clinical psychologist who can further assess and treat the psychological concerns. Then, we schedule a follow-up exam in six months to track changes in cognitive function. We also suggest self-help and executive functioning coaching to improve memory and attention.
Neurocognitive Testing Contexts
Neurocognitive testing evaluates brain function and cognitive abilities, often assessing areas like memory, attention, problem-solving, language, and reasoning. Thus, neurocognitive tests are used in a variety of contexts, including:
1. Neurocognitive Exams for Clinical Diagnosis
Neurocognitive exams can help providers get a mental health assessment and neurological diagnostic clarification, including evaluating:
- Neurological Disorders: Identifies impairments from conditions such as dementia, stroke, multiple sclerosis, epilepsy, or traumatic brain injury (TBI).
- Psychiatric Conditions: Helps differentiate cognitive effects of conditions like depression, schizophrenia, or bipolar disorder.
- Developmental Disorders: Assists in diagnosing ADHD, autism spectrum disorders, and learning disabilities.
2. Neurocognitive Testing for Treatment Planning
Neurocognitive tests aid in treatment planning for medical, outpatient psychotherapy, and occupational and physical therapy services.
- Guides treatment strategies by identifying strengths and weaknesses in cognitive functioning.
- Tracks progress or decline in cognitive abilities over time.
3. Neurocognitive Testing in Educational Settings
Neurocognitive evaluations help design educational plans such as IEPs and 504s for children, adolescents, and young adults.
- Evaluates learning disabilities or challenges to recommend grade school and college accommodations (e.g., extra time on tests, alternative learning methods).
- Identifies gifted and talented students or unique learning needs.
4. Workplace Assessments
Neurocognitive testing can help with certain vocational and workplace accommodations and fitness evaluations.
- Determines fitness for duty in cognitively demanding roles (e.g., pilots, military waiver evaluations).
- Evaluates return-to-work readiness after a brain injury or illness.
5. Research Applications of Neurocognitive Testing
Neurocognitive tests are often used in research studies.
- Studies brain-behavior relationships and the impact of interventions or therapies on cognitive function.
- Assesses cognitive effects of diseases, medications, or treatments.
6. Forensic Contexts for Neurocognitive Testing
These evaluations are used as part of forensic testing in several ways.
- Evaluates competency to stand trial or malingering (feigned cognitive impairment).
- Supports claims in personal injury cases, particularly involving head injuries.
7. Sports Medicine
In sports medicine, these assessments can be used to determine safety and functioning.
- Assesses baseline cognitive functioning and recovery post-concussion.
- Helps determine when it’s safe for athletes to return to play.
8. Aging Populations
Neurocognitive testing can be used to assess age-related issues in aging people.
- Screens for early signs of dementia or age-related cognitive decline.
- Guides decisions on care needs or legal competency.
These evaluations can be used in other contexts, but these are the main ones that are part of our comprehensive services.
Summary and Our Work
We provide neurocognitive testing in most US states. In some cases, we need to refer people to someone local to them to do some or all of the assessment when physical symptoms that are best evaluated in person are a central reason for referral. Other times, when the concerns concern memory, concentration, attention, and other cognitive aspects, we can often do the full exam.
The information above is designed to provide an overview of neurocognitive tests and what to expect. However, it is important to note that every exam is different, and we design testing around exactly what will best answer your questions. Our psychological report will point out challenges, barriers, and areas of strength and opportunity.
Please feel free to contact us or schedule a consultation if you would like to explore how neurocognitive testing would benefit you or a loved one.
