A neuropsychological assessment is a structured set of pencil-and-paper and conversational tasks that measure thinking directly, rather than relying on how well someone feels they are doing. It usually spans three appointments of about an hour each: a first consultation, the testing itself, and a session in which the findings are explained.
It is not a scan and it is not an interview
Imaging shows the structure of the brain. An assessment measures what that brain is doing. The two answer different questions, which is why a scan can be reported as unremarkable while a person is genuinely struggling, and why a scan finding does not by itself establish how someone is functioning.
The first consultation
The first appointment is a conversation. It covers the difficulties you have noticed, when they began and how they have changed, your medical history, medication, sleep, mood, and the demands you face at work or at home. Developmental and educational history matters too, because performance can only be interpreted against a reasonable expectation of what it once was.
Nothing is being tested at this stage. The purpose is to establish the question precisely enough that the right measures can be selected, since there is no single standard battery that suits every referral.
What the tasks are actually like
Most people are surprised by how ordinary the tasks are. You may be asked to remember a list of words and recall it later, copy a complex figure and then reproduce it from memory, name pictures, complete patterns, connect numbers and letters in sequence under time, or repeat sequences of digits. Some tasks are timed. Some are designed so that nobody completes them, because the point is to establish where performance changes rather than whether it is perfect.
How findings are interpreted
Raw scores mean very little on their own. Performance is compared against normative data for people of similar age and educational background, and then interpreted against your own history. A score that is unremarkable in general terms may represent a substantial decline for a particular individual, and the reverse is equally true.
Interpretation also weighs the factors that affect performance without reflecting brain function: fatigue, pain, anxiety, low mood, medication and sleep. Separating these from underlying cognitive change is a substantial part of the clinical work, and it is why an assessment is not simply a matter of administering tests and reading off the totals.
The feedback session
Findings are explained in plain language, along with what they mean for daily life, work or study, and for the people supporting you. This session is included as part of the assessment and is where most of the practical value sits. A full written report is available on request at an additional fee, and is often needed where a third party such as an employer, insurer or another clinician requires documentation.
Practical matters
A referral is not required, although many patients are referred by a neurologist, psychiatrist, general practitioner or occupational therapist. Sessions run an hour, and a two hour double session can be arranged where fewer visits would suit you better. Medical aid patients are charged at medical aid rates, and because cover varies between schemes and between plans it is worth confirming benefits before the first appointment.
Common questions
How long does a neuropsychological assessment take?
Generally three appointments of about an hour each: an initial consultation, the assessment itself, and a feedback session. More extensive assessments may run across more than one testing session, or as a two hour double session where fewer visits would suit you better.
Can you fail a neuropsychological assessment?
No. Some tasks are deliberately constructed so that nobody completes them, because their purpose is to establish the point at which performance changes. There is no pass mark, and the aim is an accurate description rather than a score.
Do I need a referral to see a neuropsychologist in Cape Town?
No. You may contact the practice directly, although many patients are referred by a neurologist, psychiatrist, general practitioner or occupational therapist.