This paper was prepared by the Encephalitis Society with advice from David A Johnson, Consultant Neuropsychologist, Royal Hospital for Sick Children, Edinburgh

What is it?

NeuropsychologicaI Assessment is an appraisal of the brain's psychological, that is cognitive and behavioural, functions.

Who does it?

Neuropsychologists are psychologists who have special training and experience in the field of neuropsychology.  Neuropsychology is a distinct field of knowledge and skill which bridges the neurosciences and psychology.

Neuropsychologists are trained in understanding how a person's behaviour, intellect, memory and emotions are related to the status of their brain.

Expertise in Neuropsychology takes many years of special training and experience with a range of patient groups.  It complements clinical psychology, educational psychology and neurology but offers additional and specific information to understanding and managing an individual who has sustained some brain insult.

Why have a Neuropsychological Assessment?

It can offer the person; their family; their colleagues; their school and their treating doctors and therapists additional information to help place any difficulties they are having in the proper context.  Knowledge of a person's strengths and weaknesses, how brain damage or injury may have affected specific aspects of their thinking ( and left others intact ), what areas need to be compensated for or be given rehabilitation, and what the likely impact of those problems might be in life is a valuable tool for managing and coping with disability.

Sometimes, neuropsychological assessments are used to help plan return to work or school, apply for special resources or to assist in medical management of problems ( e.g. adverse side effects from antiepileptic drugs, etc.)

Neuropsychological assessments can help to chart the process of change.  Improvement over time is important to document as resources and plans may need revision.  So too is any apparent worsening over time which can occur in some conditions and in some populations, such as children where "latent" deficits may be seen as they mature.

What is involved

An assessment usually consists of 3 equally important parts. 

Firstly, taking a comprehensive history from interviews with the person affected by encephalitis and their close relative, and gathering appropriate information from the medical records, This first stage allows us to gain a picture of the type and severity of injury to the brain, what the person was like before the illness and how they have progressed. 

The second stage involves the use of standard psychological tests to examine how specific functions of the brain are working.  The main areas of cognitive functioning which should be assessed are attention, memory, visual perception, reasoning and verbal ability.  For each function a number of different tests should be used.  There is no point relying on just one test of attention, for example, when attention is such a complex system and is known to have different areas and levels of working within the brain - for example, speed of thinking, sustaining concentration, keeping to one thing at a time, being able to work in a busy or noisy environment with other things going on around you.

An individual's IQ (intelligence quotient) has little relevance to brain function or neuropsychological assessment.  However, the standard tests of intelligence, which are used to calculate the IQ, can be very useful if their results are interpreted in terms of brain function, rather than numerical estimates or lQs.  An appropriate and comprehensive neuropsychological assessment yields information on how the brain is working, information which cannot be obtained in any other way. 

The third part of assessment is the psychologist's opinion and report.  The test results are now considered in relation to the person's history - both before and since the illness.  For example, do the test findings make neurological sense, does the pattern of difficulties shown fit with what one would reasonably expect to find after this type and severity of illness.  If not, were there any problems before the illness, such as dyslexia, learning or behaviour difficulties, or other injury to the brain, which may have increased the person's vulnerability and caused disproportionately severe symptoms?  The effects of two or more injuries to the brain, whatever their cause or severity, will be cumulative.

Having decided on the person's present condition, the psychologist should then be in a position to make recommendations for helping further rehabilitation or education, for example.  The so­-called "strengths and weaknesses" of the person's assessment should indicate the main problem areas (e.g. attention and memory), the nature of the difficulty (e.g. distractibility) and, by logical application of knowledge on how brain functions are organised, the best ways in which to approach the problems (e.g. working in a quiet room; one-to-one practice in learning how to learn).

How long does it take?

It varies depending on what the purpose of the assessment is, how quick the patient is able to respond, how they cope with fatigue and their age.  On average, a comprehensive assessment takes about 2 - 4 hours.

How to get a Neuropsychological Assessment

From a Chartered Clinical Psychologist who specialises in neuropsychology.

Every health district will have a Psychology service, not all will have someone who specialises in neuropsychology, but many will.

How you get to see the person may vary from one Psychology service to another ­but will usually need a referral from a doctor.

For children, ideally you aim for a Chartered Clinical Psychologist who works with children and specialises in child neuropsychology.  Realistically you are more likely to see a child psychologist who has some experience of neuropsychology.

You can check that a psychologist is properly qualified using The Register of Chartered Psychologists.

You can look for someone who is a Chartered Psychologist and offers neuropsychological assessments in the Directory of Chartered Psychologists (both available from The British Psychological Society, St Andrews House, 48 Princess Road East, Leicester, LEI 7DR).  Some of those people listed in this offer to see people privately- those who only work for public services give the contact details for that service.

What to do with a Neuropsychological Assessment

Try to gain an understanding of  what aspects of someone's thinking have changed and in what way.Pass this understanding on to anyone else who has regular contact. For example - relatives., friends, ?colleagues or boss, teachers', doctors, social services, benefits agency.

Plan any appropriate rehabilitation using the assessment.

Plan for future - education, employment, living arrangements, legal arrangements.

In some circumstances, have another assessment after a year and compare the two to see if anything is changing.

Treat it with a bit of caution - it is one of the best sorts of evidence that can be gained about how someone's thinking is working, but it never comes with a 100% guarantee of accuracy.Neuropsychological Assessment

This paper was prepared by the Encephalitis Society with advice from David A Johnson, Consultant Neuropsychologist, Royal Hospital for Sick Children, Edinburgh

What is it?

NeuropsychologicaI Assessment is an appraisal of the brain's psychological, that is cognitive and behavioural, functions.

Who does it?

Neuropsychologists are psychologists who have special training and experience in the field of neuropsychology.  Neuropsychology is a distinct field of knowledge and skill which bridges the neurosciences and psychology.

Neuropsychologists are trained in understanding how a person's behaviour, intellect, memory and emotions are related to the status of their brain.

Expertise in Neuropsychology takes many years of special training and experience with a range of patient groups.  It complements clinical psychology, educational psychology and neurology but offers additional and specific information to understanding and managing an individual who has sustained some brain insult.

Why have a Neuropsychological Assessment?

It can offer the person; their family; their colleagues; their school and their treating doctors and therapists additional information to help place any difficulties they are having in the proper context.  Knowledge of a person's strengths and weaknesses, how brain damage or injury may have affected specific aspects of their thinking ( and left others intact ), what areas need to be compensated for or be given rehabilitation, and what the likely impact of those problems might be in life is a valuable tool for managing and coping with disability.

Sometimes, neuropsychological assessments are used to help plan return to work or school, apply for special resources or to assist in medical management of problems ( e.g. adverse side effects from antiepileptic drugs, etc.)

Neuropsychological assessments can help to chart the process of change.  Improvement over time is important to document as resources and plans may need revision.  So too is any apparent worsening over time which can occur in some conditions and in some populations, such as children where "latent" deficits may be seen as they mature.

What is involved

An assessment usually consists of 3 equally important parts. 

Firstly, taking a comprehensive history from interviews with the person affected by encephalitis and their close relative, and gathering appropriate information from the medical records, This first stage allows us to gain a picture of the type and severity of injury to the brain, what the person was like before the illness and how they have progressed. 

The second stage involves the use of standard psychological tests to examine how specific functions of the brain are working.  The main areas of cognitive functioning which should be assessed are attention, memory, visual perception, reasoning and verbal ability.  For each function a number of different tests should be used.  There is no point relying on just one test of attention, for example, when attention is such a complex system and is known to have different areas and levels of working within the brain - for example, speed of thinking, sustaining concentration, keeping to one thing at a time, being able to work in a busy or noisy environment with other things going on around you.

An individual's IQ (intelligence quotient) has little relevance to brain function or neuropsychological assessment.  However, the standard tests of intelligence, which are used to calculate the IQ, can be very useful if their results are interpreted in terms of brain function, rather than numerical estimates or lQs.  An appropriate and comprehensive neuropsychological assessment yields information on how the brain is working, information which cannot be obtained in any other way. 

The third part of assessment is the psychologist's opinion and report.  The test results are now considered in relation to the person's history - both before and since the illness.  For example, do the test findings make neurological sense, does the pattern of difficulties shown fit with what one would reasonably expect to find after this type and severity of illness.  If not, were there any problems before the illness, such as dyslexia, learning or behaviour difficulties, or other injury to the brain, which may have increased the person's vulnerability and caused disproportionately severe symptoms?  The effects of two or more injuries to the brain, whatever their cause or severity, will be cumulative.

Having decided on the person's present condition, the psychologist should then be in a position to make recommendations for helping further rehabilitation or education, for example.  The so­-called "strengths and weaknesses" of the person's assessment should indicate the main problem areas (e.g. attention and memory), the nature of the difficulty (e.g. distractibility) and, by logical application of knowledge on how brain functions are organised, the best ways in which to approach the problems (e.g. working in a quiet room; one-to-one practice in learning how to learn).

How long does it take ?

It varies depending on what the purpose of the assessment is, how quick the patient is able to respond, how they cope with fatigue and their age.  On average, a comprehensive assessment takes about 2 - 4 hours.

How to get a Neuropsychological Assessment

From a Chartered Clinical Psychologist who specialises in neuropsychology.

Every health district will have a Psychology service, not all will have someone who specialises in neuropsychology, but many will.

How you get to see the person may vary from one Psychology service to another ­but will usually need a referral from a doctor.

For children, ideally you aim for a Chartered Clinical Psychologist who works with children and specialises in child neuropsychology.  Realistically you are more likely to see a child psychologist who has some experience of neuropsychology.

You can check that a psychologist is properly qualified using The Register of Chartered Psychologists.

You can look for someone who is a Chartered Psychologist and offers neuropsychological assessments in the Directory of Chartered Psychologists (both available from The British Psychological Society, St Andrews House, 48 Princess Road East, Leicester, LEI 7DR).  Some of those people listed in this offer to see people privately- those who only work for public services give the contact details for that service.

What to do with a Neuropsychological Assessment

Try to gain an understanding of  what aspects of someone's thinking have changed and in what way.Pass this understanding on to anyone else who has regular contact. For example - relatives., friends, ?colleagues or boss, teachers', doctors, social services, benefits agency.

Plan any appropriate rehabilitation using the assessment.

Plan for future - education, employment, living arrangements, legal arrangements.

In some circumstances, have another assessment after a year and compare the two to see if anything is changing.

Treat it with a bit of caution - it is one of the best sorts of evidence that can be gained about how someone's thinking is working, but it never comes with a 100% guarantee of accuracy.