Neuropsychometric testing

What neuropsychometric testing is

Neuropsychometric testing is a structured assessment of cognitive abilities by a trained clinical neuropsychologist. It uses a battery of standardised tests to characterise:

• Attention and processing speed;
• Working memory;
• Long-term memory (verbal and visual, learning and recall);
• Language (naming, fluency, comprehension, repetition);
• Visuospatial and constructional skill;
• Executive function (planning, inhibition, flexibility);
• Social cognition (in selected cases).

Results are compared against age-, sex- and education-matched norms to identify which abilities are reduced and by how much.

When neuropsychometric testing is recommended

NICE NG97 recommendation 1.2.11 supports neuropsychometric testing when:

• It is unclear whether the person has cognitive impairment;
• The cognitive impairment is unusual or unexpected for the person's age;
• The subtype diagnosis is uncertain (particularly Frontotemporal Dementia versus atypical Alzheimer's);
• Premorbid intelligence is high (the standard tests may underestimate impairment in highly intelligent people);
• There are co-existing factors (depression, anxiety, English not first language, learning difficulty) that complicate interpretation of standard tests;
• Pre-treatment baseline is required for monitoring (for example, before anti-dementia medication or clinical trial enrolment).

What to expect on the day

The assessment usually takes 2 to 4 hours, sometimes spread over more than one appointment. You will be asked to:

• Complete pencil-and-paper tasks (drawing, copying, completing patterns);
• Repeat lists of words and recall them later;
• Name pictures and define words;
• Solve puzzles and problems;
• Read short passages;
• Time-pressured tasks for some elements.

Bring glasses and hearing aids. Eat normally. Take any usual medications. Take breaks as needed; you can ask to pause at any time.

How the report differs from the ACE-III

The ACE-III is a 15- to 20-minute screening test out of 100. Neuropsychometric testing is a multi-hour battery producing a multi-dimensional cognitive profile. The neuropsychometric assessment can:

• Detect subtle impairments that the ACE-III misses;
• Characterise asymmetric or focal cognitive deficits;
• Distinguish cognitive impairment from depression-related cognitive slowing;
• Establish premorbid intelligence and compare current performance against it;
• Provide a baseline for monitoring over time.

UK availability

NHS access to neuropsychometric testing is variable. Some memory clinics have an embedded clinical psychologist; others refer to regional services with substantial waiting times. Private neuropsychometric assessment is available in many UK cities, typically costing £600 to £1,200. The Dementia Service can arrange neuropsychometric assessment through partner providers.

How to use the report

A typical neuropsychometric report includes premorbid estimates, current performance across each domain (with percentiles or z-scores), a discussion of patterns and a clinical formulation. The report informs:

• The diagnostic conclusion;
• Specific recommendations (for example, Speech and Language Therapy in Primary Progressive Aphasia, occupational therapy in Posterior Cortical Atrophy);
• Capacity assessments for legal purposes;
• Educational and work recommendations.