Increasingly, clinical neuropsychologists are asked to answer questions well beyond the traditional decision as to whether or not brain pathology exists in a given individual. We are asked to answer the more functional questions: "What can this person do, despite his brain pathology?" "What accommodations will she need to function independently?" "Can he go back to work?" "Will she get better?"

Several unifying ideas underlie the neuropsychological assessment. The first essential task is to determine the nature and severity of cognitive, emotional, and behavioral disturbances for the client. This highly integrative task must take into account not only the test results of formal neuropsychological assessment, but how these results fit against the background of the individual's presenting problems, medical status, psychosocial history, and level of adjustment prior to the onset of the brain pathology.

In order to sort out the complexities of a given case, the neuropsychologist must have sufficient knowledge of normal brain functioning, as well as the behavioral correlates of various pathological conditions that affect the brain. In addition, the clinical neuropsychologist must have sound diagnostic skills for mental health and emotional problems, which often mimic neurobehavioral symptoms. Attention and concentration problems, for example, are often symptomatic of depression.

After obtaining a profile of the person's abilities, the second task in the neuropsychological evaluation is to formulate diagnostic conclusions, and make recommendations, based on findings, regarding treatment or rehabilitation. The recommendations range from providing guidance for optimal living arrangements to addressing vocational issues. They may discuss the nature and type of vocational accommodations clients need to keep their present jobs, or the extent to which they would benefit from formal rehabilitation services. Ideally, the neuropsychologist is available to consult with care-providers to help formulate specific, interdisciplinary care plans.

Though lengthy to conduct, neuropsychological evaluations are well worth the effort. They facilitate appropriate planning. They minimize unproductive therapies and unrealistic vocational planning. They reduce the possibility of failure.

The assessment routinely draws on the following sources of information:

Results of neuropsychological tests are organized by discreet cognitive domains because that is the most useful way to consider a person's cognitive abilities. While different neuropsychologists will "carve up" these domains in various ways, most evaluations include the following factors:

As useful as the test information is, a neuropsychological evaluation is more than simply a way to catalogue strengths and weaknesses in the various cognitive domains. It must explicitly construct these pieces into a story, a complete picture of an individual. Without that final step, the evaluation would be similar to a critique of a symphony orchestra performance which analyzed each section separately with no consideration of the music produced in concert by all the sections.

The orchestra's conductor, leading the performance, is analogous to the executive brain functions (located in the frontal lobes). Executive functions are particularly important, and elusive, because they involve the abilities deemed most characteristic of the human mind. Formulating, planning, timing, initiating goal-directed behaviors, evaluating the effectiveness of outcomes and changing plans accordingly form the essence of the executive functions.

In order to obtain the most useful information for a specific client, referring professionals are best served by directing specific questions to the neuropsychologist conducting the evaluation. This allows the neuropsychologist to make concrete and specific recommendations, which meet the referring professional's immediate decision-making needs. The most useful referral questions list concerns about specific abilities. They also list the living, work, and treatment situations under consideration for the client. With this information, the neuropsychologist can tailor conclusions and recommendations to the needs of both the client and the referring professional.