Neuropsychology: what clinical neuropsychologists do, assessment and rehabilitation

Neuropsychology sits between neurology and psychology. It asks how a change in the brain, whether from injury, stroke, a degenerative condition, an operation or a developmental problem, shows up in everyday thinking: remembering appointments, following a conversation, planning a task, controlling impulses or managing emotions.

A clinical neuropsychologist is a clinical psychologist who has undertaken additional specialist training in neuropsychology. The British Psychological Society’s Division of Neuropsychology describes a Specialist Register of Clinical Neuropsychologists as the gold standard for registration of clinicians practising in this field, and it also publishes a guide to the profession for patients and the public.

They usually work in neurology, neurorehabilitation, stroke, epilepsy surgery and memory services, and in independent practice for medicolegal and private assessments. Colleagues include neurologists, rehabilitation physicians, occupational therapists, speech and language therapists and old age psychiatrists.

• Traumatic brain injury and concussion, including persistent symptoms after a head injury.

• Stroke and other vascular brain conditions, where memory, attention or language may be affected.

• Dementia and mild cognitive impairment, including distinguishing early dementia from depression, anxiety or other causes of memory complaints.

• Multiple sclerosis, epilepsy, Parkinson’s disease and brain tumours, where cognitive change can affect work and daily life.

• Functional neurological disorder and other conditions in which cognition, mood and symptoms interact.

• Before and after brain surgery, such as epilepsy surgery or deep brain stimulation.

• Developmental and acquired learning difficulties and, in some services, ADHD or autism-related questions.

Headway says that after referral a clinical neuropsychologist may complete specialist tests, known as neuropsychological tests or assessments, to assess areas of cognitive impairment. In practice the first part is an interview about your history, symptoms, work, mood and sleep, and often a conversation with a relative or partner who can describe what they see.

The testing itself uses paper-and-pencil tasks, puzzles and computer tests that measure memory, attention, processing speed, language, visual and spatial skills and executive functions such as planning and flexible thinking. Sessions can last from one to several hours, with breaks, and some people are seen over more than one visit. You do not need to prepare except to be rested and to bring glasses or hearing aids.

A report explains how your performance compares with others of your age and background, what the pattern suggests, and what that means for work, driving, safety and support. It is not a pass or fail.

Headway notes that clinical neuropsychologists and clinical psychologists with experience in brain injury can often help with the cognitive effects of brain injury, and that psychologists or counsellors with experience can help with the emotions of living with its effects. Typical approaches include strategies for memory such as diaries and routines, pacing and fatigue management, structured problem-solving, and work-based adjustments.

Neuropsychologists also support families, advise employers and educators, and contribute to capacity and decision-making assessments. For conditions such as FND or persistent symptoms after concussion, they work as part of multidisciplinary rehabilitation rather than alone.

On the NHS, referral is usually made by a neurologist, rehabilitation consultant, stroke team, memory clinic or GP. The NHS says that for suspected dementia, a GP rules out other causes and may refer you to specialists in a memory clinic, such as an old age psychiatrist, geriatrician or neurologist. Neuropsychology services are limited, so waits and thresholds vary and not everyone with a memory complaint will be offered formal testing.

Private assessments are available from independent neuropsychologists and hospital-based services. Check that the clinician is a chartered psychologist with specialist neuropsychology training, ask what the fee covers, including testing, report writing and feedback, and ask who will receive the report. If the assessment is for legal or insurance purposes, say so at the outset because the process and report format differ.

• Previous scans, clinic letters and a medicines list.

• A relative or friend who can describe changes, or a short written summary from them.

• Glasses and hearing aids, and a snack or drink for breaks.

• Questions: what is being tested, how long it will take, who will see the report, and what practical advice will follow?

• Ask whether driving, work or safety questions will be addressed in the report.

Neuropsychology is a planned service. Call 999 for sudden confusion, speech difficulty, facial droop, weakness or severe headache, which may signal stroke or bleeding. Seek urgent help from NHS 111 or an urgent GP appointment for rapid change in memory or behaviour over days. If someone expresses suicidal thoughts or cannot keep themselves safe, use 999 or A&E, or call NHS 111 and choose the mental health option.