Myth 6: Neuropsychological testing is subjective.

Because standard and traditional neuroimaging such as MRI, CT scans, and EEGs normally are neither specific nor sensitive enough to detect the damage done to the axons and neurons of the brain, the only objective testing which may be sensitive enough to detect and diagnose mild traumatic brain injury is neuropsychological testing. Neuropsychological testing consists of numerous tests designed to measure brain function. Because this testing requires a patient give his or her best efforts, some defense- oriented doctors suggest neuropsychological testing is subjective, not objective. This viewpoint has been rejected by mainstream medicine.

Strubb and Black in their text, Mental Status Examination in Neurology, explain that the neuropsychological evaluation is a comprehensive objective assessment of a wide range of cognitive adaptive and emotional behaviors that reflect the adequacy or inadequacy of higher brain functions. In essence, the neuropsychological evaluation is a greatly expanded and objectified mental status examination. The objective and highly qualified nature of most neuropsychological tests aids in the detection of subtle changes in performance over time.

Because of the wide range of behaviors assessed and the depth to which they are evaluated, the neuropsychological evaluation may detect subtle deficits not apparent on the mental status examination.

Not long ago, the American Academy of Neurology assembled a subcommittee to examine and validate the use of neuropsychological testing. That committee found that neuropsychological assessment is accepted and appropriate by the practicing medical community.

In summary, they found that neuropsychological assessment is most useful in patients with more subtle deficits. It also is useful for detecting deficits in patients with particularly high pre-morbid intelligence levels in which bedside type clinical testing may be insensitive to mild alterations.

Neuropsychiatrists also use neuropsychological testing. Formal neuropsychological testing is an essential part of the neuropsychiatric evaluation of the TBI patient. In fact, it often is the single-most sensitive indicator of subtle brain disturbances that may be contributing to the cognitive, emotional and behavioral dysfunctions that bring TBI patients to the psychiatrist, especially those with a history of only mild to moderate brain injury.

Neuropsychological assessment of the patient with TBI is essential to document cognitive and intellectual deficits and strengths.