As a clinical neuropsychologist with expertise in neuropsychological testing, I often encounter patients, families, or referring physicians who feel confused or concerned when faced with neuropsychological evaluations that seem to contradict each other. Perhaps one assessment indicated significant memory problems, while a later one showed improvement, or maybe different evaluations highlighted different areas of cognitive weakness. The natural question that arises is, "Which results are right? Which ones should we go with?"
It’s a valid question, but the answer isn't usually about picking a "winner." Neuropsychological assessment isn't like a single blood test yielding a definitive number. It's a complex process involving a battery of standardized tests to assess various cognitive functions, like memory, attention, processing speed, language, executive skills. These areas of cognition are measured within a specific context and at a particular moment in time, and I like to remind patients and providers that one data point is only one data point. Understanding why results might differ is the first step to making sense of inconsistent neuropsych test results.
Why Do Neuropsychological Evaluation Results Vary?
Several factors can contribute to inconsistencies between evaluations:
Real Change Over Time: Brain function isn't static. Cognitive abilities can genuinely change for a few reasons.
Recovery: Healing after a brain injury (like concussion or stroke).
Decline: Progression of a neurodegenerative condition (like Alzheimer's or disease or Lewy Body dementia).
Treatment Effects: Positive or negative impacts of medications, therapy, or surgery.
Aging: Normal cognitive changes associated with aging.
Differences in Testing Context:
Patient Factors: How were you feeling on those specific test days? Fatigue, pain, stress, anxiety, motivation, or even the time of day can influence performance. Medications taken on one day but not another can also play a role.
Environmental Factors: Differences in the testing room (quiet vs. noisy) or the examiner's style and rapport can have subtle effects.
Differences in Tests Used:
Neuropsychologists have a vast toolkit. While different tests might aim to measure "memory," they tap into distinct aspects (e.g., immediate recall vs. delayed recall, verbal vs. visual memory). One evaluator might use tests more sensitive to subtle difficulties than another.
Validity Concerns:
We use specific measures to help determine if the results accurately reflect a person's actual abilities. Sometimes, factors like poor effort, misunderstanding instructions, a language barrier, or symptom exaggeration can lead to artificially low scores. The validity findings might differ between evaluations, impacting the interpretation.
Practice Effects:
Repeating the same or similar tests within a relatively short timeframe can sometimes lead to improved scores simply due to familiarity, not necessarily true cognitive improvement.
So, Which Results Do We Trust?
Instead of asking "which report is right?", the more productive approach is: "What do these different sets of results, taken together, tell us about this individual's cognitive functioning over time and across contexts?"
When interpreting neuropsychological evaluation data, a neuropsychologist’s job is to integrate all available information. So, I would:
Review Both Reports: We carefully examine the findings, methodologies, and interpretations of each evaluation.
Consider the Context: We look at the reason for each referral, the patient's state during testing (if documented), and any relevant medical or life events occurring between evaluations.
Analyze Test Data: We compare the specific tests used, the patterns of scores (which areas are consistently strong or weak?), and critically, the validity testing results from each assessment.
Look Beyond Scores: We integrate test findings with clinical history, observations during the evaluations, and reported real-world functioning. Does the pattern of results make sense given everything else we know? Are there factors that would explain the differences across tests and time?
The goal is to develop a cohesive understanding. Do the differences reflect genuine recovery or decline? Do they point towards variability related to effort or psychological factors? Or perhaps methodological differences between the evaluations?
Inconsistency isn't necessarily a roadblock; it's often a crucial piece of the puzzle, offering insights into the dynamic nature of brain function and behavior. By carefully integrating all data points, we can arrive at the most accurate and clinically meaningful understanding to guide diagnosis and treatment recommendations. If you're facing conflicting results, discuss your concerns openly with your neuropsychologist or doctor to understand the whole picture.
Talk with a Neuropsychologist in South Bay Who Can Help You Make Sense of the Full Picture
Conflicting test results can feel overwhelming—but you don’t have to sort through them alone. Working with a skilled neuropsychologist can help you understand the context behind inconsistent findings and how they may reflect real changes, methodological differences, or testing variability.
If you’re looking for clarity and next steps, Dr. Stacy Reger offers in-depth neuropsychological consultations to help individuals and families navigate confusing evaluations with confidence. Whether you need a second opinion or help integrating multiple assessments, we're here to support you. Here’s how to get started:
Contact (424) 262-1925 to schedule your appointment
Meet with an experienced neuropsychologist for an assessment
Gain clarity and move forward with a more integrated understanding of your cognitive profile.
OTHER SERVICES OFFERED BY DR. REGER IN LOS ANGELES, CA
Beyond individual therapy, Dr. Reger is happy to offer various other services to serve her clients. She provides neuropsychological assessments for ADHD, dementia, traumatic brain injury, and more. She also offers therapy for older adults, med-legal and capacity assessments, workers’ compensation assessments, and pre-surgical evaluations. In addition to evaluations, she provides mental health consultations and presentations. Visit Dr. Reger’s blog for more helpful insights today!