• Bring all relevant medical records and intake packet to the appointment, including reports from prior neuropsychological evaluations. Even better, send them in advance of your appointment.

• Relax and get a good night of sleep the night before.

• Take your medications like normal.

• Eat breakfast the morning of your appointment.

• If you wear hearing aids or glasses, please bring them.

• Bring a small snack if you might need one.

• Allow yourself plenty of travel time to the appointment.

Brain imaging, such as a brain MRI or CT scan can provide a picture of the structures of your brain. This is critical to making sure there are no urgent problems such as a stroke, tumor, or infection. However, the structure of the brain does not tell you about how it is functioning and there are many neurological problems that can cause significant problems in people’s thinking and behavior, but do not necessarily show significant abnormalities on brain imaging (e.g., early neurodegenerative diseases such as Alzheimer’s disease, initial reoccurrence of brain tumors). There are other types of brain imaging that can provide information about how active different brain areas are or how much of a certain nutrient, chemical, or other biological material is present in specific brain regions. These can be helpful in identifying the area of the brain that might not be functioning well or causing problems (e.g., show the source of a seizure) or identify the underlying disease affecting the brain. However, knowing this information does not tell us how the brain problem impacts a person’s thinking or emotional and behavioral functions. These are the questions that a neuropsychological evaluation can uniquely answer.

A neuropsychologist is a licensed psychologist specializing in the area of brain-behavior relationships. Although a neuropsychologist has a doctoral degree in psychology, he or she does not just focus on emotional or psychological problems. Neuropsychologists have additional training in the specialty field of clinical neuropsychology. That means a neuropsychologist is educated in brain anatomy, brain function, and brain injury or disease. The neuropsychologist also has specialized training in administering and interpreting the specific kinds of tests included in your neuropsychological evaluation. As a part of the required education, a neuropsychologist also has years of practical experience working with people who have had problems involving the brain. For an official, more detailed definition of a neuropsychologist visit the National Academy of Neuropsychology website.

If you need to cancel, please do so at least 48 hours before your scheduled appointment so we can allow a patient on our wait list to have the opportunity to be seen during that appointment time. Only one patient can be seen per day, and last-minute cancellations have a significant impact on the clinic's workflow.

Cancellations within the 48-hour period will be charged a no-show fee equal to two hours of our hourly rate. This retainer fee will be charged at the time of scheduling the appointment, and will be reimbursed after the initial appointment is completed. This fee will not be covered by your insurance company.

There are many factors that can affect a person’s thinking skills and emotional and behavioral functions. Some questions may feel less relevant to the problems and concerns you are currently facing; however, they help us best understand parts of your history that could impact your test performances. Having you fill out the history questionnaire in advance of your appointment helps us make the most of your appointment so we can focus on the issues most concerning to you now. If you can provide us the questionnaire in advance of your appointment, this can help us better plan for your visit and make sure you get the most out of your evaluation.

Evaluations range in cost depending on the nature and extent of assessment required. Please contact us directly to learn more about our pricing.

Neuropsychological evaluations are tailored to the needs of each person, but typically take between 3-4 hours. First, the neuropsychologist will meet with you and your loved ones for about an hour to ask you questions about your history and current concerns. After the interview, the neuropsychologist will work with you one-on-one to complete the testing, which typically takes about 2-3 hours. Your loved one(s) do not need to stay during this portion of the evaluation.

After the appointment, the neuropsychologist will prepare a written report, which will be reviewed with you and your loved one(s) during the feedback session. The report will summarize the results of the evaluation and provide a diagnosis (if applicable) and recommendations for the future. The feedback session lasts an hour long and typically scheduled about two weeks after your testing is completed. We highly recommend that your loved one(s) attend the feedback session with you. This session is your opportunity to review the results in-person and have all your questions answered. You will be provided a copy of the report and additional copies will be sent to whomever you like.

The goals of each person’s evaluation are different, but some common reasons for an evaluation include:

• Help describe thinking abilities before, during, or after an illness, injury, or treatment

• Better understand the impact of a medical issue on thinking abilities, behavioral or emotional functioning

• Identify subtle cognitive problems

• Help determine if someone is a good candidate for a medical procedure (e.g., spinal cord stimulation implant, deep brain stimulation, epilepsy surgery)

• Provide a diagnosis

• Provide opinions about whether cognitive problems are likely to get worse, stay the same, or get better

• Define strengths and weaknesses in thinking skills and provide recommendations to help a person compensate for their challenges.

• Guide treatment for personal, educational, or vocational needs

• Determine if cognitive problems are likely to make certain activities difficult such as working, driving, or living alone.

• Document disabilities in persons pursing school or community supports.

• Answer legal questions such as whether a person’s injuries are consistent with their cognitive problems or whether a person continues to have the capacity to make decisions for themselves.

A neuropsychological evaluation uses a series of puzzle-based tasks, oral questions, and written tests to assess thinking skills, emotional functions, and behavior related to brain functions. These tests are most often standardized, which means that the tests were designed to be given to people following a specific procedure. The researchers that develop these tests conduct studies to show how the tests are related to specific brain functions. In order to be able to know what performances are normal for people of different ages and backgrounds, the tests are given to large groups of diverse persons, following the same standard procedures. A patient’s performances on these tests are then compared to the performances of other persons from the most similar background, particularly age. Most people have some abilities that are personal strengths as well as skills that may be more challenging; however, certain patterns can be concerning for problems with brain functions.

A neuropsychological evaluation involves much more than administering and scoring cognitive tests, however. For test interpretation to be valid and useful, a neuropsychologist must consider other factor’s in a patient’s life that could impact their performances. This requires a thorough review of the current problems; how problems are impacting the person’s daily life, as well as the person’s medical, psychological, and social history. A comprehensive evaluation involves a review of medical records, an interview with the patient and trusted loved ones, and standardized testing and questionnaires. The neuropsychologist will then produce a written summary of results as well as provide their interpretation of the meaning of the results and recommendations, which s(he) will typically review with the patient and loved one(s) in a feedback session.

It is normal to feel a little nervous about any medical evaluation. We strive to make the process as positive as possible. During your assessment, you will be given the opportunity to take breaks and work at your own pace. Sometimes we will do puzzle-like activities, sometimes we will ask you questions, and sometimes we will ask you to complete pen-and-paper tasks. The purpose of the evaluation is to see what your brain does well and what skills your brain may have difficulty with. To do this, we will challenge your brain. This is like when a doctor asks someone with heart concerns to run on a treadmill to see how the heart reacts to a challenge. Because these tests are administered in the same way to everyone, you will not be given specific feedback about whether you answered a question correctly. This can cause some people to assume they are doing poorly even when they are doing quite well. Your neuropsychologist is highly trained in helping people get through these moments. While you likely feel challenged by this testing and may, at times, feel frustrated by how you think you are doing, most people leave feeling testing was a positive experience.

While board certification is not required for professional practice of clinical neuropsychology, the position of the National Academy of Neuropsychology is that “successful completion of a rigorous peer examination of neuropsychological knowledge and skill through board certification provides the clearest evidence of competence to practice clinical neuropsychology.”

The largest board certification group in psychology is the American Board of Professional Psychology (ABPP) and its specialty board, the American Board of Clinical Neuropsychology (ABCN). The mission of the ABPP is to protect the public by examining the competency of psychologists in specific specialty areas.

At this time, the only insurance that Bay Area Cognitive Health formally contracts with is Medicare. If you have a PPO plan from a non-Medicare insurance company, you may still be eligible to receive partial or full reimbursement for a neuropsychological evaluation. While Bay Area Cognitive Health cannot be responsible for collecting payment from your insurance company directly, we can provide you with the necessary information to submit to your insurance company to facilitate the reimbursement process.

In general, you should be prepared for the possibility that your insurance company will reimburse you no more than 50% of the fee they allow for a neuropsychological or psychological evaluation. However, some policies pay 80–100% of charges. We strongly recommend that you speak directly to a representative of your insurance company to confirm the nature of your coverage for the neuropsychological evaluation.

Cognition refers to various thinking skills such as learning, memory, attention, mental speed, abstract reasoning and problem solving, processing and integrating visual information, and executive abilities (managing thinking skills and behavior in pursuit of a goal).

We encourage you to bring one or two trusted friends or family members to accompany you to your initial appointment. Your loved one(s) will join us for the first hour (the clinical interview) but are free to leave after that is completed. Telephone interviews can be done if it is difficult for them to come.

Neuropsychology is a specialized area of neurosciences and psychology that studies how behavior is related to normal and abnormal brain functioning. Clinical neuropsychology applies this basic science to help individual people who may be suffering from neurological, psychiatric, or medical problems.

In clinical evaluation, the neuropsychologist’s primary role is to assess brain behavior relationships to answer CLINICAL questions. Does the person have a change or problem in thinking abilities and behavior due to changes in brain function? What are the likely causes of these problems? What would best help the person get better or function better? In some cases, the neuropsychologist may act as an advocate to assist the person or may even provide some types of treatment. The clinician has a doctor-patient relationship with the person they are evaluating. These types of evaluations are frequently covered by medical insurance plans.

In a forensic evaluation, the neuropsychologist’s primary role is to objectively answer a LEGAL question. This may be to answer if someone has the capacity to make a legal decision such as change their will, or it might be to assess damages from an accident or injury. In forensic evaluations, the neuropsychologist is often asked to meet a legal standard of proof, which may require us to focus on different aspects of the case that are more relevant to the legal question. This also may require more extensive review of records, interviews with collateral sources, testing, and documentation. The neuropsychologist is generally hired by an attorney, and there is no patient-doctor relationship. While the neuropsychologist may be hired by a plaintiff or defense attorney, their duty is to render an opinion based on verified and objective data. This type of evaluation is not covered by medical insurance.

Depending on the nature of your complaint or injury, you may very well benefit from a clinical evaluation AND a forensic evaluation. However, a clinical evaluation will generally not provide sufficient evaluation and documentation to withstand the scrutiny of cross examination. Clinical evaluations are, by definition, biased in favor of the patient, and this can hurt your case’s credibility. In some cases, getting a clinical evaluation instead of a forensic evaluation can hinder a later forensic evaluation as it may limit the specific methods the evaluator can employ. Getting an unbiased, objective comprehensive assessment also provides your attorney with critical information so that they can evaluate the strengths and weaknesses of your case and anticipate the kinds of responses they may get from the opposing side’s expert. Remember, you are hiring an expert, not an advocate.

Forensic evaluation must be scheduled and paid for through a third-party such as an attorney or disability insurance company.

Results are communicated to the requesting third party (i.e., attorney, insurance company, court). Generally, forensic assessments are meant to be submitted to a court as evidence for a legal proceeding. They may also be used as attorney-client work product to help the attorney assess the strengths and weaknesses of your case. It is up to the discretion of the hiring agent whether the results of the evaluation are submitted to the court.

Worker’s Compensation
Evaluations to determine causation and impairment ratings for workers’ claims of cognitive and/or psychological symptoms. Dr. Marreiro is certified as a psychological Qualified Medical Evaluator (QME). Because neuropsychology is no longer considered a QME specialty, it is advised to designate Dr. Marreiro as an Agreed Medical Evaluator (AME) or request from the claims adjuster for Dr. Marreiro to perform an evaluation as a medical-legal one.
Independent Medical Examination
Evaluations to assess an injury or illness that is not work-related. This may be required as part of a submission for disability income through a private insurance company.
Civil Personal Injury Cases
To assess for psychological or neuropsychological impairments due to an injury or traumatic event
Conservatorship, Testamentary Capacity & Undue Influence Evaluations
To determine is a person retains the capacity to make certain decisions (i.e., make a will) or to determine if the person has made certain decisions under undue influence.
Fitness for Duty
To determine if an individual is able to perform their job duties in a manner that is safe, reliable and consistent