Older Adult Neuropsychological Evaluations
If you or a loved one is noticing memory changes, increasing confusion, or a shift in everyday functioning, a neuropsychological evaluation can provide crucial information and practical guidance. Older adult evaluations are designed to clarify whether changes are consistent with normal aging, medical or emotional contributors, or a neurocognitive condition such as mild cognitive impairment. We begin with a careful interview and records review and often include input from a family member or caregiver to better understand day-to-day functioning. Testing is paced with comfort in mind, and results are reviewed in a feedback session focused on clear explanations and practical planning, followed by a comprehensive written report.
Conditions We Evaluate
Cognitive changes in older adulthood can be confusing and concerning for both the individual and their family. Our evaluations at Brush Neuropsychology Services in Southeast Michigan are designed to answer the questions that matter most: Is this normal aging? Is something else going on? What can we do about it? Below are some of the conditions we most commonly evaluate. If you have questions about whether an evaluation is appropriate for your situation, we encourage you to reach out by calling us or through our contact page.
Older Adult Evaluations
- ADHD and Executive Dysfunction
- Alzheimer’s Disease
- Anxiety and Avoidance
- Cancer-Related Cognitive Changes
- Capacity
- Concussion and TBI
- Dementia
- Depression
- Epilepsy and Seizure Disorders
- Frontotemporal Dementia
- Lewy Body Dementia
- Long COVID
- Mild Cognitive Impairment and Memory Changes
- Mixed Dementia
- Multiple Sclerosis
- Obsessive-Compulsive Disorder (OCD)
- Parkinson’s Disease and Movement Disorders
- PTSD and Trauma
- Stroke and Vascular Dementia
ADHD and Executive Dysfunction
What is ADHD?
Attention-Deficit/Hyperactivity Disorder (ADHD), also previously referred to as ADD, is a neurodevelopmental condition that affects attention regulation, impulse control, and executive functioning skills such as planning, organization, task initiation, and time management. ADHD can present differently across the lifespan. In children, it may show up as restlessness, difficulty following directions, and inconsistent academic performance. In teens and adults, it often looks like chronic disorganization, missed deadlines, difficulty sustaining effort on routine tasks, and mental overload.
Common signs and symptoms
- Distractibility or difficulty sustaining focus
- Disorganization, losing items, forgetting tasks or deadlines
- Trouble starting tasks, procrastination, difficulty estimating time
- Executive dysfunction
- Impulsivity in conversation or decision-making
- Restlessness or difficulty staying still
- Strong ability with inconsistent output
Common look-alikes and co-occurring concerns
Inattention is not specific to ADHD. Anxiety, depression, sleep problems, learning disorders, concussion history, medication effects, and chronic stress can mimic or worsen ADHD-like symptoms. Many individuals also have overlapping learning differences or emotional concerns that affect daily functioning.
How a neuropsychological evaluation helps
A neuropsychological evaluation clarifies whether ADHD is the best explanation for ongoing difficulties using more than just questionnaires. Evaluation identifies the specific mechanisms contributing to symptoms (for example, working memory limits, slowed processing speed, weak inhibition, or reduced sustained attention). Formal evaluation is often required to receive necessary accommodations, guide treatment, and results can support school planning, workplace accommodations, and a practical strategy plan.
What an ADHD evaluation typically includes
A typical evaluation includes a detailed interview and history review, record review when available, and standardized testing across attention, executive functioning, processing speed, learning and memory, and other domains as needed, along with thorough questionnaires.
Alzheimer’s Disease
What is Alzheimer’s?
Alzheimer’s disease is a neurodegenerative condition that most commonly affects memory systems first and gradually impacts other cognitive domains over time. People may notice difficulty learning new information, retaining recent events, or keeping track of daily details. Because many conditions can mimic memory loss, objective assessment is often an important part of diagnostic clarification and care planning.
Common concerns that may raise suspicion
- Repeating questions or stories, forgetting recent conversations
- Difficulty remembering appointments, recent events, or new information
- Increased reliance on notes, reminders, or family support
- Getting lost in familiar places or difficulty navigating routines
- Trouble managing complex tasks such as finances or medications
- Changes in judgment, problem-solving, or organization
How neuropsychological testing helps
Neuropsychological evaluation characterizes strengths and weaknesses across memory, language, executive functioning, attention, visuospatial skills, and processing speed. The pattern of performance can support differential diagnosis, clarify functional implications, help guide next steps in medical work-up and monitoring, provide practical recommendations for daily structure, safety, and support needs, and establish a baseline for tracking change over time.
Anxiety and Avoidance
Why anxiety is evaluated in neuropsychology
Anxiety can significantly affect cognitive efficiency. When the brain is in a heightened threat state, attention becomes harder to sustain, working memory becomes overloaded, processing speed slows, and test performance becomes less consistent. Anxiety can also lead to avoidance, which reduces learning opportunities and increases stress over time.
Common signs and concerns
- Persistent worry, perfectionism, or fear of making mistakes
- Avoidance of school, assignments, or social situations
- Physical complaints such as headaches or stomachaches
- Panic symptoms or shutdown under pressure
- Difficulty speaking in certain settings (selective mutism)
- Inconsistent performance that worsens with evaluation demands
- Restlessness or difficulty relaxing
Common look-alikes and overlaps
Anxiety can mimic ADHD or amplify learning problems. It can also co-occur with ADHD, learning disorders, and depression. A neuropsychological evaluation helps clarify whether cognitive concerns are primarily skill-based, attention-based, anxiety-driven, or a combination.
How testing helps
Evaluation identifies how anxiety affects cognition and access to learning. Results can inform school recommendations that reduce impairment, improve predictability, and support performance without reinforcing avoidance. It also helps guide next-step referrals and provides a clear explanation of why the individual is struggling.
Cancer-Related Cognitive Changes
Why cancer and treatment can affect cognition
Cognitive changes can occur during or after cancer treatment due to chemotherapy, radiation, surgery, fatigue, sleep disruption, stress, mood symptoms, and medication effects. Many people describe “brain fog,” reduced stamina, or difficulty returning to prior levels of efficiency at work or school.
Common concerns
- Slowed processing speed and reduced mental stamina
- Difficulty concentrating and multitasking
- Word-finding inefficiency
- Memory inefficiency, especially under fatigue or stress
- Increased effort required for routine cognitive tasks
How neuropsychological testing helps
A neuropsychological evaluation characterizes cognitive strengths and weaknesses and clarifies contributing factors such as sleep, fatigue, stress, and mood. Results support practical strategies and accommodations when needed, including return-to-work planning, workload modification recommendations, and compensatory approaches. Baseline testing can also help monitor change over time.
Capacity
What is a capacity evaluation?
A capacity evaluation assesses whether an individual has the cognitive ability to make a specific decision or perform a specific function at a particular point in time. Capacity is not all-or-nothing and is not a global label. A person may have capacity for some decisions and not others, depending on the complexity of the task, cognitive status, and available supports.
Common referral questions
- Ability to understand and make medical decisions
- Ability to manage medications safely
- Ability to handle financial tasks and budgeting demands
- Ability to live independently with or without supports
- Ability to continue driving
- Decision-making abilities during cognitive decline or medical illness
How neuropsychological testing helps
A comprehensive evaluation measures cognitive abilities directly relevant to the capacity question (memory, attention, reasoning, executive functioning, language), assesses functional skills and practical judgment, identifies supports that may enhance functioning, and provides clear documentation describing findings, reasoning, and recommendations.
Concussion and TBI
What is a concussion or traumatic brain injury (TBI)?
A traumatic brain injury (TBI) is an injury to the brain caused by an external force, such as a fall, motor vehicle accident, sports injury, or other force to the head. Mild TBI, or concussion, can temporarily affect attention, processing speed, memory efficiency, sleep, and emotional regulation. The impact of any TBI can vary widely depending on injury severity, medical complications, and factors such as sleep, pain, stress, and mental health.
How neuropsychological testing helps
Neuropsychological testing clarifies which cognitive systems are affected and which remain strengths, identifies factors that may be amplifying symptoms (such as sleep disruption, pain, anxiety, or depression), and translates findings into practical recommendations including return-to-learn and return-to-work planning, pacing strategies, and rehabilitation planning when recovery is more complex.
Dementia
What is dementia?
Dementia is a clinical term describing a decline in cognitive functioning that is significant enough to interfere with everyday independence. Dementia is not a single disease. It is an umbrella term that can result from different underlying conditions, including Alzheimer’s disease, vascular causes, Lewy body dementia, frontotemporal dementia, mixed dementia, and other medical or neurologic contributors.
Common signs and concerns
- Increased repetition, forgetting recent conversations or events
- Missing appointments, losing track of schedules
- Trouble managing complex tasks (finances, medications, planning)
- Language changes such as word-finding difficulty
- Disorientation, getting lost, or difficulty navigating familiar places
- Changes in judgment, problem-solving, or decision-making
- Behavioral changes, reduced motivation, or increased irritability
What else can look like dementia?
Not all cognitive decline is dementia. Depression, anxiety, grief, sleep disorders, medication side effects, pain, metabolic or thyroid changes, vitamin deficiencies, infections, and other medical conditions can mimic or worsen cognitive symptoms. Neuropsychological assessment helps clarify whether the pattern is more consistent with a neurodegenerative process versus potentially reversible or modifiable contributors.
How neuropsychological testing helps
A neuropsychological evaluation provides detailed, objective measurement of cognitive skills including memory, attention, processing speed, executive functioning, language, and visuospatial skills. This cognitive profile can help differentiate dementia subtypes, identify areas of preserved strength, and translate findings into practical recommendations for daily routines, safety planning, caregiver support, and coordination with medical providers.
Depression
How mood affects thinking
Depression can reduce energy, motivation, initiation, and cognitive efficiency. People may notice slowed thinking, difficulty concentrating, indecision, reduced mental stamina, and memory complaints. These experiences are real, and they can impact performance even when underlying cognitive abilities remain strong.
Common concerns
- Low mood or irritability, loss of interest, reduced drive
- Fatigue, low initiation, difficulty sustaining effort
- Slowed processing speed or feeling mentally “foggy”
- Concentration problems and inconsistent performance
- Sleep disruption that worsens cognitive functioning
Why neuropsychological evaluation can be helpful
Cognitive complaints can be caused by many factors. Sometimes they reflect mood, stress, sleep disruption, or burnout. Other times there is an underlying learning, attention, medical, or neurologic contributor. Neuropsychological evaluation helps clarify the most accurate explanation, identifies which cognitive systems remain strengths, and provides practical recommendations for school, work, and home.
Epilepsy and Seizure Disorders
Why seizures can affect cognition
Epilepsy and seizure disorders can affect thinking in ways that vary by seizure type, seizure frequency, sleep disruption, medications, and the brain systems involved. Some people notice consistent changes; others experience fluctuations tied to fatigue, stress, or seizure activity.
Common concerns
- Memory inefficiency or inconsistent recall
- Attention lapses and reduced cognitive stamina
- Word-finding difficulty or slowed language efficiency
- Slowed processing speed
- Academic or work performance changes
How neuropsychological testing helps
Neuropsychological evaluation provides a detailed profile of cognitive strengths and weaknesses, clarifies functional implications, and helps identify contributors such as sleep, mood, and medication effects. It can support school and workplace recommendations and provide objective baseline data for monitoring change over time.
Frontotemporal Dementia
What is frontotemporal dementia?
Frontotemporal dementia (FTD) refers to a group of neurodegenerative conditions that primarily affect frontal and temporal brain networks. Unlike Alzheimer’s disease, early symptoms may be less about memory loss and more about changes in behavior, personality, judgment, organization, or language. Because these changes can sometimes resemble psychiatric concerns or life stressors, objective evaluation can be especially helpful for clarification.
Common concerns that may raise suspicion
- Noticeable changes in personality, empathy, or social judgment
- Increased impulsivity, poor boundaries, or reduced inhibition
- Apathy, reduced initiative, or loss of motivation that is out of character
- Rigid routines or behavioral inflexibility
- Problems with planning, organization, decision-making, or multitasking
- Language-based changes, such as difficulty finding words or producing fluent speech
How neuropsychological testing helps
A neuropsychological profile characterizes executive functioning, behavioral regulation, and language functioning in detail. It identifies relative strengths that can support daily routines, translates cognitive findings into practical guidance, supports planning as needs evolve, and establishes a baseline for monitoring change over time.
Lewy Body Dementia
What is Lewy body dementia?
Lewy body dementia is a neurodegenerative condition that often involves a combination of cognitive changes, attention and alertness fluctuations, visuospatial difficulties, and sometimes movement symptoms. Many families describe “good days and bad days,” with thinking and attention varying more than expected. Because symptoms can overlap with Alzheimer’s disease, Parkinson’s-related cognitive change, and medical or psychiatric factors, careful assessment is helpful for clarification.
Common concerns that may raise suspicion
- Fluctuating attention or alertness that is noticeable day to day
- Slowed thinking and reduced efficiency, especially under fatigue
- Visuospatial changes such as navigation difficulty or visual organization problems
- Increased confusion in complex environments
- Changes in sleep quality that strongly impact daytime functioning
- Behavioral changes, anxiety, or sensitivity to certain medications
How neuropsychological testing helps
Evaluation provides detailed measurement of attention, processing speed, executive functioning, visuospatial abilities, memory, and language. It identifies cognitive fluctuation patterns and functional implications, supports practical recommendations for daily routines and caregiver strategies, and establishes a baseline for monitoring progression and guiding care planning.
Long COVID
Why post-viral syndromes can affect cognition
Some individuals experience persistent cognitive symptoms after viral illness, often described as brain fog. Common domains include attention, processing speed, working memory, and stamina. Symptoms are frequently influenced by fatigue, sleep disruption, autonomic symptoms, pain, mood, and other medical factors.
Common concerns
- Mental fatigue and reduced cognitive endurance
- Slowed processing speed and difficulty multitasking
- Concentration problems later in the day
- Working memory strain, losing track mid-task
- Word-finding inefficiency or slowed retrieval
How neuropsychological testing helps
Evaluation provides objective data about cognitive functioning and real-world impact. It helps determine whether the pattern reflects reduced stamina and efficiency versus a primary memory disorder, clarifies contributing factors, and generates practical strategies for work, school, and daily routines. Baseline testing can also be useful for tracking improvement over time.
Mild Cognitive Impairment and Memory Changes
What are memory changes and mild cognitive impairment?
Mild Cognitive Impairment (MCI) refers to cognitive changes that are measurable and greater than expected for age, while daily independence is largely preserved. MCI is not the same as dementia. Some people with MCI remain stable for years, some improve when contributing factors are addressed, and some progress over time.
Common concerns that lead people to seek evaluation
- Forgetting recent conversations or repeating questions more often
- Misplacing items frequently or losing track of daily routines
- Difficulty concentrating, multitasking, or keeping up with complex tasks
- Word-finding pauses that feel new or increasing
- Feeling mentally slower or more easily overwhelmed
- Family members noticing changes even when the individual is unsure
How neuropsychological testing helps
A neuropsychological evaluation provides objective data about thinking skills including memory, attention, processing speed, language, executive functioning, and visuospatial abilities. This profile helps answer whether observed changes are within expected limits for age, whether there is evidence of a specific memory storage problem versus attention or retrieval inefficiency, and what practical strategies can reduce daily impact.
Mixed Dementia
What is mixed dementia?
Mixed dementia refers to cognitive decline driven by more than one underlying process. A common example is a combination of Alzheimer-type changes and vascular brain changes, but other combinations can occur. When multiple contributors are present, symptoms may be broader, more variable, or develop in a less typical pattern.
Common concerns
- Memory loss alongside slowed thinking and reduced efficiency
- Difficulty with planning, organization, and multitasking
- Changes in attention and problem-solving
- Word-finding concerns and reduced mental flexibility
- Greater functional impact than expected from any single factor
How neuropsychological testing helps
Evaluation defines strengths and weaknesses across cognitive domains, identifies patterns consistent with combined memory and executive or processing speed impairment, translates cognitive findings into practical individualized supports, and establishes baseline data for monitoring change over time.
Multiple Sclerosis
Why MS can affect thinking
Multiple sclerosis can affect cognition directly and indirectly. Cognitive symptoms may arise from changes in brain networks as well as fatigue, sleep disruption, pain, medication effects, and mood symptoms. Processing speed, attention, working memory, and executive functioning are common areas of concern.
Common concerns
- Slowed thinking, especially under fatigue
- Reduced concentration and difficulty multitasking
- Working memory strain, losing track mid-task
- Word-finding inefficiency
- Fluctuating performance from day to day
How neuropsychological testing helps
Evaluation clarifies the cognitive profile and distinguishes MS-related cognitive patterns from sleep and mood contributors. Results support practical recommendations for daily functioning, workplace accommodations when appropriate, pacing strategies, and a baseline to monitor cognitive change over time.
Obsessive-Compulsive Disorder (OCD)
What is OCD?
Obsessive-Compulsive Disorder involves intrusive thoughts and repetitive behaviors or mental rituals intended to reduce distress. OCD can consume time, narrow attention, and disrupt daily routines. Symptoms may present as reassurance-seeking, checking, repeating, fear of mistakes, or rigid routines. It also often leads to slowed efficiency, avoidance, and significant interference with work and daily life.
Common signs and concerns
- Excessive checking or repeating
- Rigid routines, fear of mistakes, “stuck” thinking
- Slow completion due to compulsions or perfectionism
- Avoidance of triggers and distress when interrupted
- Difficulty shifting attention away from intrusive thoughts
Why neuropsychological testing can help
OCD-related difficulties can resemble processing speed weakness or ADHD. Evaluation clarifies which mechanisms are driving functional difficulty and identifies strengths that can support intervention planning and day-to-day strategies.
Parkinson’s Disease and Movement Disorders
Why movement disorders can affect cognition
Parkinson’s disease and related movement disorders can affect executive functioning, processing speed, attention, and visuospatial skills, sometimes alongside changes in mood, sleep, and motivation. Cognitive changes can be subtle early on and may appear as reduced mental flexibility, slowed efficiency, or increased difficulty managing complex tasks.
Common concerns
- Slowed thinking or reduced mental flexibility
- Difficulty planning, organizing, and switching tasks
- Reduced attention and multitasking tolerance
- Visuospatial changes such as navigation or visual organization difficulty
- Sleep-related cognitive effects, fatigue, or apathy
How neuropsychological testing helps
Evaluation clarifies the cognitive profile and functional implications, differentiates cognitive change from mood and sleep contributors, and provides practical supports and strategies for day-to-day functioning. Baseline testing can be helpful for monitoring change over time and guiding planning as needs evolve.
PTSD and Trauma
Why these concerns show up in neuropsychology
Trauma exposure and chronic stress can shift the brain into a heightened threat state, affecting attention, working memory, sleep, and emotional regulation. Eating disorders can be associated with cognitive rigidity, perfectionism, reduced flexibility, impaired concentration, and slowed thinking, particularly when sleep, nutrition, and medical stability are affected.
Common concerns
- Difficulty concentrating or staying mentally organized
- Memory inefficiency under stress or during emotional activation
- Hypervigilance, shutdown, avoidance, or irritability
- Reduced stamina and worsening performance over the day
- Cognitive rigidity and trouble shifting strategies
How neuropsychological testing helps
Neuropsychological evaluation clarifies whether cognitive symptoms are primarily related to stress and regulation, medical factors, attention and executive functioning constraints, or another neurologic contributor. It identifies strengths and vulnerabilities and links results to real-world recommendations for school or workplace functioning.
Stroke and Vascular Dementia
Why vascular changes affect cognition
Stroke, transient ischemic attacks, and vascular brain changes can affect processing speed, attention, executive functioning, language, visuospatial skills, and memory, depending on the brain networks involved. Some individuals notice clear changes after an event; others experience gradual slowing and reduced efficiency over time.
Common concerns
- Slowed thinking and reduced multitasking tolerance
- Difficulty planning, organizing, or shifting between tasks
- Word-finding changes or comprehension inefficiency
- Visuospatial changes such as navigation difficulty
- Fatigue and reduced endurance
How neuropsychological testing helps
Evaluation characterizes strengths and weaknesses, supports rehabilitation planning, and provides practical strategies for daily functioning. It can also establish a baseline to monitor recovery, stability, or progression, helping patients and families plan supports and expectations.
- ADHD and Executive Dysfunction
- Alzheimer’s Disease
- Anxiety and Avoidance
- Cancer-Related Cognitive Changes
- Capacity Evaluations
- Concussion and Traumatic Brain Injury
- Dementia
- Depression
- Epilepsy and Seizure Disorders
- Frontotemporal Dementia
- Lewy Body Dementia
- Long COVID Cognitive Concerns
- Mild Cognitive Impairment and Memory Changes
- Mixed Dementia
- Multiple Sclerosis
- Obsessive-Compulsive Disorder (OCD)
- Parkinson’s Disease and Movement Disorders
- PTSD, Trauma, and Significant Stressors
- Stroke and Vascular Dementia