Neuropsychology for Memory, Executive Function and Cognitive Change

Forgetting appointments, losing track halfway through a task or finding it hard to plan the week can have many causes. When these difficulties are persistent, affect everyday life or have changed noticeably, a neuropsychological assessment can help explain what is happening and what will help.

This guide explains memory and executive function in plain language, the signs that cognitive change may need assessing, what a neuropsychological assessment involves and how the findings can guide supports for NDIS participants.

What is executive function?

Executive function is the set of thinking skills that help us plan, organise and carry out goals. Brain Injury Australia describes it as the capacity to formulate, plan and carry out plans effectively, and links it closely to the frontal lobes of the brain (Brain Injury Australia).

In everyday life, executive function helps a person:

• plan and organise tasks, such as preparing a meal or getting ready for work

• start tasks without needing a prompt

• switch between tasks and adapt when plans change

• manage time and keep track of what needs to happen next

• monitor their own behaviour and notice mistakes

• control impulses and manage emotional reactions

When executive function is affected, a person may know what to do but struggle to get started, lose their place in a task or have trouble solving an unexpected problem.

What do we mean by memory?

Memory is not one single skill. Researchers describe several types, including short-term and working memory, which hold information for a brief time while we use it, and long-term memory (Queensland Brain Institute). Long-term memory includes:

• episodic memory: remembering events and experiences, such as a conversation yesterday

• semantic memory: facts and general knowledge

• procedural memory: skills and routines, such as how to ride a bike

A person may have difficulty with one type of memory but not another. For example, someone may struggle to remember new appointments but still perform familiar routines well. Understanding which type is affected helps choose the right strategy.

Signs cognitive change may need assessing

A neuropsychological assessment may be worth discussing when a person:

• has trouble retaining new information or routines, even with repeated support

• struggles to plan, start or finish multi-step tasks

• has noticed a change in thinking skills after a brain injury, stroke, illness or neurological event

• is not progressing in therapy as expected, and no one knows why

• is facing a decision, such as living arrangements or returning to work, that depends on understanding their thinking skills

Cognitive impairment is a symptom rather than an illness, and it is not a normal part of ageing. It can have many causes, including brain injury, stroke, medicines, depression, delirium and dementia, and some causes are treatable (healthdirect). If the change is new or getting worse, the person's GP should be involved first so medical causes can be checked.

What a neuropsychological assessment involves

A clinical neuropsychologist is a psychologist with advanced training in how brain conditions affect thinking and behaviour. An assessment usually includes:

1. An interview about concerns, history, daily life and goals, often with family or carers involved with consent.

2. A review of records such as hospital, rehabilitation, school or therapy reports.

3. Standardised testing of memory, attention, processing speed, language, problem-solving and executive function.

4. Interpretation that compares results with expected performance and relates them to everyday life.

5. A report and feedback session explaining strengths, difficulties and practical recommendations.

Testing can be tiring, so sessions are paced and may be split across appointments. Many standardised tests need to be done face to face, although parts of the process may suit telehealth.

How findings can guide support

Knowing why a task is hard changes the support that helps. For example:

• a person with memory difficulties may benefit from written checklists, phone reminders or a visual schedule

• a person with initiation difficulties may remember the task but need someone to help them start it

• a person who struggles with planning may do well with tasks broken into short steps and a consistent routine

Findings can also help Occupational Therapists, psychologists and support workers adapt how they work, and can provide evidence about cognitive and functional support needs.

Cognitive change, dementia and the NDIS

Dementia that starts before age 65 is called younger onset dementia. Early signs can include changes in executive function, language, behaviour or personality, and there is no single test; other causes are usually ruled out first (healthdirect). To apply for the NDIS, a person must be younger than 65 on the day they apply (NDIA).

The NDIA treats diagnosis and clinical treatment of health conditions as the health system's responsibility. It may fund assessment by health professionals that helps plan disability support needs (NDIA mainstream supports guideline). The purpose of the assessment therefore matters. For more detail, read Does the NDIS Fund Neuropsychology?

Next step

This article is general information, not individual clinical or NDIS advice. If you are concerned about memory, planning or other thinking skills, CARED's neuropsychology team can talk through whether an assessment is the right starting point. For the full picture, read NDIS Neuropsychology: Assessments, Reports and Support.

Book an assessment or learn more about CARED's neuropsychological assessments.