10/22/09

A sub-specialty of clinical psychology Neuropsychologists focus on expressed brain

function: Reasoning/problem solving Learning/recall processes Selective attention/concentration Perception Sensation Language processes Controlled/directed movement processes

Neuropsychologists use models of brain-behavior relationships to determine whether expected neurobehavioral function is different from normal, or has changed to a degree that is consistent with impairment

Typically, neuropsychologists perform assessments (psychological tests) that evaluate functioning of the brain Determine if performance is in expected range Determine if performance is consistent with brain

damage Make recommendations about how to manage cope

with weaknesses, utilize strengths, and improve functioning

We test all of your thinking abilities such as memory, concentration, language, etc.

Look at your score on these tests and compare to people with your same background (age, education, gender) to determine if your score is where we would expect it to be or not

If your score is below the expected range in a certain area, this helps us know what things are more difficult for you, so we can make recommendations to help you function better

We usually give several different types of tests, and a neuropsychological evaluation can take anywhere from 2-6 hours depending on the number of tests given

We give a number of tests so we can see if your scores fall into an overall pattern of scores that is similar to the pattern shown by others with a certain disorder

Repeated neuropsychological evaluations may be conducted to monitor deteriorating neurobehavioral performance Examples: Deteriorating conditions such as dementia,

multiple sclerosis

Repeated evaluations are also conducted to monitor improving neurobehavioral function Examples: Recovery from a traumatic brain

injury or in response to surgical intervention

Neuropsychologists are different from other clinical psychologists because they have extensive knowledge of the brain

Many take specialized courses in neuroanatomy, neurobiology, and neurological illness

Also have extensive use and knowledge of neuropsychological test administration and interpretation

Have specific expertise in understanding cognitive deficits as well as in the management, treatment, and rehabilitation of brain injured and cognitively impaired patients

Many seek board certification in clinical neuropsychology, which generally requires additional training and certification beyond the PhD or PsyD

American Board of Clinical Neuropsychology American Board of Professional

Neuropsychology American Board of Pediatric Neuropsychology

Typical cases: Traumatic brain injury Brain tumors Cerebrovascular accidents (CVA)

Stroke, aneurysm rupture Encephalitis Epilepsy/Seizure disorders Dementias (Alzheimer’s disease, vascular

dementia, etc.) Mental illnesses with neuropsychological markers

Schizophrenia ADHD, learning disabilities

Inpatient Settings: Conducting rounds on your patients to monitor daily cognitive

functioning Interviewing new inpatients and their family members to gather

background information about things that could affect their brain functioning and recovery

Seeing outpatients (who were previously hospitalized as inpatients) Interview patient and family about recovery Conduct neuropsychological tests to measure recovery (typically tech) Provide feedback to patient and family about functioning

What areas have improved, what areas are still weak Recommendations in terms of driving, financial management, return to

work, methods to continue improving functioning Report writing

Document progress on rounds Document findings for outpatients

Team meetings (Usually 1-2x/week) Meet with medical doctor, social worker, physical therapists, speech

therapists, nurses, etc. Discuss cognitive functioning and any issues/advice for therapists Determine if person is able to be discharged

Outpatient Setting: Interview patients and families about current brain

functioning and background Perform neuropsychological evaluations (tech or

neuropsychologist, depending on practice) Provide feedback about performance on evaluations Report writing to document findings; may also send

report/discuss with other treatment providers such as medical doctor

Therapy Some neuropsychologists also provide therapy to their

patients May work on mood functioning, adherence, family

therapy, or other issues Depends on neuropsychologists interest, and

availability in practice

85 y/o Caucasian Male 16 years education, career military Son brought in with complaints of:

Memory problems beginning 2 years ago Frequently writes notes, but then doesn’t act on them Sometimes writes several notes saying same thing

6 months before eval, son discovered that patient had not filed his taxes for the previous 2 years

Also reported difficulty with: Balancing checkbook, paying bills Driving—several accidents, has become lost in familiar

areas Wondering if problems related to dementia

Neuropsychological Evaluation: Patient interview

Patient does not believe he is having any problems

Family interview Son reported problems described on previous slide

Assessment and Interpretation See next Slide

Assessment Results: Memory Test:

Initial recall: 50%ile Delayed recall: 63%ile

Attention tests: 63%ile simple attn, 91%ile complex Language: Boston 6%ile, verbal fluency 70%ile Problem Solving: verbal-68%ile, visual 6%ile Visuospatial Construction: 5%ile

Is his pattern of performance consistent with that of others with dementia?

No, his memory is too good as is his attention, language and problem-solving

So, what areas is he having problems with? And what could this suggest?

AMD = a loss of vision in the center of the visual field caused by damage to the retinaDry Type: Drusen accumulates between retina

and choroidWet Type: blood vessels grow up behind the

retina Retina = nerves that communicate sight Choroid = blood supply to the retina Prevalence:

10% of patients 66-74 years30% of patients 75-85

Inability to recognize faces despite intact visual abilities

Caused by damage to the fusiform gyrus (in the temporal lobe)

http://www.youtube.com/watch?v=vwCrxomPbtY