Transcript Neuropsychology

10/22/09
A
sub-specialty of clinical psychology
 Neuropsychologists focus on expressed brain
function:
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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
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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
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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
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Examples: Deteriorating conditions such as dementia,
multiple sclerosis
 Repeated
evaluations are also conducted to
monitor improving neurobehavioral function
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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
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 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)
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Stroke, aneurysm rupture
Encephalitis
 Epilepsy/Seizure disorders
 Dementias (Alzheimer’s disease, vascular
dementia, etc.)
 Mental illnesses with neuropsychological markers
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Schizophrenia
ADHD, learning disabilities
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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)
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Report writing
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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
Document progress on rounds
Document findings for outpatients
Team meetings (Usually 1-2x/week)
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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
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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
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Therapy
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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:
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Memory problems beginning 2 years ago
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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:
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Balancing checkbook, paying bills
Driving—several accidents, has become lost in familiar
areas
Wondering if problems related to dementia
 Neuropsychological
 Patient
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interview
Patient does not believe he is having any problems
 Family
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interview
Son reported problems described on previous slide
 Assessment
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Evaluation:
and Interpretation
See next Slide
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Assessment Results:
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Memory Test:
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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?
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 AMD
= a loss of vision in the center of the
visual field caused by damage to the
retina
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Dry Type: Drusen accumulates between retina
and choroid
Wet Type: blood vessels grow up behind the
retina
 Retina
= nerves that communicate sight
 Choroid = blood supply to the retina
 Prevalence:
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10% of patients 66-74 years
30% 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=vwCrxomP
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