10/22/09. a sub-specialty of clinical psychology neuropsychologists focus on expressed brain...
TRANSCRIPT
10/22/09
A sub-specialty of clinical psychology Neuropsychologists focus on expressed
brain function:Reasoning/problem solvingLearning/recall processesSelective attention/concentrationPerceptionSensationLanguage processesControlled/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 functionExamples: 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 InterpretationSee 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