Cognition Issues in Cognition Issues in Veterans:Veterans:

A Primer for ProvidersA Primer for ProvidersGudrun Lange, PhD

Monica Clement, PhDLawrence Weinberger, PhD

AcknowledgementsAcknowledgements We would like to thank the following

individuals for their valuable contributions during the development of this presentation: Psychology Staff of the Mental Health and

Behavioral Sciences Service at the New Jersey Health Care System

Social Work Staff of the War Related Illness and Injury Study Center in New Jersey

DisclaimerDisclaimer

The views expressed in this presentation are those of the authors and do not reflect the

official policy of the Department of Veterans Affairs or US Government.

Focus of this presentationFocus of this presentation

Presentation’s SignificancePresentation’s Significance

Presentation’s SignificancePresentation’s Significance Influx of a large number of younger

OEF/OIF/OND Veterans with complex health conditions Positive screens for probable history of

PTSD, TBI, Substance use/abuse Need to be sensitive to slowed information

processing and poor attention affecting decision making and multi-tasking

Veteran safety and possible rehabilitation

……the Other Side of the Cointhe Other Side of the Coin

Current State of AffairsCurrent State of Affairs

Current State of AffairsCurrent State of Affairs

Current State of AffairsCurrent State of Affairs

Goals of PresentationGoals of Presentation

Practical Tips for ProvidersPractical Tips for Providers

Behavioral Indicators of Behavioral Indicators of Cognitive DysfunctionCognitive Dysfunction

Veteran is not able to pay attention and concentrate…eyes are wandering around

Veteran seems to be confused Veteran doesn’t seem to get what I am saying Veteran asks me to repeat everything I’m saying Veteran is not compliant with medications Veteran is not able to accurately recall the

meeting with me

Older VetsOlder Vets Repeats stories/questions within

5 – 10 minutes Word-finding difficulty (uses

description or sentence to substitute for single word) Routine tasks becoming challenging Novel activities are perplexing; can not be mastered

with repetition Spouse/family reporting difficulties but vet dismisses

concern in an angry tone Impaired judgment / deterioration in driving skills

Middle-Age / YoungerMiddle-Age / Younger

Middle Age – Mild Middle Age – Mild DysfunctionDysfunction

OEF/OIF VetsOEF/OIF Vets

Practical Tips for ProvidersPractical Tips for Providers

Practical Tips for ProvidersPractical Tips for Providers

Conditions that Affect Conditions that Affect Cognitive FunctionCognitive Function

Make Sure You Think of Make Sure You Think of Rule OutsRule Outs

Case Study: Tom L.Case Study: Tom L. 77 year old, married, white male. Brought to Neuropsychology clinic as wife

complained to his PCP about Tom becoming progressively more forgetful and irritable at home.

College graduate Retired from a sales job x 13 years.  Extensive travel in retirement & socially active, but now more reclusive. Interest in gardening maintained Hypertension- labile for years, now well-controlled x 3 years

Wife’s examples of changes in behavior

Tom repeats stories during the course of a visit which irritates guests Prone to speak less precisely, describing objects by function rather than

name 

Case Study: Tom L.Case Study: Tom L.

Tom’s CaseTom’s Case

Tom’s CaseTom’s Case

The Referral for The Referral for Neuropsychological Neuropsychological

EvaluationEvaluation Quote from Dr. Rodney Vanderploeg:

“Refer if the evaluation/referral will: Tell you something you don’t already know Make a difference in the patient’s treatment or management”

Referral for neuropsychological evaluation Take rule outs into account Check for prior evaluation by Mental Health, Behavioral

Medicine or Neuropsychology Consider severity of symptom presentation and safety concerns

Assessment of level of Assessment of level of cognitive dysfunctioncognitive dysfunction

What Should a Consult Request for What Should a Consult Request for Neuropsychological Evaluation Neuropsychological Evaluation

Include?Include?

What should a consult request for What should a consult request for neuropsychological evaluation neuropsychological evaluation

include?include?

What should a consult request for What should a consult request for neuropsychological evaluation neuropsychological evaluation

include?include?

The Neuropsychological The Neuropsychological EvaluationEvaluation

Communication is KeyCommunication is Key If you suspect cognitive

problems in a Veteran, make sure to communicate in a variety of modalities Written Verbal Let them try out or repeat what you asked them

to do Keep our Veterans safe!!!

Communication is KeyCommunication is Key Talk to the Veteran about his/her cognitive

problems and possible referral to a Neuropsychologist

Demystify cognitive dysfunction “Am I stupid now?” “Do I have Alzheimer's?” Offer Reassurance

Closing the boxClosing the box

Closing the boxClosing the box

Questions???Questions???