Neuropsychology

1. Neuropsychology 10/22/09

2. Clinical Neuropsychology • 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

3. Clinical Neuropsychology • 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

4. Neuropsychological Evaluation: An Explanation for Clients • 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

5. Clinical Neuropsychology • 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

6. Clinical Neuropsychology • 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

7. Clinical Neuropsychology • 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

8. Clinical 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

9. Typical Activities of a Clinical Neuropsychologist • 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

10. Typical Activities of a Clinical Neuropsychologist • 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

11. Case Example: Patient A • 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

12. Case Example: Patient A • 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

13. Case Example: Patient A • 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?

14. Age-related macular degeneration • AMD = a loss of vision in the center of the visual field caused by damage to the retina • 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: • 10% of patients 66-74 years • 30% of patients 75-85

17. Prosopganosia • 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