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Screening for Cognitive Impairment in the Neurologist’s Office: Computerized
Neuropsychological Assessment and Other Quick Screening Tools
Jeffrey Wilken, Ph.D.Jeffrey Wilken, Ph.D.Cynthia Sullivan, Ph.D.Cynthia Sullivan, Ph.D.
Department of Veterans Affairs, Washington, DCDepartment of Veterans Affairs, Washington, DCUniversity of Maryland at College ParkUniversity of Maryland at College Park
Robert Kane, Ph.D.Robert Kane, Ph.D.Department of Veterans Affairs, Baltimore, MDDepartment of Veterans Affairs, Baltimore, MD
University of Maryland at Baltimore Medical CenterUniversity of Maryland at Baltimore Medical Center
MS-Associated MS-Associated Inflammation Leads to...Inflammation Leads to...
Myelin DamageMyelin Damage
Axonal DamageAxonal Damage
Brain AtrophyBrain Atrophy
Impact ofImpact ofInflammatory DamageInflammatory Damage
Physical Physical and/orand/or Sensory Sensory SymptomsSymptoms
Neuropsychological Neuropsychological SymptomsSymptoms
The Neuropsychological Evaluation Cognitive Domains AssessedCognitive Domains Assessed
Attention:Attention:
Simple attention SpanSimple attention Span
• DSp ForwardDSp Forward
Vigilance/sustained attentionVigilance/sustained attention
• Continuous Performance TestContinuous Performance Test
Focused AttentionFocused Attention
• Trail Making Test (Part A), WCST Failures to Maintain SetTrail Making Test (Part A), WCST Failures to Maintain Set
Flexible AttentionFlexible Attention
• Trail Making Test (Part B)Trail Making Test (Part B)
Complex Attention/ Working MemoryComplex Attention/ Working Memory
• PASAT, Arithmetic, Letter/Number SequencingPASAT, Arithmetic, Letter/Number Sequencing
The Neuropsychological Evaluation Cognitive Domains AssessedCognitive Domains Assessed
Learning and Memory:Learning and Memory:
Encoding:Encoding:
• California Verbal Learning Test (CVLT, acquisition trials)California Verbal Learning Test (CVLT, acquisition trials)
• Wechsler Memory Scale-III (WMS-III; Learning trials of List learning, Logical Memory, Faces, Visual Wechsler Memory Scale-III (WMS-III; Learning trials of List learning, Logical Memory, Faces, Visual Reproduction, Family Pictures)Reproduction, Family Pictures)
ConsolidationConsolidation
• Recognition Trials of tests described above, cued recall of CVLTRecognition Trials of tests described above, cued recall of CVLT
RetrievalRetrieval
• Free recall trials of tests listed aboveFree recall trials of tests listed above
• Delay can be anywhere from 20 minutes to 4 hoursDelay can be anywhere from 20 minutes to 4 hours
• MMSE doesn’t cut it!MMSE doesn’t cut it!
The Neuropsychological Evaluation Cognitive Domains AssessedCognitive Domains Assessed
Information Processing Speed:Information Processing Speed:
Psychomotor speed: WAIS Digit Symbol, Symbol Search, Computerized Assessment (ANAM)Psychomotor speed: WAIS Digit Symbol, Symbol Search, Computerized Assessment (ANAM)
Mental Processing Speed: PASAT, ACT, Computerized Assessment (ANAM)Mental Processing Speed: PASAT, ACT, Computerized Assessment (ANAM)
Visuomotor (construction) speed: WAIS-III Block DesignVisuomotor (construction) speed: WAIS-III Block Design
Motor Functioning/Speed:Motor Functioning/Speed: Fine Motor Speed (Finger Tapping), Fine Motor Coordination (Grooved Pegboard, 9 hole peg), Strength (Grip Fine Motor Speed (Finger Tapping), Fine Motor Coordination (Grooved Pegboard, 9 hole peg), Strength (Grip
Strength/dynamometer)Strength/dynamometer)
The Neuropsychological Evaluation Cognitive Domains AssessedCognitive Domains Assessed
Executive Functioning:Executive Functioning:
Problem SolvingProblem Solving
• Wisconsin Card Sorting Test (WCST), HRB Category TestWisconsin Card Sorting Test (WCST), HRB Category Test
SequencingSequencing
• WAIS-III Picture Arrangement, LuriaWAIS-III Picture Arrangement, Luria
Abstract ReasoningAbstract Reasoning
• Visual: WAIS-III Matrix Reasoning, Ravens Coloured Progressive Matrices, Ravens Visual: WAIS-III Matrix Reasoning, Ravens Coloured Progressive Matrices, Ravens Standard Progressive MatricesStandard Progressive Matrices
• Verbal: WAIS-III Similarities, parts of WAIS-III ComprehensionVerbal: WAIS-III Similarities, parts of WAIS-III Comprehension
The Neuropsychological Evaluation Cognitive Domains AssessedCognitive Domains Assessed
Language (Not the same as speech):Language (Not the same as speech):
Language Batteries:Language Batteries:
• Boston Diagnostic Aphasia Exam, Western Aphasia ExamBoston Diagnostic Aphasia Exam, Western Aphasia Exam
Verbal FluencyVerbal Fluency
• Controlled Oral Word Association Test (COWAT): FAS, CFL (lexical fluency)Controlled Oral Word Association Test (COWAT): FAS, CFL (lexical fluency)
• Animals, Supermarket (Categorical Fluency)Animals, Supermarket (Categorical Fluency)
Word FindingWord Finding
• Boston Naming TestBoston Naming Test
ComprehensionComprehension
• Token TestToken Test
The Neuropsychological Evaluation
Cognitive Domains AssessedCognitive Domains Assessed
General Intellect:General Intellect:
Is it important to know about?Is it important to know about?
What is the IQ? How is it assessed?What is the IQ? How is it assessed?
Assessing premorbid functioningAssessing premorbid functioning
Neuropsychological Neuropsychological DysfunctionDysfunction
in MSin MS
COGNITIVE domains regularly affected:COGNITIVE domains regularly affected:
AttentionAttention Learning and Retrieval (Memory)Learning and Retrieval (Memory) Information processing speedInformation processing speed Visuospatial perceptionVisuospatial perception Executive FunctionExecutive Function
COGNITIVE domains usually spared:COGNITIVE domains usually spared:
Language/Verbal SkillsLanguage/Verbal Skills
Cognitive Cognitive DysfunctionDysfunction in MS
COGNITIVE domains regularly affected:COGNITIVE domains regularly affected:
AttentionAttention Learning and Retrieval (Memory)Learning and Retrieval (Memory) Information processing speedInformation processing speed Visual spatial perceptionVisual spatial perception Executive FunctionExecutive Function
COGNITIVE domains usually spared:COGNITIVE domains usually spared:
Language/Verbal SkillsLanguage/Verbal Skills
Cognitive Cognitive DysfunctionDysfunction in MS
Components of MemoryComponents of Memory
ENCODINGENCODING(getting the information in)(getting the information in)
CONSOLIDATIONCONSOLIDATION
(transferring the information into long-term store)(transferring the information into long-term store)
RETRIEVALRETRIEVAL (getting the information out)(getting the information out)
Free Recall Free Recall vsvs. Recognition Memory. Recognition Memory
Cognitive Cognitive DysfunctionDysfunction in MS
COGNITIVE domains regularly affected:COGNITIVE domains regularly affected:
AttentionAttention Learning and Retrieval (Memory)Learning and Retrieval (Memory) Information processing speedInformation processing speed Visual spatial perceptionVisual spatial perception Executive FunctionExecutive Function
COGNITIVE domains usually spared:COGNITIVE domains usually spared:
Language/Verbal SkillsLanguage/Verbal Skills
Cognitive Cognitive DysfunctionDysfunction in MS
COGNITIVE domains regularly affected:COGNITIVE domains regularly affected:
AttentionAttention Learning and Retrieval (Memory)Learning and Retrieval (Memory) Information processing speedInformation processing speed Visuospatial perceptionVisuospatial perception Executive FunctionExecutive Function
COGNITIVE domains usually spared:COGNITIVE domains usually spared:
Language/Verbal SkillsLanguage/Verbal Skills
Cognitive Cognitive DysfunctionDysfunction in MS
COGNITIVE domains regularly affected:COGNITIVE domains regularly affected:
AttentionAttention Learning and Retrieval (Memory)Learning and Retrieval (Memory) Information processing speedInformation processing speed Visuospatial perceptionVisuospatial perception Executive FunctionExecutive Function
COGNITIVE domains usually spared:COGNITIVE domains usually spared:
Language/Verbal SkillsLanguage/Verbal Skills
Wisconsin Card Sorting Test
00
1010
1515
2020
2525
3030
MSMS ControlsControls
Perseverative ErrorsPerseverative Errors
Non-PerseverativeNon-PerseverativeErrorsErrors
Wisconsin Card Sorting Test*Wisconsin Card Sorting Test*
*Rao et al., Journal of Consulting and Clinical Psychology, 1987, 55, 263-265
Cognitive Cognitive DysfunctionDysfunction in MS
COGNITIVE domains regularly affected:COGNITIVE domains regularly affected:
AttentionAttention Learning and Retrieval (Memory)Learning and Retrieval (Memory) Information processing speedInformation processing speed Visuospatial perceptionVisuospatial perception Executive FunctionExecutive Function
COGNITIVE domains usually spared:COGNITIVE domains usually spared:
Language/Verbal SkillsLanguage/Verbal Skills
Indicators of Potential NeuropsychologicalDysfunction in MS
Help in ADLs in the absence of disability.Help in ADLs in the absence of disability.
Unemployment in the absence of physical disabilityUnemployment in the absence of physical disability
Mood disorder other than depressionMood disorder other than depression
Withdrawal from usual activities/socializationWithdrawal from usual activities/socialization
Opinion of significant other personality shiftOpinion of significant other personality shift
Significantly increased likelihood of Significantly increased likelihood of cognitive dysfunction in patients with:cognitive dysfunction in patients with:
Greater overall T2 lesion areaGreater overall T2 lesion area11
Greater T1 and T2 lesion loadGreater T1 and T2 lesion load2,32,3
Greater number of juxtacortical lesionsGreater number of juxtacortical lesions44
Relationship Between Cognitive Dysfunction and
Lesion Load
1 Rao SM, Leo GJ, Haughton VM, St Aubin-Faubert P, Bernardin L. Correlation of magnetic resonance imaging with neuropsychological 1 Rao SM, Leo GJ, Haughton VM, St Aubin-Faubert P, Bernardin L. Correlation of magnetic resonance imaging with neuropsychological testing in multiple sclerosis. testing in multiple sclerosis. NeurologyNeurology 1989; 1989; 3939: 161-166. 2 Comi G, Rovaris M, Falautano M, Santuccio G, Martinelli V, Rocca : 161-166. 2 Comi G, Rovaris M, Falautano M, Santuccio G, Martinelli V, Rocca MA, Possa F, Leocani L, Paulesu E, Filippi M. A multiparametric MRI study of frontal lobe dementia in multiple sclerosis. MA, Possa F, Leocani L, Paulesu E, Filippi M. A multiparametric MRI study of frontal lobe dementia in multiple sclerosis. Journal of the Journal of the Neurological SciencesNeurological Sciences 1999; 1999; 171171: 135-144. 3 Rovaris M, Filippi M, Falautano M, Minicucci L, Rocca MA, Martinelli V, Comi G. : 135-144. 3 Rovaris M, Filippi M, Falautano M, Minicucci L, Rocca MA, Martinelli V, Comi G. Relation between MR abnormalities and patterns of cognitive impairment in multiple sclerosis. Relation between MR abnormalities and patterns of cognitive impairment in multiple sclerosis. NeurologyNeurology 1998; 1998; 5050: 1601-1608. 4 : 1601-1608. 4 Lazeron RH, Langdon DW, Filippi M, van Waesberghe JH, Stevenson VL, Boringa JB, Origgi D, Thompson AJ, Falautano M, Polman Lazeron RH, Langdon DW, Filippi M, van Waesberghe JH, Stevenson VL, Boringa JB, Origgi D, Thompson AJ, Falautano M, Polman CH, Barkhof F. Neuropsychological impairment in multiple sclerosis patients: The role of juxtacortical lesion on FLAIR. CH, Barkhof F. Neuropsychological impairment in multiple sclerosis patients: The role of juxtacortical lesion on FLAIR. Multiple Multiple SclerosisSclerosis 2000; 2000; 66: 280-285.: 280-285.
0
1
2
3
4
5
6
7
0-7.5 7.5-23.7 >23.7
Total T2 Lesion Area (sq cm)
Number of Cognitive Tests Performed < 5th Percentile of Controls*
*Rao et al., Neurology, 1989, 39, 161-166
Atrophy as a Predictor of Cognitive Dysfunction
Brain atrophy has been found to be an independent predictor of Brain atrophy has been found to be an independent predictor of cognitive dysfunctioncognitive dysfunction1,21,2
Recent research suggests that, in fact, central atrophy, as measured by Recent research suggests that, in fact, central atrophy, as measured by third ventricle width, was more strongly predictive of cognitive third ventricle width, was more strongly predictive of cognitive dysfunction than either global atrophy or lesion load.dysfunction than either global atrophy or lesion load.33
Quantitative analysis of MRIs of patients with MS suggests that Quantitative analysis of MRIs of patients with MS suggests that atrophy of the superior frontal lobes is associated with cognitive atrophy of the superior frontal lobes is associated with cognitive morbiditymorbidity3,43,4
1. Zivadinov et al. Neuroradiology. 2001;43:272.2. Zivadinov et al. J Neurol Neurosurg Psychiatry. 2001;70:773.3. Benedict et al. Arch Neurol. 2004;61:226.4. Benedict et al. J Neuropsychiatry Clin Neurosci. 2002;14:44.
1010
99
88
77
66
55
44
33
22
77
66
55
44
33
22
VERBALVERBAL SPATIALSPATIAL
TRIALSTRIALS
Normal Ventricular Size (N=19)Normal Ventricular Size (N=19)
Mild Ventricular Dilatation (N=19)Mild Ventricular Dilatation (N=19)
Mod./Severe Ventricular Dilatation (N=9)Mod./Severe Ventricular Dilatation (N=9)
Mea
n w
ord
s re
call
edM
ean
wo
rds
reca
lled M
ean i tem
s recal ledM
ean item
s recalledAtrophy And Memory Performance*Atrophy And Memory Performance*
*Rao et al., Archives of Neurology, 1985, 42, 678-682
Assessment Of CognitiveDysfunction
In the office? What can be done during In the office? What can be done during a neurological examination?a neurological examination? Screening batteries are available, but training is essential and Screening batteries are available, but training is essential and
supervision is highly recommended.supervision is highly recommended.
If you independently use formal or informal screening batteries, If you independently use formal or informal screening batteries, ongoing consultation with a neuropsychologist is strongly ongoing consultation with a neuropsychologist is strongly recommended.recommended.
Assessment Of CognitiveDysfunction
MS Functional Composite (MS Functional Composite (NMSS Clinical Outcomes NMSS Clinical Outcomes Assessment Task Force, 1997)Assessment Task Force, 1997) 3 measures (includes PASAT) 3 measures (includes PASAT) used as outcome measure in clinical trials,used as outcome measure in clinical trials, administered and scored by non-neuropsychologist administered and scored by non-neuropsychologist
MS Functional Composite
Timed 25 Foot WalkTimed 25 Foot Walk
9 Hole Peg Test 9 Hole Peg Test average of right and left armsaverage of right and left arms
Paced Auditory Serial Addition TestPaced Auditory Serial Addition Test number correct, 3 sec. versionnumber correct, 3 sec. version
25
50
75
100
Easy (3s) Hard (2s)
Per
cen
t C
orr
ect
Paced Auditory Serial Addition Test (PASAT)
Control
Multiple Sclerosis
4 6 3 1 9 5
“10” “9” “4” “10” “14”
Assessment Of CognitiveDysfunction
NPSBMS (Neuropsychological Screening Battery for Multiple NPSBMS (Neuropsychological Screening Battery for Multiple Sclerosis, Rao, 1991)Sclerosis, Rao, 1991) Can be administered by subdoctoral personnel after brief Can be administered by subdoctoral personnel after brief
training (30 min)training (30 min) 30-40 minutes to administer,used to screen patients in 30-40 minutes to administer,used to screen patients in
clinical settingclinical setting administered and scored by non-neuropsychologistadministered and scored by non-neuropsychologist Not good for research needing repeated measuresNot good for research needing repeated measures
Neuropsychological Screening Battery for Multiple Sclerosis
Taps 4 Cognitive DomainsTaps 4 Cognitive Domains 1. Sustained Attention and Concentration1. Sustained Attention and Concentration 2. Verbal Learning and Recall2. Verbal Learning and Recall 3. Visuospatial Learning and Recall3. Visuospatial Learning and Recall 4. Semantic Fluency4. Semantic Fluency
Impairment suspected if 2 or more tests are failed Impairment suspected if 2 or more tests are failed (test performance falls below the 5(test performance falls below the 5 thth percentile) percentile)
Assessment Of CognitiveDysfunction
ANAM Computerized Screening Battery as an MS screen ANAM Computerized Screening Battery as an MS screen (Wilken et al., 2003)(Wilken et al., 2003) 25-30 minutes to administer25-30 minutes to administer administered and scored by non-neuropsychologistadministered and scored by non-neuropsychologist Interpreted by neuropsychologistInterpreted by neuropsychologist correlates highly with traditional measurescorrelates highly with traditional measures
Wilken, J.A., Kane, R., Sullivan, C.L., et al. The utility of computerized neuropsychological assessment Wilken, J.A., Kane, R., Sullivan, C.L., et al. The utility of computerized neuropsychological assessment of cognitive dysfunction in patients with relapsing-remitting multiple sclerosis. of cognitive dysfunction in patients with relapsing-remitting multiple sclerosis. Multiple Sclerosis,Multiple Sclerosis,
2003; 2003; 99: 119-127: 119-127
Assessment Of CognitiveDysfunction
In the office? What can be done during In the office? What can be done during a neurological examination?a neurological examination? Can be billed as extended neurological visit. Can be billed as extended neurological visit.
Neuropsychologists like to use standardized tests with norms, but Neuropsychologists like to use standardized tests with norms, but testing takes a long time and is not feasible in your office.testing takes a long time and is not feasible in your office.
There are some quick ways to look at different functional domains, There are some quick ways to look at different functional domains, but these are “quick and dirty”, no normsbut these are “quick and dirty”, no norms
Require a little work up front (very quick), but can be used with Require a little work up front (very quick), but can be used with every pt to screenevery pt to screen
Assessment Of CognitiveDysfunction
In the office? What can be done during a In the office? What can be done during a neurological examination?neurological examination? Given lack of norms, only a screen. Pt will have to serve as own control. Given lack of norms, only a screen. Pt will have to serve as own control.
Do not make too much of one bad time (could be exacerbation). Best to Do not make too much of one bad time (could be exacerbation). Best to follow pt over time and see if any patterns of decline relative to past follow pt over time and see if any patterns of decline relative to past performanceperformance
Techniques for triage/screening only. If poor performance, recommend Techniques for triage/screening only. If poor performance, recommend more extensive workup. Cannot be used for disability claimsmore extensive workup. Cannot be used for disability claims
Even when just performing informal screening, it is strongly Even when just performing informal screening, it is strongly recommended that you consult with a neuropsychologist recommended that you consult with a neuropsychologist
Assessment Of CognitiveDysfunction
In the office? What can be done during In the office? What can be done during a neurological examination?a neurological examination? To look at attention:To look at attention:
1 Trial of PASAT1 Trial of PASAT
Mental Control (WMS)…days backwards, backwards serial 7’sMental Control (WMS)…days backwards, backwards serial 7’s
Cancellation test (public domain)Cancellation test (public domain)
Assessment Of CognitiveDysfunction
In the office? What can be done during a In the office? What can be done during a neurological examination?neurological examination? To look at MemoryTo look at Memory
Short word list with recognition, 10 minute delayShort word list with recognition, 10 minute delay
• Make up a list of 10 common, easy, unrelated words. Make up a list of 10 common, easy, unrelated words.
• Read list to pt 3 times, have pt give list back 3 times (allows you to look at Read list to pt 3 times, have pt give list back 3 times (allows you to look at learning curve)learning curve)
• Use same list for every patient (maybe even collect your own norms)Use same list for every patient (maybe even collect your own norms)
• 10 minute delay10 minute delay
• Need a recognition trial (yes/no, multiple choice), helps look at retrieval versus Need a recognition trial (yes/no, multiple choice), helps look at retrieval versus consolidationconsolidation
Assessment Of CognitiveDysfunction
In the office? What can be done during In the office? What can be done during a neurological examination?a neurological examination? To look at languageTo look at language
Word finding on the MMSE not enoughWord finding on the MMSE not enough
Instead, have 5-10 objects available, used for every patientInstead, have 5-10 objects available, used for every patient
Verbal (lexical) Fluency (FAS, CFL), 1 minute per wordVerbal (lexical) Fluency (FAS, CFL), 1 minute per word
Verbal (semantic) Fluency (Animals, Supermarket)Verbal (semantic) Fluency (Animals, Supermarket)
Assessment Of CognitiveDysfunction
In the office? What can be done during In the office? What can be done during a neurological examination?a neurological examination? To look at Motor Speed/ Processing SpeedTo look at Motor Speed/ Processing Speed
9 Hole Peg Test9 Hole Peg Test
Digit Symbol Modalities Test (public domain)Digit Symbol Modalities Test (public domain)
Neuropsychological Evaluation: Limitations of Screening Batteries
Cannot adequately address specific issues Cannot adequately address specific issues involving vocational counseling, disability involving vocational counseling, disability determination, competency, and rehab determination, competency, and rehab planning (Rao, NSBMS Manual)planning (Rao, NSBMS Manual)
Not suitable for Differential DiagnosisNot suitable for Differential Diagnosis
Not enough information for complicated Not enough information for complicated functional analysisfunctional analysis
Assessment Of CognitiveDysfunction
Comprehensive Neuropsychological ExaminationComprehensive Neuropsychological Examination 3-5 hours, addresses differential diagnosis, disability questions3-5 hours, addresses differential diagnosis, disability questions administered/interpreted by clinical neuropsychologistadministered/interpreted by clinical neuropsychologist Should expect full report with conclusions (e.g., MS or Should expect full report with conclusions (e.g., MS or
depression) as well as recommendations (for work, school, etc).depression) as well as recommendations (for work, school, etc). REIMBURSEMENT IS MORE FREQUENT THAN MIGHT BE REIMBURSEMENT IS MORE FREQUENT THAN MIGHT BE
BELIEVED. NEEDS TO BE A MEDICAL DIAGNOSIS (340, MS) AND A BELIEVED. NEEDS TO BE A MEDICAL DIAGNOSIS (340, MS) AND A CPT CODE FOR NEUROPSYCHOLOGICAL TESTING (96117) BILLED CPT CODE FOR NEUROPSYCHOLOGICAL TESTING (96117) BILLED BY A NEUROPSYCHOLOGIST. SOMETIMES, PRE-CERT NEEDED.BY A NEUROPSYCHOLOGIST. SOMETIMES, PRE-CERT NEEDED.
Assessment Of CognitiveDysfunction
Why to refer for a Comprehensive Neuropsychological EvaluationWhy to refer for a Comprehensive Neuropsychological Evaluation
Diagnosis of MS-related cognitive decline, determination of domains affected, often validating to pt Diagnosis of MS-related cognitive decline, determination of domains affected, often validating to pt and familyand family
Differential Diagnosis (e.g., functional vs. MS, Alz vs MS)Differential Diagnosis (e.g., functional vs. MS, Alz vs MS)
Functional analysis to determine home/school/work needs and accommodations (often, the only way Functional analysis to determine home/school/work needs and accommodations (often, the only way to force help)to force help)
Disability evaluation (Most often, the only way to get disability)Disability evaluation (Most often, the only way to get disability)
Assist the treatment team in determining capability of pt to follow through on treatment, live Assist the treatment team in determining capability of pt to follow through on treatment, live independentlyindependently
Assessment Of CognitiveDysfunction
Comprehensive Neuropsychological EvaluationComprehensive Neuropsychological Evaluation
Whom do you refer to?Whom do you refer to?
Ph.D. level clinical neuropsychologist experienced in the assessment of MS-related Ph.D. level clinical neuropsychologist experienced in the assessment of MS-related cognitive problems. For certain types of difficulties (e.g., speech/language), some cognitive problems. For certain types of difficulties (e.g., speech/language), some
other specialists will assess some aspects of cognitive functioning.other specialists will assess some aspects of cognitive functioning.
The Neuropsychological Evaluation
Sections of the Neuropsychological ReportSections of the Neuropsychological Report
Conclusions:Conclusions:
MUST ANSWER THE REFERRAL QUESTION!!!!!!MUST ANSWER THE REFERRAL QUESTION!!!!!!
Should be relevant to the referral source/needs of the patientShould be relevant to the referral source/needs of the patient
Should include an opinion on diagnosisShould include an opinion on diagnosis
Should ALSO include a functional analysis (what is the patient Should ALSO include a functional analysis (what is the patient capable of? What might they have trouble with? Should reflect needs capable of? What might they have trouble with? Should reflect needs of patient as indicated in the referral section)of patient as indicated in the referral section)
The Neuropsychological Evaluation
Sections of the Neuropsychological ReportSections of the Neuropsychological Report
Recommendations:Recommendations:
REPORT MUST CONTAIN RECOMMENDATIONSREPORT MUST CONTAIN RECOMMENDATIONS
Recommendations should be relevant with respect to the referral Recommendations should be relevant with respect to the referral questionquestion
Recommendations should be possible!Recommendations should be possible!
Should discuss healthcare providers who can help the patient.Should discuss healthcare providers who can help the patient.