neuropsychology presentation

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  • 10/22/09

  • A sub-specialty of clinical psychologyNeuropsychologists 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 impairmentTypically, neuropsychologists perform assessments (psychological tests) that evaluate functioning of the brainDetermine if performance is in expected rangeDetermine if performance is consistent with brain damageMake 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 notIf 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 betterWe usually give several different types of tests, and a neuropsychological evaluation can take anywhere from 2-6 hours depending on the number of tests givenWe 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 performanceExamples: Deteriorating conditions such as dementia, multiple sclerosisRepeated 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 brainMany take specialized courses in neuroanatomy, neurobiology, and neurological illnessAlso have extensive use and knowledge of neuropsychological test administration and interpretationHave 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 PsyDAmerican Board of Clinical NeuropsychologyAmerican Board of Professional NeuropsychologyAmerican Board of Pediatric Neuropsychology

  • Typical cases:Traumatic brain injuryBrain tumorsCerebrovascular accidents (CVA)Stroke, aneurysm ruptureEncephalitisEpilepsy/Seizure disordersDementias (Alzheimers disease, vascular dementia, etc.)Mental illnesses with neuropsychological markersSchizophreniaADHD, learning disabilities

  • Inpatient Settings:Conducting rounds on your patients to monitor daily cognitive functioningInterviewing new inpatients and their family members to gather background information about things that could affect their brain functioning and recoverySeeing outpatients (who were previously hospitalized as inpatients)Interview patient and family about recoveryConduct neuropsychological tests to measure recovery (typically tech)Provide feedback to patient and family about functioningWhat areas have improved, what areas are still weakRecommendations in terms of driving, financial management, return to work, methods to continue improving functioningReport writingDocument progress on roundsDocument findings for outpatientsTeam 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 therapistsDetermine if person is able to be discharged

  • Outpatient Setting:Interview patients and families about current brain functioning and backgroundPerform neuropsychological evaluations (tech or neuropsychologist, depending on practice)Provide feedback about performance on evaluationsReport writing to document findings; may also send report/discuss with other treatment providers such as medical doctorTherapySome neuropsychologists also provide therapy to their patientsMay work on mood functioning, adherence, family therapy, or other issuesDepends on neuropsychologists interest, and availability in practice

  • 85 y/o Caucasian Male16 years education, career militarySon brought in with complaints of:Memory problems beginning 2 years agoFrequently writes notes, but then doesnt act on themSometimes writes several notes saying same thing6 months before eval, son discovered that patient had not filed his taxes for the previous 2 yearsAlso reported difficulty with:Balancing checkbook, paying billsDrivingseveral accidents, has become lost in familiar areasWondering if problems related to dementia

  • Neuropsychological Evaluation:Patient interviewPatient does not believe he is having any problemsFamily interviewSon reported problems described on previous slideAssessment and InterpretationSee next Slide

  • Assessment Results:Memory Test:Initial recall: 50%ileDelayed recall: 63%ileAttention tests: 63%ile simple attn, 91%ile complexLanguage: Boston 6%ile, verbal fluency 70%ileProblem Solving: verbal-68%ile, visual 6%ileVisuospatial Construction: 5%ileIs his pattern of performance consistent with that of others with dementia?No, his memory is too good as is his attention, language and problem-solvingSo, 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 retinaRetina = nerves that communicate sightChoroid = blood supply to the retinaPrevalence:10% of patients 66-74 years30% of patients 75-85

  • Inability to recognize faces despite intact visual abilitiesCaused by damage to the fusiform gyrus (in the temporal lobe)

    http://www.youtube.com/watch?v=vwCrxomPbtY

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