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Neuropsychology : 

Neuropsychology 10/22/09

Clinical Neuropsychology : 

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

Clinical Neuropsychology : 

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

Neuropsychological Evaluation: An Explanation for Clients : 

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

Clinical Neuropsychology : 

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

Clinical Neuropsychology : 

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

Clinical Neuropsychology : 

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

Clinical Neuropsychology : 

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

Typical Activities of a Clinical Neuropsychologist : 

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

Typical Activities of a Clinical Neuropsychologist : 

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

Case Example: Patient A : 

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

Case Example: Patient A : 

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

Case Example: Patient A : 

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?

Age-related macular degeneration : 

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

Prosopganosia : 

Prosopganosia Inability to recognize faces despite intact visual abilities Caused by damage to the fusiform gyrus (in the temporal lobe)

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