Clinical Neuropsychology

 

What is Clinical Neuropsychology?
 
Clinical neuropsychology is a specialty field within clinical psychology, dedicated to understanding the relationships between brain and behavior, particularly as these relationships can be applied to the diagnosis of brain disorder, assessment of cognitive and behavioral functioning, and the design of effective treatment.  
 
Who is a Clinical Neuropsychologist?
 
A clinical neuropsychologist is an independent, professional, doctoral level psychologist who provides assessment and intervention services to people of all ages, based upon the scientific concepts of clinical neuropsychology. Training in clinical neuropsychology comprises a broad background in clinical psychology, as well as specialized training and experience in clinical neuropsychology.
 
Why have I been referred?
 
Neuropsychological evaluations are requested specifically to help your doctors and other professionals understand how the different areas and systems of the brain are working. Testing is usually recommended when there are symptoms or complaints involving intellectual compromise, cognitive and/or neurobehavioral dysfunction that involve but are not restricted to, memory deficits, language disorders, learning disabilities, developmental disabilities, pervasive development disorders, impairment of organization and planning, difficulty with cognition and perceptual abnormalities.
 
Neuropsychological evaluations conducted in (but not limited to) the following areas :
 
Traumatic brain injury
Learning disabilities
Attention deficit disorders
Epilepsy
Dementia
Anoxia
Autism
Movement disorders
Neuropsychiatric disorders
  (eg. Pervasive development disorders, Parkinson’s disease, anxiety and depression)
Closed head injury
Seizure disorders
Brain tumours
Strokes
Monitoring progress during rehabilitation after acquired brain injury
Anger management
Anxiety & Phobias
Asperger’s syndrome
Attention Deficit Hyperactivity Disorder (ADHD)
Bipolar disorder
Depression
Gay/lesbian issues
Grief & loss
Health-related problems
Impairment assessment
Impulsive behaviours
Memory problems
Obsessive-Compulsive Disorder (OCD)
Pre and post surgery assessment
 
Evaluation helps to understand if and where cognitive dysfunction exists. Neuropsychological examinations aid in understanding how a disease process has progressed and affected the individual. It is also used for differential diagnostic purposes and to evaluate effects of treatment and recovery.
 
What is Assessed?
 
A typical neuropsychological evaluation will involve assessment of the following :
 
General Intelect
Higher level executive skills 
  (eg. Decision making, sequencing, reasoning, problem solving)
Attention and concentration
Learning and memory
Language
Visual-spatial mskills (eg. perception)
Motor and sensory skills
Mood Adaptive behaviour
 
Some abilities may be measured in more detail than others, depending on your needs.
 
What Will the Results Tell Me?
 
Test results can be used to understand your situation in a number of ways:
 
Testing can identify weaknesses in specific areas. It is very sensitive to mild memory and thinking problems that might not be obvious in other ways. When problems are very mild, testing may be the only way to detect them. For example, testing can help determine whether memory changes are normal age-related changes or if they reflect a neurological disorder. Testing might also be used to identify problems related to medical conditions that can affect memory and thinking, such as diabetes, metabolic or infectious diseases or alcoholism.
 
Test results can also be used to help differentiate among illnesses, which is important because appropriate treatment depends on accurate diagnosis. Different illnesses result in different patterns of strengths and weaknesses on testing. Therefore, the results can be helpful in determining which areas of the brain might be involved and what illness might be operating. For instance, testing can help to differentiate among Alzheimer’s disease, stroke and depression. Your physician will use this information along with the results of other tests, such as brain imaging and blood tests, to come to the most informed diagnosis possible.
 
Sometimes testing is used to establish a “baseline” or document a person’s skills before there is any problem. In this way, later changes can be measured very objectively. Test results can be used to plan treatments that use strengths to compensate for weaknesses. The results help to identify what target problems to work on and which strategies to use. For example, the results can help to plan and monitor rehabilitation or to follow the recovery of skills after a stroke or traumatic brain injury.
 
Studies have shown how scores on specific tests relate to everyday functional skills, such as managing money, driving or readiness to return to work. Your results will help your doctors understand what problems you may have in everyday life. This will help guide planning for assistance or treatment.
 
Examples of common referral issues :
 
Learning and development; Does this patient have a developmental disorder affecting learning? If so how can we help him to circumvent these weakness?
 
Traumatic brain injury; Can this person resume normal tasks such as returning to employment/school, what are the cognitive effects of his injury? Are there are neuropsychological effects post surgery? How can we help this person integrate back into their daily normal life post injury?
 
Memory related issues; Does my child have any issues with memory? Is she better at some aspects of memory and not so at others? If so how can we help her?
 
Questions that address Medical / Legal Issues:
 
Does the person have cognitive and / or behavioral problems a consequence of an accident / or injury?  If so, what types of problems, how severe are the problems and what are the functional consequences of the injury?
 
What can you expect from a Neuropsychological Evaluation?
 
A neuropsychological evaluation usually consists of an interview and testing. During the interview, information that is important for the neuropsychologist to consider will be reviewed. You will be asked about your symptoms, medical history, medications and other important factors. Testing involves taking paper and pencil or computerized tests and answering questions. The time required depends on the problem being assessed. In general, several hours are needed to assess the many skills involved in processing information. Some tests will be easy while others will be more complex. The most important thing is to try your best. Bring glasses or hearing aids if you use them. Try to rest and relax before your evaluation. You will probably find testing interesting and the detailed information that is gathered will contribute to your care.