Neuropsychologists add to knowledge of issues
Mom has multiple sclerosis and the family doctor sent her to a geriatrician because of her cognitive and physical changes. She was seen and then sent for another assessment by a neuropsychologist. I am not sure what this specialty adds. Signed, Feeling bounced
I will start off by saying that you are lucky. As an occupational therapist, I have had the privilege of working with this group of talented professionals. We often put our findings together to understand what is happening as the result of an illness that is diagnosed or one that is in need of clarification.
To clarify for you, neuropsychologists are psychologists who specialize in the area of how the brain and nervous system affect daily function. These professionals often are referred to in order to help us gain a better understanding of how the brain is working in different areas.
Neuropsychologists study brain anatomy and how the different parts of the brain are used and how they interact. This puts them in a particularly good position to help with diagnoses, as well as getting a better understanding of some of the cognitive, behavioural and other changes that are associated with particular neurological conditions.
Examples of the kinds of patients seen by neuropsychologists are patients with Alzheimer’s disease, Parkinson’s disease, stroke, traumatic brain injuries and brain tumours. Patients with these conditions often are referred to neuropsychologists so that the referring physician can obtain a clearer picture of the specific effects of a given condition on a person’s cognitive functions and that person’s ability to function adaptively in everyday life.
For example, the physician may see physical changes on an MRI or a CT scan, but the daily issues that may be present are best assessed through neuropsychological testing.
Neuropsychological testing is also valuable in other respects. For example, an initial assessment serves to establish a baseline of an individual’s cognitive functioning in the early stages of a disease. A reassessment can identify what specific changes have occurred with its progression. It also can provide information about how a different pharmacological (medication) treatment is affecting the individual.
The types of tests neuropsychologists use are designed to assess such functions as attention, memo- ry, learning and problem-solving skills. Some people wonder why these are necessary if the cognitive screening was already conducted by a family physician. Front-line screening tests are usually brief and narrow in scope. They provide a general idea of an individual’s cognitive capacities and can help identify individuals in need of more comprehensive assessment.
Dr. Dmytro Rewilak, a neuropsychologist at Baycrest Health Sciences, explains: “When it comes to dementias, two general patterns of neuropsychological impairment have been identified and have been named, according to what part of the brain is most involved. One pattern is called ‘cortical’ because it primarily involves the cortex (i.e., the outer layer of brain). The second pattern is called ‘subcortical’ because it primarily involves areas of the brain lying beneath the cortex. The importance of this distinction can be illustrated with reference to memory. When impaired, the nature of the memory impairment differs, depending on what brain areas are most affected. The memory problems associated with Alzheimer’s disease, a cortical dementia, are different than those associated with Parkinson’s disease, a subcortical dementia. In the former, the person cannot form new memories, while in the latter the person can form them but needs cues and prompts to retrieve them. A neuropsychological assessment helps to define the nature of the memory problem, and this has different implications for management.”
Testing is lengthy (two to six hours) and sometimes needs to be broken down for people who cannot tolerate it due to physical or other reasons. However, many individuals actually enjoy the testing. Some indicate that they liked the challenge, while others find it helpful to know what cognitive areas have been affected by their disease.
Another useful outcome of neuropsychological testing is that it identifies strengths the person can utilize, even in the midst of other problems and issues. Families, other professionals and staff caring for someone can utilize this information to help the individual.
Unfortunately, not every medical centre or health unit has access to this service, but if yours does, remember — you are not being bounced. Rather, I urge you to look at it as a welcome, additional resource in the tool kit of understanding, planning and caring for any neurological issue. Nira Rittenberg is an occupational therapist who specializes in geriatrics and dementia care at Baycrest Health Sciences Centre and in private practice. She is co-author of Dementia A Caregiver’s Guide available at baycrest.org/dacg. Email questions to caregivingwithnira@baycrest.org.