Transcription:

Melanie Cole (Host): Welcome to Expert Insights with the Carle Foundation Hospital. I'm Melanie Cole and today we're exploring Neuropsychology Evaluation. Joining me is Dr. Tara Riddle. She's a Neuropsychologist with the Carle Foundation Hospital. Dr. Riddle, it's a pleasure to have you join us today. Tell us a little bit about a neuropsych evaluation and identify for us some of the common conditions that may benefit from this type of assessment.  

Tara Riddle, PhD (Guest): So, neuropsychology evaluations are requested when there is a concern either by the patient or by their treating provider, that there have been some changes to the patient's thinking. And that includes changes to skills such as memory, attention, speed of processing, language, problem solving, those sorts of skills. Probably the most common concern that we see people for is when they're having concerns about their memory. There's lots of different conditions that can be related to those sorts of changes. So, we're often asked to develop a more comprehensive and objective assessment of what might be causing some of the symptoms the patient is having. So, common concerns that we see people for include memory disorders along the lines of different types of dementias.

Most commonly, people think of Alzheimer's disease, though there are many other types of dementias that can also have cognitive symptoms such as frontotemporal dementia, vascular dementias or dementias associated with other sorts of conditions like Parkinson's disease. We also see people in relation to acquired conditions from brain injuries, so traumatic brain injury or concussion as well as later effects of stroke. And then other neurological conditions, things like epilepsy, multiple sclerosis, if there's been a neurological tumor. Other chronic conditions that can affect cognition include different sorts of systemic illnesses. So, things like diabetes, hepatitis, HIV, cardiac issues. So, really a wide range of things. Anything that can really affect the brain's function or cognition in general are things that we can help to assess.

Host: Wow that was an excellent explanation Dr. Riddle. So, tell us the types of skills and abilities that are assessed with the neuropsych assessment.

Dr. Riddle: So as far as the skills that we assess with cognitive testing, our tests are non-invasive. So, it's not anything that is scary or that physically hurts. It's a lot of paper and pencil testing, some things where they answer questions out loud, some skills that are tested with use of a computer. Really just allows us to get a nice standardized picture of someone's strengths and weaknesses. So, we assess skills including attention, speed of processing, memory, both visual and verbal, problem solving skills, language, visual spatial skills, and then sometimes the motor testing as well, looking at strength or speed. And those are all assessed in a way that allows us to compare a person's performance to what would be typical or expected when we take into consideration other sorts of demographic factors, such as their age or their access to education. So, it allows us to get a nice benchmark of where they're functioning relative to what we might expect.

So, a lot of times I describe it to patients that it's kind of like getting lab values for your brain function. So, just like we would check something like an A1C or someone's cholesterol levels, it gives us numbers. But they're not really numbers like scores or grades that we associate with school testing. There are things that let us know if people are within a range of what would be typical or normal. And if we see deviations from that, it gives us an idea of what other sorts of medical factors we may need to check out further.

Host: Isn't that so interesting what you do, it's fascinating. So, tell us a little bit about the processes of a neuropsych eval to determine those strengths and weaknesses of the patients in regards to helping the team come up with the best treatment plan.

Dr. Riddle: So, when a patient comes in, first step is that we sit down with them and then any family member that they may have brought along with them to get a good comprehensive history. So, we ask a lot of questions, both about what sort of symptoms they are experiencing and the timeline of these symptoms, but also getting good details as far as background. So, we start with developmental history. Thinking about things like their development of cognitive skills, even in early childhood to determine if there's any kind of baseline cognitive challenges. We cover medical history to determine what sort of medical risk factors they may have for cognitive change.

We also look at aspects of their psychiatric history to determine if there's any sorts of mood or emotional factors that could be playing a role in changes to thinking. And then we also cover other aspects of family history in terms of weighing risk, as well as other sorts of demographic or biographical details that allow us to understand a little bit better what their baseline level of functioning might be like. And it's very helpful for us to have a collateral informant, like a family member present for that initial interview, because depending on the cause of the patient's cognitive issues, they may have varying ability to pick up on the sorts of things that others may notice or have concern about. So, it just provides us with some extra information to try and best sort out what would be typical for this patient? What is the change? And how do we integrate all that information from the testing so once we finished that first bit of the interview, then the patient will transition to doing testing with one of our psychometricists.

So, a psychometrist is a specialized technician that administers all those standardized tasks for us. And that's really what takes up most of the time for the appointment is having the patient perform those testing tasks. And they'll do that one-on-one with the psychometrist. So, if they have brought someone with them, they will be waiting for them during that time. And the types of tasks that they are doing with the psychometrist again, are noninvasive. So, it's nothing that's painful. Though it does take several hours to get through things usually between two and three hours of testing would be typical for most common concerns. But those tests are done one-on-one in a quiet setting without interruptions to really get us a good picture of how their brain has the ability to function. So, they're provided with instructions for those different tasks and the technician records their responses, and then we get the patient through all of that.

And then following that, the technician will have everything scored up and allow us to get that good data, that allows us to see that pattern of strengths and weaknesses, from which point we can then evaluate what that pattern looks like. Does it resemble specifically, any characterological patterns that would show that there's a specific diagnosis or a specific type of additional information that we might need to help in developing their treatment plan.

So, oftentimes when we're looking at those patterns, if we see something that suggests one type of specific cause, those will be details that we forward back to that referring provider, as well as discuss with the patient as far as what next, the steps might be. Whether that's additional workup from a medical standpoint, whether that's consultation with a different sort of specialist, such as a neurologist or whether there's other sorts of specific behavioral interventions to help with managing strengths or weaknesses.

So, for example, different ways of approaching tasks or different sorts of ways to work at improving memory like using calendars or lists, those sorts of things. As well as if there's a need for additional supports to the family or the caregivers. So, does there seem like there needs to be a greater level of supervision or do they need to be linked up with social work to assist them with caregiving resources? Those sorts of things. So, it really spans quite a bit that we're considering when we think about those recommendations. And we try to get that consolidated as best we can when we discuss with the patient to get them set up for next steps.

Host: I understand there's a large variety of patients that could benefit from a neuropsych evaluation, but how do they respond to these?

Dr. Riddle: It's not really a specialty that people have come in contact with often, before they're referred to us. So, a lot of times there's just a lot of questions. Oftentimes when people hear neuro-psychology, sometimes there was some initial concern, because psychology is in that, that people have concerned that it's a psychiatric evaluation. Or that we are specifically only assessing for a mental health issue. But really it's sort of other factors that we're looking at more focused on the cognitive side. So, while we are trained as psychologists, the role that we have in a neuropsych evaluation is really assessing that cognition as opposed to doing any sort of mental health intervention.

So, I would say that probably one of the most common questions we get is exactly what are we going to be doing here? Oftentimes there's some apprehension because people wonder if we're going to be doing something more invasive, like lab work or putting them in a scanner or things along those lines. But it's really not anything that is physically uncomfortable. I'd say the main demand for the sort of assessment we do, is just time. But as we go through this, I like to emphasize to the patients as well that the whole reason we do these evaluations is because people are having concerns about their thinking.

So, if there is any sort of hesitance or worry about performing poorly on the testing, it's really not like school testing where you get a grade or anything along those lines. It's just more data for us to try to determine strengths and weaknesses and how to help. And most folks really do seem to respond pretty well to that. I think oftentimes after you get a chance to talk to them through that interview and develop a rapport and work on helping them feel more comfortable about everyone's willingness to help, that really seems to help quite a bit in terms of getting them through the testing to help us make those next steps.

Host: So interesting. Dr. Riddle wrap it up for us. What would you like other providers to take from this podcast today about the recommendations that are made from a neuropsych evaluation, why it's important to refer and really what kinds of patients you're looking for?

Dr. Riddle: Really we're just here to help. So, if you do hear concerns from your patients or their families, that they are having concerns about any aspects of cognition, please feel free to send them on to us, to have us take a look. If you have questions about if a referral is appropriate or not for our service, also feel free to reach out, contact our office. We're happy to take questions if you're kind of on the fence about whether something's an appropriate referral or not. But I think, you know, having that good understanding of where things are at can be very helpful. We see just as many folks that are worried well as opposed to people that we do detect problems with.

And so I think sometimes even that information about what's not present on the testing can be hugely helpful as far as giving people a roadmap to work on healthy aging. So, anytime that there is concern along those lines, and again, please feel free to reach out. If there are other questions, our office is happy to try to answer those.

Host: Thank you so much. What an informative episode this was. Thank you, Dr. Riddle for joining us today. And that concludes this episode of Expert Insights with the Carle Foundation Hospital. For a listing of Carle providers and to view Carle sponsored educational activities, please visit our website at carleconnect.com for more information and to get connected with one of our providers. Thanks so much for listening. I'm Melanie Cole.