Selected Podcast
Northwestern Medicine Neuropsychology
This episode of the Better Edge podcast features James L. Reilly, MD, associate professor of Psychiatry and Behavioral Sciences at Northwestern Medicine. Dr. Reilly discusses neuropsychological testing at Northwestern Medicine and how teams use it to establish a baseline of brain function to measure rehabilitation progress in patients with brain injuries. He goes into detail about the multidisciplinary approach to “brain mapping” in the OR that provides real-time feedback during brain surgery.
Featured Speaker:
James Reilly, PhD
James Reilly, PhD is an Associate Professor of Psychiatry and Behavioral Sciences. Transcription:
Northwestern Medicine Neuropsychology
Melanie Cole, MS (Host): Welcome to Better Edge, a Northwestern Medicine podcast for physicians. I'm your host, Melanie Cole. Joining me today is Dr. James Reilly. He's an Associate Professor of Psychiatry and Behavioral Sciences at Northwestern Medicine. And today, we're delving into the field of neuropsychology. Dr. Reilly, thank you so much for joining us today. I'd like you to start by telling us what a neuropsychologist does and how they work with psychiatrists and other specialists to really provide comprehensive patient care.
Dr James Reilly: Hi, Melanie. I'd be happy to. So, neuropsychology is a field that is a subspecialty within the larger field of clinical psychology. And it focuses on the study and evaluation of brain-behavior relationships. Much of the work that we do as neuropsychologists is to provide what's called a neuropsychological assessment, and this is simply a comprehensive evaluation of a patient's cognitive, emotional, and behavioral functioning when there's a concern for a change or a decline in that person's level of functioning, or if there's a longstanding known issue and there's further characterization of how that individual is doing.
And what our goal is, is to try to work with our physician colleagues and other healthcare providers to help understand what might be underlying from a brain-based perspective any changes in cognition, behavior, emotional functioning; help work with patients and other care providers and family members to guide treatment planning, and then monitor individuals over time, perhaps as they're recovering or if it's a particular condition for which we know there may be some progression, and monitoring that progression.
Melanie Cole, MS (Host): That's a fascinating field that you're in, Dr. Reilly. So, how do you partner with the Northwestern Medicine neurology team to treat patients with epilepsy, Parkinson's and other movement disorders, because we know those movement disorders affect quality of life and psychosocial and emotional issues, psychological issues, all come along with those types of disorders. How do you work together?
Dr James Reilly: Yes. So, we work really closely with a lot of our neurology colleagues. Within the epilepsy program itself, we do conduct a lot of evaluations of patients who are being worked up for a particular type of epilepsy that the neurologist is trying to better understand, particularly any cognitive or behavioral implications from that condition. If it is an epilepsy patient who is having seizures that are not optimally managed by medications and are considered a potential surgical candidate, we provide a pre-surgical evaluation of patients to again characterize their cognitive, behavioral and emotional functioning.
A goal of that is to see if our cognitive findings align with what we would expect for disruption if we think seizures are origining from a particular area within the brain. And if so, provide that information to the neurologist and neurosurgical team to speak to matters around potential risk for any sort of post-surgical cognitive decline as well as to evaluate overall mood and emotional functioning as those factors are going to be important for surgical candidacy and certainly post-surgical adjustment.
Melanie Cole, MS (Host): Interesting. So, how does neuropsychological testing inform the care of a patient? What does that testing really look like?
Dr James Reilly: So, first, we have the opportunity to evaluate patients after they've typically been seen by a neurologist, other medical provider, psychiatrist and such. And we're in the unique position to be able to integrate a lot of preexisting data that may have been already compiled for these individuals. Our evaluations are also fairly comprehensive and time-intensive. And by that I mean, in terms of face-to-face hours spent with a patient, these can range anywhere from, you know, two up to six or more hours. So, we really have the benefit of being able to work with patients over an extended period of time, evaluating using a series of standardized neuropsychological assessment tools to evaluate a whole range of different cognitive abilities, so attention and executive functioning, language, visual-spatial processing, learning and memory.
And for the patient, the experience typically starts with a fairly comprehensive interview conducted by the neuropsychologist prior to any testing that may last upwards of 60 to 90 minutes. The patient then undergoes about a two to four hour neurocognitive or neuropsychological battery under the guidance of the neuropsychologist where we, again, are administering these standardized measures. And after that, the patient is more or less done on their part. And we then compile all of the data acquired from our cognitive evaluation and then incorporate that into other important history information gathered from the clinical interview with the patient, and oftentimes a family member as well as any additional medical records or neurologic or neurodiagnostic findings, and provide this really integrative, comprehensive report. The goal of which is to provide the answers to questions that may have generated the need for the evaluation, and then again, speak to recommendations and/or other guidance around treatment planning, both for the patient and family as well as to the referring provider.
Melanie Cole, MS (Host): Thank you for that comprehensive answer. You really painted a picture for us of how you all work together. Can you go into detail about the brain mapping done by neuropsychologists in the OR in collaboration with neurosurgeons?
Dr James Reilly: Yes. So, this is actually a fairly unique practice for neuropsychologists within the Northwestern Medicine system. And this is largely spearheaded by my colleague, Dr. Melissa Mackey. And for patients who are undergoing, a surgical resection of either a brain tumor or potentially a seizure focus, the neurosurgeon is of course not wanting to resect any patent brain tissue or functional brain tissue. And so, cortical mapping occurs when the patient is in the OR. The brain in fact is exposed. The patient is awake while undergoing this procedure, and the neurosurgeon is providing brief electrical stimulation to the cortical surface of the brain.
The goal of which is to identify areas that are critical for sensory, motor and language-based functions, because of course, they would want to spare those regions for any resection that they're. planning. And so, the neuropsychologist in that intraoperative setting may be conducting some brief assessments of language-based and other brief cognitive skills. Again, the goal of which is to provide some sparing of any resection for those important, critical and functional cortical areas.
Melanie Cole, MS (Host): Dr. Reilly, since this is such a unique advancement in medicine and you're doing it there at Northwestern Medicine, what would you like to tell other physicians as we wrap up about how neuropsychological testing can really benefit their patients should they want to refer or start their own program?
Dr James Reilly: Well, I think, again, neuropsychological assessment is, a really critical component to managing the care and complexity of a number of patients for whom, again, there's a concern about any sort of change in their cognitive, behavioral, or emotional status. We have a number of means to evaluate this person's functioning from an overall functional cognitive standpoint to identify areas of cognitive weakness or decline that may be reflective of an underlying disease process or consequence of injury. And importantly, we can also identify areas of cognitive strengths or preserved abilities which may provide some leverage during a course of cognitive remediation or working with the patient and family and other care providers to maintain that patient's level of functional independence.
Melanie Cole, MS (Host): It's really about quality of life. Absolutely fascinating. Thank you so much, Dr. Reilly, for joining us today. To refer your patient or for more information, please visit our website at breakthroughsforphysicians.nm.org/psychiatry to get connected with one of our providers.
That concludes this episode of Better Edge, a Northwestern Medicine podcast for physicians. Please always remember to subscribe, rate, and review this podcast and all the other Northwestern Medicine podcasts. I'm Melanie Cole.
Northwestern Medicine Neuropsychology
Melanie Cole, MS (Host): Welcome to Better Edge, a Northwestern Medicine podcast for physicians. I'm your host, Melanie Cole. Joining me today is Dr. James Reilly. He's an Associate Professor of Psychiatry and Behavioral Sciences at Northwestern Medicine. And today, we're delving into the field of neuropsychology. Dr. Reilly, thank you so much for joining us today. I'd like you to start by telling us what a neuropsychologist does and how they work with psychiatrists and other specialists to really provide comprehensive patient care.
Dr James Reilly: Hi, Melanie. I'd be happy to. So, neuropsychology is a field that is a subspecialty within the larger field of clinical psychology. And it focuses on the study and evaluation of brain-behavior relationships. Much of the work that we do as neuropsychologists is to provide what's called a neuropsychological assessment, and this is simply a comprehensive evaluation of a patient's cognitive, emotional, and behavioral functioning when there's a concern for a change or a decline in that person's level of functioning, or if there's a longstanding known issue and there's further characterization of how that individual is doing.
And what our goal is, is to try to work with our physician colleagues and other healthcare providers to help understand what might be underlying from a brain-based perspective any changes in cognition, behavior, emotional functioning; help work with patients and other care providers and family members to guide treatment planning, and then monitor individuals over time, perhaps as they're recovering or if it's a particular condition for which we know there may be some progression, and monitoring that progression.
Melanie Cole, MS (Host): That's a fascinating field that you're in, Dr. Reilly. So, how do you partner with the Northwestern Medicine neurology team to treat patients with epilepsy, Parkinson's and other movement disorders, because we know those movement disorders affect quality of life and psychosocial and emotional issues, psychological issues, all come along with those types of disorders. How do you work together?
Dr James Reilly: Yes. So, we work really closely with a lot of our neurology colleagues. Within the epilepsy program itself, we do conduct a lot of evaluations of patients who are being worked up for a particular type of epilepsy that the neurologist is trying to better understand, particularly any cognitive or behavioral implications from that condition. If it is an epilepsy patient who is having seizures that are not optimally managed by medications and are considered a potential surgical candidate, we provide a pre-surgical evaluation of patients to again characterize their cognitive, behavioral and emotional functioning.
A goal of that is to see if our cognitive findings align with what we would expect for disruption if we think seizures are origining from a particular area within the brain. And if so, provide that information to the neurologist and neurosurgical team to speak to matters around potential risk for any sort of post-surgical cognitive decline as well as to evaluate overall mood and emotional functioning as those factors are going to be important for surgical candidacy and certainly post-surgical adjustment.
Melanie Cole, MS (Host): Interesting. So, how does neuropsychological testing inform the care of a patient? What does that testing really look like?
Dr James Reilly: So, first, we have the opportunity to evaluate patients after they've typically been seen by a neurologist, other medical provider, psychiatrist and such. And we're in the unique position to be able to integrate a lot of preexisting data that may have been already compiled for these individuals. Our evaluations are also fairly comprehensive and time-intensive. And by that I mean, in terms of face-to-face hours spent with a patient, these can range anywhere from, you know, two up to six or more hours. So, we really have the benefit of being able to work with patients over an extended period of time, evaluating using a series of standardized neuropsychological assessment tools to evaluate a whole range of different cognitive abilities, so attention and executive functioning, language, visual-spatial processing, learning and memory.
And for the patient, the experience typically starts with a fairly comprehensive interview conducted by the neuropsychologist prior to any testing that may last upwards of 60 to 90 minutes. The patient then undergoes about a two to four hour neurocognitive or neuropsychological battery under the guidance of the neuropsychologist where we, again, are administering these standardized measures. And after that, the patient is more or less done on their part. And we then compile all of the data acquired from our cognitive evaluation and then incorporate that into other important history information gathered from the clinical interview with the patient, and oftentimes a family member as well as any additional medical records or neurologic or neurodiagnostic findings, and provide this really integrative, comprehensive report. The goal of which is to provide the answers to questions that may have generated the need for the evaluation, and then again, speak to recommendations and/or other guidance around treatment planning, both for the patient and family as well as to the referring provider.
Melanie Cole, MS (Host): Thank you for that comprehensive answer. You really painted a picture for us of how you all work together. Can you go into detail about the brain mapping done by neuropsychologists in the OR in collaboration with neurosurgeons?
Dr James Reilly: Yes. So, this is actually a fairly unique practice for neuropsychologists within the Northwestern Medicine system. And this is largely spearheaded by my colleague, Dr. Melissa Mackey. And for patients who are undergoing, a surgical resection of either a brain tumor or potentially a seizure focus, the neurosurgeon is of course not wanting to resect any patent brain tissue or functional brain tissue. And so, cortical mapping occurs when the patient is in the OR. The brain in fact is exposed. The patient is awake while undergoing this procedure, and the neurosurgeon is providing brief electrical stimulation to the cortical surface of the brain.
The goal of which is to identify areas that are critical for sensory, motor and language-based functions, because of course, they would want to spare those regions for any resection that they're. planning. And so, the neuropsychologist in that intraoperative setting may be conducting some brief assessments of language-based and other brief cognitive skills. Again, the goal of which is to provide some sparing of any resection for those important, critical and functional cortical areas.
Melanie Cole, MS (Host): Dr. Reilly, since this is such a unique advancement in medicine and you're doing it there at Northwestern Medicine, what would you like to tell other physicians as we wrap up about how neuropsychological testing can really benefit their patients should they want to refer or start their own program?
Dr James Reilly: Well, I think, again, neuropsychological assessment is, a really critical component to managing the care and complexity of a number of patients for whom, again, there's a concern about any sort of change in their cognitive, behavioral, or emotional status. We have a number of means to evaluate this person's functioning from an overall functional cognitive standpoint to identify areas of cognitive weakness or decline that may be reflective of an underlying disease process or consequence of injury. And importantly, we can also identify areas of cognitive strengths or preserved abilities which may provide some leverage during a course of cognitive remediation or working with the patient and family and other care providers to maintain that patient's level of functional independence.
Melanie Cole, MS (Host): It's really about quality of life. Absolutely fascinating. Thank you so much, Dr. Reilly, for joining us today. To refer your patient or for more information, please visit our website at breakthroughsforphysicians.nm.org/psychiatry to get connected with one of our providers.
That concludes this episode of Better Edge, a Northwestern Medicine podcast for physicians. Please always remember to subscribe, rate, and review this podcast and all the other Northwestern Medicine podcasts. I'm Melanie Cole.