Transcription:
The Role of Neuropsychology in Health and Healthcare

Another informational resource from UK Healthcare. This is UK HealthCast, featuring conversations with our physicians and other healthcare providers.

Prakash Chandran: Welcome to UK HealthCast from the University of Kentucky Healthcare. I'm your host Prakash Chandran. Today, we'll be talking about the emerging field of neuropsychology, how it can help patients and healthcare overall. And here to educate us is Dr. Timothy Ainger. He's a clinical neuropsychologist at the UK College of Medicine and Kentucky Neuroscience Institute. Dr. Ainger, thank you so much for joining us today. I really appreciate your time. I'm curious, let's just start with the basics, what exactly is neuropsychology?

Timothy Ainger, PhD: Thank you. My pleasure. Neuropsychology is a specialty field of clinical psychology, and it looks at how the brain works with the rest of the body. And the easiest thing that we tend to say is it's focusing on the brain and behavior relationship. So it looks at how mood factors, medical factors, disease characteristics, neurologic concerns, all of these things, et cetera, how it influences cognition, so your thinking skills, your behavior and we can evaluate and make recommendations on any changes that individuals may be experiencing.

Prakash Chandran: So, just as a lay person, are you saying that, if I'm having, for example, a pain in my knee or some other area of the body, that it could actually be my brain misfiring and telling that pain to go there?

Timothy Ainger, PhD: One of the things that I like to explain to people who ask why they need a neuropsychological evaluation is I say that we are evaluating the part of your body that literally controls the rest of your body. So there are certain conditions or concerns or presentations where people may find that there are parts of their body that are not in their head that are experiencing changes and they may represent concerns or be symptomatic of changes that are going on in their brain. And it's the integrated approach of the neuropsychologist and a neurologist that can usually work together to get to the bottom of those things.

Prakash Chandran: And tell me, is this a relatively new field?

Timothy Ainger, PhD: Well, that's yes and no. If you look at where the real roots of brain behavior relationships come from, in ancient Egypt around the year 3000 to 2700 BC, there was a script that was written that we refer to it now as the Edwin Smith Surgical Papyrus. It's largely attributed authorship to Imhotep and it chronicles a series of physical injuries and descriptions of medical treatments that were sustained while some of the pyramids are being built.

And what's noteworthy about this is that on this papyrus, there are detailed descriptions of how injuries that were sustained in the head manifested in behavior or in other parts of the body. So if you want to go all the way back, you can say that about 3000 BC, people were starting to look at the relationship that the brain had with behavior and other areas of functioning. But fast forward several thousands of years, the concept of modern day neuro-psychology is fairly contemporary. The first time that neuropsychology was used in a presentation was in 1913. It was being used in the context to talk about mind disorders. Then, the first real fundamental textbook of neuropsychology came out in 1980 that properly defined the field as we know it today.

Prakash Chandran: Wow. That is fascinating. So the ancient Egyptians had it right. And it kind of became a lost art and then was picked up and modernized, right?

Timothy Ainger, PhD: We weave from Ancient Egypt to Aristotle in Ancient Greece, who based behavioral findings on research that he did on brains. And then, we wound our way into the 1700s and then, as psychiatry and psychology developed as a field, we sort of refined further through all of that.

Prakash Chandran: Got it. So Dr. Ainger, tell me who might benefit from seeing a neuropsychologist?

Timothy Ainger, PhD: Neuropsychologists would be very useful for someone who believes that they are experiencing changes in their thinking skills which we broadly define as cognition. So memory, attention, concentration, word-finding abilities, things like that. A neuropsychologist would also be a great referral for someone who has experienced some sort of injury or insult or diagnosis of the central nervous system or brain. We contribute to evaluation and predicting trajectory of rehabilitation for traumatic brain injury or stroke or even chronic medical conditions like multiple sclerosis or epilepsy.

Prakash Chandran: Okay. So it really sounds like there's a range. And, you know, just asking for myself and my wife, we always say that we're forgetful people. Like you can tell us something and we won't remember it the next day. And, you know, I'm sure that there's a lot of people that can relate to that. Is that something that like we would go to see a neuro psychologist for if that's something we wanted to improve?

Timothy Ainger, PhD: Well, just like anything else that you see in your life, as we get older, once we realize we're not 19 years old anymore, every part of our body starts to change and behave differently. We get creeks in our knees and we don't wake up as easily in the morning and, you know, we get arthritis and things like that.

Some of these are just normal concerns for aging. You know, we expect our minds to change slightly and sort of refine as we get older. But once this becomes problematic, it's gone from, "I forgot where I put my keys" to "I forgot where I parked my car" to "I forgot what your birthday is" to "I forgot your name." There's a progression of these things. So once things become bothersome, noteworthy problematic, or generally outside of the normal expectations, then it would be time to initiate an evaluation and really see what's going on.

Prakash Chandran: Okay. Yeah, I was just going to ask you, how do you know when you need to see a neuropsychologist? And it sounds like when something is progressively getting worse, then when you need...

Timothy Ainger, PhD: That's a great indication, when you feel like something is progressively getting worse. Also, there are times when we, as an individual, don't notice the changes significantly, but those who we see on a periodic basis, it's brought to our attention by them. So, you don't notice changes as much when you see somebody on a day to day to day. But if you're seen every six months or every year, and people notice that you've progressed from where you were the last time you saw them, which is why so many of these referrals come from great referring providers who treat people over time and say, "Over the past two or three appointments, we've noticed a significant change in X, Y, and Z ability. Let's get it checked out."

Prakash Chandran: Okay. And is the demographic of people that you serve typically on the older side?

Timothy Ainger, PhD: It varies widely. There is a lot of older population that comes to see neuropsychology because of concerns of aging, which, you know, memory being a big one of those. And there are a lot of neurodegenerative conditions, which are conditions where the brain sort of changes, weakens and progresses to a more debilitating state over time that are more prevalent among the older set, the big ones being like Alzheimer's disease or Parkinson's disease, et cetera. But neuropsychology is not restricted to the older set. We see younger adults, teenagers and children as needs fit, because there are several conditions that can affect people across the lifespan. One of the examples that jumps out is in being on our multidisciplinary epilepsy team and making sure we're providing evaluative services and better classifying functional abilities for people who have epilepsy. We see children, teenagers, young adults, middle adults, and older adults and just modify our approach accordingly.

Prakash Chandran: Understood. So let's say someone is referred to a neuropsychologist like yourself, talk to us about what a visit entails.

Timothy Ainger, PhD: It can be a little intimidating because a neuropsychology visit tends to be a longer doctor's appointment where you might go to see your regular physician for 15, 30, 45 minutes and have that be the end of it. A neuropsychology visit can be hours in length. The typical structure of a visit would be you would spend time first doing what we would call a clinical interview, where the neuropsychologist would talk with you about the symptoms you've been experiencing, patterns, lifestyle changes. We would talk about medical diagnoses, what's going on in your social environment, your psychiatric history, your substance abuse, history, et cetera.

Once that's done, we would begin the testing evaluation process, which is where we use standardized measures to evaluate very specific and broad functions across the brain, across the cognitive skill area that a person would have. And that can take time because we want to be thorough, but not, you know, oppressive. So we want to make sure we get as much information as we can. But not to the point where someone is becoming too fatigued. Once that evaluation is over, we then score all the measures and standardize the scores and produce a report that integrates all of the data, summarizes everything, and then makes inferences about functional abilities based upon the scores and the performances that we saw on the tests.

Prakash Chandran: So one of the things that you alluded to earlier is that a neuropsychologist might be part of a multidisciplinary team that treats a patient. So I'm curious as to how neuropsychology itself can add to the medical care and treatment patients receive.

Timothy Ainger, PhD: Absolutely. A neuropsychologist is a great addition to really any multidisciplinary team because, in our training and in our experience, we sort of straddle the line between both psychology and neurology. So we're able to look at things from multiple perspectives and talk about how multiple systems and abilities work together and one may beget the other or a manifestation of one may influence the other. And there are several multidisciplinary teams here at UK Healthcare on which our neuropsychologists sit or take part in regularly. One of the big things we do is we talk about how the physical symptoms or the diagnoses or the neurologic concerns can also manifest as emotional or affective concerns. Is the patient experiencing emotional distress or psychiatric symptoms that are complicating their neurologic presentation or vice versa? What can be attributed to emotional concerns? What can be attributed to a physical condition? And how can we better manage that? And it's a way of getting an enhanced more in depth and, frankly, more broad, functional understanding of a patient.

Prakash Chandran: So, you know, we talked about neuropsychology as it relates to, you know, symptoms that are potentially progressively getting worse. But I'm curious as to the role neuropsychologists play in treating patients who have experienced trauma.

Timothy Ainger, PhD: Are you referring to psychological trauma, physical trauma or all trauma?

Prakash Chandran: Let's just talk about more generalized trauma that covers all of what you just mentioned.

Timothy Ainger, PhD: Okay. So trauma can be multifaceted. If we talk about someone who experiences a physical trauma, like an accident or a head injury, something of that effect if there's any suspicion whatsoever that the head or the brain or the central nervous system may have been impacted or damaged from the incident, the neuropsychologist can go in and evaluate the functional skills of that individual and look and see how change might progress over time. We can get a baseline evaluation immediately following the insult or the injury, and then use it as a benchmark against which we can score future evaluations to show how much progress has been made in rehabilitation or we can look at the overall pattern of scores and see if there's one particular functional area that has been impacted more significantly. And it'll give us a very precise understanding of what that region of the brain really does and how it's going to be impactful going forward, making recommendations functionally for what they can, can't, should be able to do as they progress post-trauma.

If we're talking about psychological trauma, individuals who have experienced any number of traumatic incidences or diagnosed with PTSD, have anxiety, et cetera, there are very tangible behavioral presentations that can come about that can present as some other neurologic manifestation. Some people may begin to experience memory impairment or attention deficits or focus or vigilance problems that look like perhaps the presentation of a neurodegenerative system problem or brain lesion or something like that. But in turn, it's actually a response to the psychological trauma and there's no physical brain injury. So being able to parse that out would better enhance the treatment recommendations we would have because you don't want to look at the symptoms and treat the wrong underlying condition for that individual.

Prakash Chandran: So Dr. Ainger, this conversation so far has been fascinating. I'm curious as to how you specifically became interested in the field of neuropsychology and what led you to become a neuropsychologist.

Timothy Ainger, PhD: So, if you were to backtrack where all the training comes from, neuropsychology is a branch of clinical psychology, which is a specific branch of psychology in general. So people who study mental health, psychological functioning, interest in neuropsychology really begins at sort of the upper high school to collegiate level. So you would get into your psychological studies and get your backgrounds of that theory and systems and history. And then when people hear psychologists, they typically think a therapist or an interventionist, someone that you go and speak with, who helps you with your emotional concerns. That would be sort of the classical presentation of a clinical psychologist. But there are neuropsychologists or people who have that base training and knowledge, and then further specialize through advanced training and degrees in neurologic functioning, medical history and systems, and then look at how these two worlds sort of come together. So it's an understanding more about the mechanics of the mind and the brain and how different areas of neurologic functioning can produce specific psychological, behavioral, emotional manifestations.

So I got interested in neuropsychology, really backtracking it to my undergraduate studies in psychology. And I was in the camp where I wanted a deeper understanding of the nervous system and the biomechanics and the physical aspect of how things sort of worked and really how the sausage got made before it presented to be an emotional or an affective presentation.

Prakash Chandran: Yeah. And, you know, I suppose, related to that analysis, we've been living in this interesting time over the past couple of years with COVID, right? So I'm curious as to what these last couple of years of living through a pandemic like COVID has meant for the field of neuropsychology.

Timothy Ainger, PhD: It's been trying for neuropsychologists. It's one of the biggest hurdles that we've had to clear as a field, is that we provide a service that basically requires us being face to face with our patients for evaluation. There are some things that can be done remotely. And I'm talking about being, you know, over video connection if need be. But when we were temporarily on pause and not seeing individuals face to face before we knew how to manage COVID in the hospital setting, everybody was sort of scrambling to adapt our practice to what's the best case model and how can we do this. Because there are things that we do as part of our evaluation that rely on time and speed and interaction and responding in the moment that you just sort of lose once you're no longer physically in the room with someone. So one of the biggest hurdles we had to clear was, A, figuring out how we could continue to provide healthcare while we were physically separated and then, B, how do we adapt what we do once we're able to come back together and be in person? So that's the initial challenge that we had.

Beyond that, the other challenge is now we're talking about the neuropsychological changes that people are experiencing because of COVID whether or not it's because they're impacted because they're socially isolated or their distance, or their social challenges are causing emotional changes or individuals who have been afflicted with COVID as an illness, that on the backside now are experiencing cognitive and neurologic changes. So it's been an ever-evolving process for us. And there's been so many challenges and hurdles as we've gone through this.

Prakash Chandran: What about for you yourself? You know, you have obviously a very thorough understanding of neuropsychology. How has that benefited your own life?

Timothy Ainger, PhD: It's always been a passion for me. I'm one of those people who mercifully after I got through all of my training years and years and years, I still very much loved what I did. The fascinating and amazing thing about neuropsychology is that it has a way of reaching every aspect of what we do. It's our personality. It's our behavior. It's our physical health. It's our mental health. So it's always something that's in the forefront of my mind, because it's a part of how we are on a day-to-day basis.

I'm passionate about my work because of how much applicability there is, and I've been very rewarded where I get to work because I'm a part of so many different multidisciplinary teams and it can be monotonous at times to just sit in and do evaluations over and over again. But being a part of these multidisciplinary teams and working with so many different integrated workforces across the hospital, we can see how our evaluation can beget patient improvement or change or drive research.

So for myself, neuropsychology has not only given me a way to -- it's challenged me. It's challenged me to learn more about myself, about my patients, about my coworkers, about the field. And it's always a surprise. Every time there's a new patient, a new diagnosis, a new situation, it's always good to investigate and see neuropsychologically what's been happening. You know, COVID came out, it was a respiratory illness. And then, we started to see all these cognitive concerns on the backside of it. So for us, it was this new challenge of, "Hey, now, there's a whole new disease on the block that we sort of have to understand because it's going to impact so many people." So, it's always there. You know, it's omnipresent and I really like what it's been able to do for me and how it challenges me to think about myself and others on a regular basis.

Prakash Chandran: So Dr. Ainger, this has been a fascinating conversation. But just before we close here today, do you have any practical tips on how we all can best nurture our brain health?

Timothy Ainger, PhD: Absolutely. Because of the reciprocal relationship that the brain has with the rest of the body, so many of the health recommendations that you hear from other providers for physical wellbeing have mental wellbeing and neurocognitive wellbeing implications as well. Things like getting regular exercise, eating a healthy diet, getting appropriate sleep. These sound like generic health recommendations. But when you think about how promoting better exercise is good for cardiac health and vascular health, you know, your brain thrives on healthy blood flow and healthy nutrients and proper oxygenation. So doing all of those things is good for your mind and your brain. Eating a well-balanced diet is good for the amount of proteins, nutrients, vitamins, et cetera, that you need for thinking skills. Making sure you're getting restorative sleep, giving your brain time to reset and recharge, so you have optimal functional abilities. If there are things that impede your ability to do those, like if you're concerned that you have sleep apnea, getting that evaluated, so you're getting proper oxygenation while you sleep. Anything that you can do for your physical health is going to be good for your mental health and wellbeing as well, but challenging your brain, doing puzzles and games and reading, and always trying to learn new information. All of that is great for your mind. So any of those physical health recommendations go hand in hand with mental health recommendations too.

Prakash Chandran: I love it. And I think that's the perfect place to end. Thank you so much for your time today, Dr. Ainger.

Timothy Ainger, PhD: Thank you very much. It's been a pleasure.

Prakash Chandran: That was Dr. Timothy Ainger, clinical neuropsychologist at the UK College of Medicine and Kentucky Neuroscience Institute. And that wraps up another episode of UK HealthCast with the University of Kentucky Healthcare. To contact the Kentucky Neuroscience institute, you can call (859) 323-5661. if you found this podcast to be helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you.

Thanks for checking out this episode of UK HealthCast with the University of kentucky healthcare. My name is Prakash Chandran, and we'll talk next time.ac