Scott Webb (Host): Welcome to UK HealthCast, a podcast from UK HealthCare. I'm Scott Webb. And today, we're going to learn about the field of Neuropsychology, the UK HealthCare Neuropsychology Division, and the types of tests that are administered at UK HealthCare from Dr. Sheliza Ali. She's a neuropsychologist with UK HealthCare.

Doctor, it's so nice to have you here today. We're going to talk about Neuropsychology. And I'm saying that like I know what that means, but the truth is, it's why we have experts. It's why we have experts on because I need to learn from them, listeners need to learn from them. So, just as a baseline question here, before we get rolling, what is Neuropsychology?

Dr. Sheliza Ali: So Neuropsychology, also known as Clinical Neuropsychology, it's a specialty of the field of Clinical Psychology. So when you think about Psychology, that's the study of the mind and behavior. And Neuropsychology is the study of the brain, neuro, and behavior, psychology. And in Clinical Neuropsychology, we're really interested in how various factors like, you know, your mental health, medical conditions, sleep, and so on, how those impact your thinking skills.

Host: You know, had I taken the time, doctor, to break down the word, you know, neuro, brains, I probably could have figured it out. But that's why I have you here. I'm going to let you do the heavy lifting. All right. So, we have a sense there of what the field of Neuropsychology is and what you do. So then, why or when would someone be referred for neuropsychological assessment?

Dr. Sheliza Ali: So, the short answer to that is that if there's any concern about the person's cognition or their thinking. For example, for a child, maybe there is some medical condition like epilepsy that might be disrupting their brain development and they're not hitting, you know, milestones at school and family are concerned.

Same thing, you know, on the other end of the lifespan, maybe an older adult is noticing that they're more forgetful or their language has changed and they want to know or their doctors want to know what specifically is going on and how can we help.

Host: Right. Because I assume then we talk about on the other end, and I'm definitely on the other end at 56. So, on the other end, we might be talking about Alzheimer's, dementia, something like that. Is this sort of like the first step, if you will, in trying to figure out what's going on for folks?

Dr. Sheliza Ali: I wouldn't say it's the first step exactly. Often folks talk to their family doctor or maybe they're seeing a neurologist. And it might be pretty clear from talking to your doctor that they're concerned about something based on your medical history and they might move straight into treatment. But if there is a bigger question of, "Okay, let's get a little bit more detail about what specifically is going on with your thinking before we kind of jump into a treatment."

Host: Got it. Okay. Good. So then, in terms of the UK HealthCare Neuropsychology Division, what exactly do you do?

Dr. Sheliza Ali: So, we're under the Department of Neurology and our faculty are involved in both clinical care and research. So when I say clinical care, that's us seeing patients in our clinic who are coming because of those thinking changes. And then, we also have faculty who are doing research on various conditions like Parkinson's disease, TBI, epilepsy, stroke, and so on, and how those conditions can impact your thinking.

Host: All right. So, a wide range of experts and expertise, and I'm assuming that tests are performed. We're talking about assessment, right? So, I'm assuming that tests are performed to identify things, symptoms, and otherwise. And if that's true, then what kind of tests do you perform?

Dr. Sheliza Ali: Yeah. So first of all, they're not like your typical medical test, what you would immediately think of. And I really like to clarify that, especially with kids, so there's no needles, there's no blood draws that's happening. Still, unfortunately for kids, it's not fun for them to hear. It's going to feel a little bit like school. We're going to be doing some, you know, paper and pencil tests. I like to tell folks, I'm going to take your brain for a little bit of a test drive and find out how things are going. And that can be a little bit intimidating for some folks because they're having a change in memory and I'm telling you, "I'm going to test your memory." So, that can be a little bit anxiety-provoking. But we try our best to kind of keep everyone happy and managing anxiety a little bit.

Host: Yeah. Nice to hear. I asked an expert on a podcast yesterday. She said something about paper and pencil. I'm like, do people still do that? You do we still use, because we were talking about smartwatches and all these like wearable consumer-grade devices and things. And then, she said paper and pencil. And I was like, "Wow, it never occurred to me that I could still do that because I'm so used to using all my electronic devices." So, I have a sense then of the kind of testing that you do. And I'm just trying to get a sense, I guess, like a typical appointment. What's that like? Like, what can folks expect? You've given us a sense there of what kind of tests or how you do the test. But just in general, what can we expect when we walk in the door?

Dr. Sheliza Ali: So, our appointments are longer than your typical doctor's appointments. So often, our appointment can last anywhere between, you know, two to three, even four hours long because of that testing component. So, we break it up into two pieces. First, we like to meet with you, meet with the patient, have a conversation with you and maybe a family member who you've brought in, talk about what's going on, you know, when did the concern start, what are some other health conditions you might have, how's your sleep and mood and so on. So, we kind of really get a comprehensive idea of what are your concerns as a person coming in.

And then, we switch to the second part of the appointment where we do the actual testing, and this is usually done by one of our licensed psychological associates, and they work one-on-one in a quiet room. They're given instructions for each task, and they kind of complete them in a sequence. So, I say like, you know, between two to four hours, because for some people, they might need a break in between or they take longer to get through things or they need stuff repeated a bit more often for them to grasp the purpose of the task. So, things might take longer. So, we like to give folks that heads up that it's longer than your typical appointment. So, to just be prepared for that.

Host: Yeah. Longer than the 15 minutes that most of us get with our primary care physician, right? So, you've got a sense there. It's going to be a couple of hours at least. And wondering how does a neuropsychologist determine whether symptoms are due to a medication, like the medication itself, versus a condition.

Dr. Sheliza Ali: Yeah. So, I guess with medications and, you know, medical conditions, we're thinking a lot about what do we know about this medication? What are common side effects that might be due to this medication? So, it's not an easy kind of black and white answer, but it might be a trial and error. So based on how the person did on the testing, we might say, "Hey, you know, these medications have common side effects that can impact someone's concentration." And then, we kind of send that back to their doctor and they may consider, "Let's try something different." And if we try something different and the concentration difficulty is lower, doesn't get better, then maybe it's more likely to the underlying condition that exists. So really, it's trial and error.

Host: Yeah. So, we're talking here a few hours, some paper and pencil maybe, some testing, some trial and error. Are there some other ways in which symptoms are diagnosed?

Dr. Sheliza Ali: So with that one, I would say observation is a big factor. So for some folks who are coming in, say for example, this is after a stroke and we know where the stroke happened, what are common symptoms that occur after the stroke. Your doctor might be able to see that, you know, you've had a left-sided stroke and you're having difficulty with language, this is consistent, maybe we don't want to put you through a two to three-hour neuropsychological assessment, but move forward with kind of treatment recommendations now, see how things improve before sending you for that neuropsych eval. So, I think, the clinical side of things, that's when it can come into play and be really handy.

Host: Yeah, and you mentioned stroke there. What are some of the common conditions, if you will, that you encounter in your practice?

Dr. Sheliza Ali: So for me personally, I see a lot of folks with Parkinson's disease, including those who are considering doing deep brain stimulation surgery to help with their motor symptoms. But through our clinic, we see a wide range of presentations. You know, we see folks with a history of epilepsy, stroke, like I mentioned, maybe brain injury, folks who are considering organ transplants, and then, you know, maybe just typical aging, "Hey, my memory has changed. I want to know a little bit about what's going on."

Host: Yeah, I mentioned I'm on the other end of that 56, and I'm like, "All right, I should remember this," right? And then, I'll be like, "But I can remember my childhood phone number," right? You know what I mean? Like my mom doesn't remember our phone number when I was a kid, but for some reason that I can remember, but I can forget to take the thing my wife said to take to the thing, to the place, you know? And it's hard to make sense of. I feel like I'm all right, but at least I know there's some options for diagnosis if I'm not. So, all right, we've gone through the testing, some evaluations, assessment, all of that. So then like after testing, what's next?

Dr. Sheliza Ali: So after you've gone through our testing, what we do is we score up the tests. Now, these are standardized tests. So if, you know, someone in their 50s with 16 years of education comes in and completes our tests, we're not going to compare them to a 22-year-old with 16 years of education. We want to make sure that we're comparing you to folks your own age and education level to get a sense of, are you performing where we would expect you to be for your age and education? Are you doing a little bit better? Are you doing a bit worse? So that way, we can really get what that individual's strengths and weaknesses are. Once we have an idea of your strengths and weaknesses and we can say, "Oh, do these weaknesses kind of fit with the medical conditions you're reporting?" And also, what recommendations can we put forward that may help you compensate for these weaknesses so that you can stay as independent as possible for as long as possible?

Host: Interesting. Yeah, sort of comparing apples to apples or whatever metaphor works. Yeah, whatever metaphor works for folks, right? Don't compare me to a 25-year-old because that's just not fair to them or me.

Dr. Sheliza Ali: That's just not fair. It's not.

Host: You know, you mentioned early on when we were talking about the UK HealthCare Division and some of the research that's going on, just wondering what are some of the new advancements in Neuropsychology?

Dr. Sheliza Ali: You mentioned that piece about the paper and pencil, and I completely get that. So, there are new advancements in our test itself that, you know, I'm really excited about. There are tablet-administered tests that we can use. This kind of, you know, takes a lot of human error out of things. But with the pandemic that we just went through, a lot of services could not be completed in person and we had to kind of pivot and adapt and try to do things through telehealth, over the phone, and so on. And with these new technological advancements in actually delivering neuropsychological tests, I think it's really exciting to think about the communities and the people who you can reach remotely who may have access to a stable internet, but who may not, you know, really be able to drive in four hours for a four-hour appointment. So, I think it can really increase our folks' access to Neuropsychology and also, you know, you're doing it in the comfort of your home. So, I that's really exciting and something to look forward to.

Scott Webb: Yeah. Yeah. It's an interesting thing, doctor, about the pandemic, right? Some good, some bad. But when it comes to healthcare, especially, as you say, you know, taking advantage of existing technology, reimagining how it can be used, making it easier on folks. As you say, driving four hours, to be there four hours, then fours home, you can see how that would be pretty daunting or nearly impossible for some folks. So, good to hear about that. And just wondering about you personally, what are you working on, things that you're researching that you can share with listeners.

Dr. Sheliza Ali: Like I said, I see mostly folks with Parkinson's disease. So I am part of a team with Neurosurgery. And they're looking at cognition following deep brain stimulation surgery. So, I do the cognitive testing before they go into surgery, you know, often that's to kind of screen for any red flags that the patient should know about before agreeing to surgery. And then, testing them again about a year after surgery to see how things have changed. We know with Parkinson's disease specifically, there can be some cognitive changes later on in the disease. And it's really interesting from a research perspective to look at how that changes, you know, following surgery and treatment and to have a good idea of what is unusual versus what is typical changes.

Host: Yeah, it's just so exciting. I told you before we got rolling here today that, you know, some of these that I host, I kind of already know the answers. But today, I didn't already know the answers. So, it's great to have you here and get the answers from you. So, let's just finish up here and just talk about some of the training, some of your background to get to be a neuropsychologist, like what did you have to do?

Dr. Sheliza Ali: Yeah. So for Neuropsychology, I did a bachelor's degree and then you have to go on to do graduate training in Clinical Psychology. So, there are programs where within Clinical Psychology, they offer a specialization in Neuropsychology as well. So, that would be completing either a PhD or a PsyD in clinical psychology. And then, if you're interested in being licensed as a clinical neuropsychologist, you'd have to go on and do two additional years after you've completed your graduate degree, so two years of postdoctoral training in Clinical Neuropsychology. And for me, I did that training here at UK.

Host: Well, that's nice for you. I went to school there. You're employed there. That must be kind of nice for you.

Dr. Sheliza Ali: Yeah. Yeah. I've been really enjoying it.

Host: That's great. Well, I really appreciate your time today. I love learning. I love learning from experts. I love learning things that I, you know, don't already know and what the future might be. Gave us a sense moving away from paper and pencil, which I can appreciate on some level, and using tablets and all of that. So, thank you so much for your time today.

Dr. Sheliza Ali: Yeah, no problem. Thank you for having me.

Host: And for more information, visit ukhealthcare.com. And that wraps up another episode of UK HealthCast from UK HealthCare. Please remember to subscribe, rate, and review this podcast and all the other UK HealthCare podcasts. I'm Scott Webb. Stay well.