Frequently Asked Questions

Patient FAQ

Neuropsychological Evaluation​

A neuropsychological evaluation provides comprehensive assessment of patients in whom impairments of cognitive or neuropsychiatric functioning are evident or suspected. Assessment involves a systematic evaluation of higher cognitive abilities in order to identify possible problems with brain functioning, help lead to a diagnosis, define strengths and weaknesses, and make treatment recommendations.
A wide range of conditions may affect neuropsychological functioning, such as:
  • Traumatic Brain Injury
  • Neurological conditions including stroke, epilepsy, brain tumors, multiple sclerosis (MS), Alzheimer’s disease, Parkinson’s disease, etc.
  • Medical conditions such as liver disease, Lupus, HIV infection, or cardiac disease
  • Learning and Developmental Disorders
  • Attention-Deficit Disorders
  • Various psychiatric conditions
  • Suspected memory problems or dementia
A typical neuropsychological evaluation involves an assessment of the following cognitive and behavioral functions: General intellect, Attention/Concentration, Learning and Memory, Language, Perceptual and Motor skills, Problem Solving, Planning and Organization, and Mood States.
 
The evaluation consists of a review of available medical records, a diagnostic interview with the patient and often a family member/significant other, testing and a feedback session.  During the diagnostic interview, the doctor and patient go over the patient’s medical history, family medical history, education, social history, medications, allergies, issues the patient is facing, etc. The testing involves answering questions and taking paper and pencil tests.  The time required depends on the problem being assessed and patient characteristics such as severity of cognitive functioning, level of fatigue, and/or level of pain.  No invasive procedures such as needles or electrodes are used. In general, the evaluation will take several hours to complete. Two weeks after testing the patient is scheduled for a feedback session. During the feedback session the doctor goes over the testing results and the next steps in the patient’s treatment. 
Neuropsychological evaluations are often requested by your doctor or other professionals to help them understand how the different areas of your brain are functioning.  A neuropsychological evaluation involves testing that is sensitive to problems in brain functioning. Unlike CT or MRI scans, which show what the structure of the brain looks like, neuropsychological testing examines how well the brain is working when it performs certain functions (for example, remembering). These functions or tasks form the necessary building blocks of successful living in the individual’s daily life. Impairment in many of these functions may exist because of brain abnormalities that cannot be detected on CT or MRI scans. Therefore, neuropsychological assessment is a procedure with a unique purpose; it can be used to reveal or diagnose brain dysfunction when no structural brain abnormalities can be seen. Furthermore, when structural abnormalities have been found, neuropsychological assessment provides a way to determine what functions may be impaired because of the structural defects, and to determine the degree to which they may be impaired.
 
Testing is recommended when there are changes in concentration, organization, language, memory, reasoning, perception, coordination, or personality.  These changes may be secondary to a medical condition (diabetes, heart, lung or liver disease, infectious processes, etc.), a neurological illness, (head trauma, stroke, multiple sclerosis, Alzheimer’s disease, etc.) or a psychological disorder (depression, anxiety, etc.). 

A complete evaluation generally takes between two and six hours to complete, but can take longer depending on the complexity of the issues to be addressed by the evaluation and the patient’s condition (for example, fatigue, confusion, and motor slowing can extend the time required for an evaluation). Occasionally, it is necessary to complete the evaluation over two or more sessions. In general, the clinician attempts to elicit the patient’s best possible performance under optimal conditions.

Test results can be used to understand an individual’s situation in a number of ways. A neuropsychological evaluation may contribute to decisions about:
  • Rehabilitation issues
  • Ability to return to work
  • Ability to function independently
  • Tracking of changes in functioning over time
  • Educational and vocational planning
The goal is to help the person being evaluated to safely function at the maximum level of independence.
 
  1. Test results can be used to plan treatments that use strengths to compensate for weaknesses.  The results help to identify problems to work on and which strategies to use. For example, the results can help to plan and monitor rehabilitation or to follow the recovery of skills after a stroke or head injury.
  2. Scores on specific tests have a relationship to everyday functional skills such as the level of care or supervision required, managing medication regimens, managing money, driving, or readiness to return to work or school.  Testing can therefore guide discharge planning from the rehabilitation setting.
  3. Testing can be used to help differentiate among illnesses.  This is important because appropriate treatment depends on accurate diagnosis.  Different illnesses result in different patterns of strengths and weaknesses on testing.  For example, testing can help to differentiate normal age-related changes in thinking and memory from those due to a neurological disorder such as Alzheimer’s disease, or from depression.

A child may be referred for a neuropsychological evaluation when there are concerns about one or more areas of their development. This can include a child’s cognitive, academic, memory, language, social, self-regulatory, emotional, behavioral, motor, visual-spatial, and adaptive functioning.

This type of evaluation can help rule out diagnoses such as Attention Deficit/Hyperactivity Disorder, Autism Spectrum Disorder, Specific Learning Disorder, Language Disorder, as well as various emotional and behavioral disorders. A neuropsychological evaluation can also be helpful if your child has been diagnosed with a medical condition such as Down Syndrome or other genetic disorders, Traumatic Brain Injury, or Epilepsy. The purpose of the evaluation is to identify a child’s patterns of strengths and challenges in order to provide parents, schools, and other providers with strategies to help them succeed across contexts. It can also be used to track a child’s progress and response to targeted interventions. It can provide knowledge of what to expect from the child at the the time the child is tested or in the future. The evaluation can also provide suggestions for improving behavior.

During an evaluation, we may assess:

*Memory:  how a child learns information and retrieves it
*Processing skills:  how a child interprets what they hear, see and touch
*Language:  how the child understands what others’ say and how they put words together to share information, thoughts, and feelings
*Visual perceptual skills:  how a child interprets what they see visually
*Fine and gross motor skills: how a child moves around their world and how they coordinate their hand movements
*Attention:  how a child selects or maintains their attention
*Organizational/Executive Skills:  how a child plans a task, initiates work and problem solves

These are not tests that one can study for, but there are several things that one can do to facilitate the evaluation:

The patient should bring a current list of ALL medications and doses (because medicines may change frequently for some persons, it is important to make sure the list is up to date)
If the patient has difficulty providing information about their history, it is helpful for a family member or friend to accompany them (for at least part of the clinical interview).
It is helpful if the patient can provide records of previous neurodiagnostic testing (e.g., brain scans such as CT or MRI scans) and/or results from previous neuropsychological evaluations if completed at another hospital or institution.
It is the goal of the neuropsychologist to get the best possible picture of the patient’s current functioning. Several things can interfere with this goal such as if the patient is:

  • Excessively tired or fatigued or has sudden, unexpected “sleep attacks”;
  • Not motivated to put forth their best effort;
  • Very emotionally distraught or has a severe psychiatric condition;
  • Under the influence of medications or illicit substances which interfere with cognitive functioning;
  • Experiencing frequent changes in the ability to move.
  • Patients should let the examiner know if they anticipate that any of these issues are likely to interfere with the evaluation.

It is important to get a good night’s rest before evaluation. Patients who live far away might consider spending the evening prior to the evaluation at a local hotel or with friends or family rather than getting up and driving or flying most of the night to get to the appointment. Patients are encouraged not to consume any alcohol 24 hours prior to the evaluation. If taking sleep medicine, patients should check with their doctor whether it might affect test performance the next day.

Patients should not worry about whether they will “pass” the tests. The tests cannot be passed or failed; instead they describe how well a person performs relative to peers.

ADHD

Coming Soon
  1. The Mindfulness and Acceptance Workbook for Anxiety by John P. Forsyth, Ph.D. and Georg H, Eifert.
  2. Taking Charge of ADHD 3rd Edition by Russell Barkley Ph.D.

Asperger's and Autism

Dementia

Dementia is the loss of cognitive functioning—thinking, remembering, and reasoning—and behavioral abilities to such an extent that it interferes with a person’s daily life and activities. These functions include memory, language skills, visual perception, problem solving, self-management, and the ability to focus and pay attention. Some people with dementia cannot control their emotions, and their personalities may change. Dementia ranges in severity from the mildest stage, when it is just beginning to affect a person’s functioning, to the most severe stage, when the person must depend completely on others for basic activities of living.

While dementia is more common as people grow older (up to half of all people age 85 or older may have some form of dementia), it is not a normal part of aging. Many people live into their 90s and beyond without any signs of dementia. One type of dementia, frontotemporal disorders, is more common in middle-aged than older adults.

The causes of dementia can vary, depending on the types of brain changes that may be taking place. Alzheimer’s disease is the most common cause of dementia in older adults. Other dementias include Lewy body dementiafrontotemporal disorders, and vascular dementia. It is common for people to have mixed dementia—a combination of two or more types of dementia. For example, some people have both Alzheimer’s disease and vascular dementia.

Cognitive and neuropsychological testing. These tests are used to assess memory, problem solving, language skills, math skills, and other abilities related to mental functioning.

Evaluation also includes assessment of the extent of impairment in instrumental activities of daily living, which include managing money and medications, shopping, housekeeping, cooking, and transportation. In the early stages of dementia, instrumental activities of daily living that require calculation and planning, such as balancing a check-book or filling a pillbox, are often the first to become impaired. Basic activities of daily living, such as dressing, eating, toileting, and grooming, are generally intact in early dementia and do not become impaired until later in the disease progression.

 

Driving

The question of an individual’s ability to safely operate a motor vehicle occurs after a medical illness or injury (such as a stroke, brain injury, breathing disorders, diabetes, seizure disorder, etc..). After a diagnosis of Parkinson’s disease, Alzheimer’s disease or dementia, with concerns about medication side effects, or in the context of normal aging. With aging, illness, or injury an individual is often not aware when vision, cognition, and motor skills fall to a dangerous level.  This evaluation allows an individual, his/her family, and physician to make a well-informed decision about whether one should continue to drive or return to driving.  The ultimate concern is to balance individual and public safety with an individual’s community mobility needs to maintain his/her independence and quality of life.
 
The following are some warning signs that suggest an individual may be an unsafe driver and in need of an evaluation:
  1. Inappropriate driving speeds (too fast or too slow)
  2. Poor judge of distances, too close to other vehicles
  3. Trouble navigating turns
  4. Drifting into the wrong lane
  5. Hitting curbs
  6. Accidents or near misses, scrapes or dents on car, garage, or mailbox
  7. Getting lost in familiar places (spouse acts as co-pilot)
  8. Confusing brake and gas pedals
  9. Stopping in traffic for no apparent reason
  10. Increased agitation or irritation when driving
The evaluation is a two-part assessment.  The initial pre-driving evaluation is an office-based neuropsychological assessment designed to assess thinking skills necessary to being able to safely operate a motor vehicle. This evaluation is composed of a reliable and valid computer based test which assesses processing speed, divided attention, and focused attention.  Additional paper and pencil or question and answer type tests are administered that assess attention/concentration, processing speed, spatial abilities, visual search and scanning, directional sense, problem solving, and learning and memory. This part of the assessment takes approximately 3 hours.
 
The second phase of the assessment is the behind the wheel evaluation.  This part of the assessment is conducted by a Certified Driver Rehabilitation Specialist (CDRS). A permit or valid driver’s license is required for this phase of the assessment.  The specialist meets the client at his/her home so that the evaluation is conducted in a familiar environment.  The client must use the specialist’s car for liability and safety reasons, as the car is equipped with a brake on the passenger’s side to help prevent an accident if necessary.  The client is given time to become familiar with the vehicle.  Depending on the client’s location the assessment will take place on residential, suburban, and/or city streets and will include highway/expressway driving if appropriate.  Speed control, brake reaction time, ability to maintain lane position, judgment and decision making in traffic situations, appropriate use of mirrors, making turns, knowledge of right of way, parking manuevers, multi-tasking, and the ability to plan and follow a route are assessed. The behind the wheel evaluation

The neuropsychological evaluation is typically covered by Medicare and most commercial insurance companies.  An order from the patient’s physician requesting a neuropsychological evaluation is recommended. The behind the wheel evaluation is not covered by insurance and is an out of pocket expense of at least $175.00 (more depending upon the distance needed to travel to client’s home to perform assessment).

Fitness to Drive Evaluations
What we do and who we serve
How are the results of the evaluation used?
 
After the neuropsychological and the behind the wheel evaluations are completed a report is written describing the patient’s cognitive and functional strengths and weaknesses. Recommendations are made regarding the patient’s ability to safely operate a motor vehicle.  In addition to giving feedback to the patient and his/her family, this report is forwarded to the referring physician. 
 
The results of the evaluation typically fall into one of several categories.  A return to independent/unrestricted driving may be recommended.  A plan to continue or resume driving after driver training sessions (after an injury/illness an individual may show potential to safely operate a motor vehicle but require training sessions to improve driving techniques) or some modifications (for example, no night or highway driving, using adaptive equipment). Lastly, there individuals who are unsafe to drive.and it is recommended that these individuals stop driving or not return to driving. In instances where an individual has suffered an acute illness/injury and further recovery is anticipated, a re-evaluation may be recommended with the possibility of a return to driving in the future. For individuals with diseases that worsen over time, re-evaluations are recommended to evaluate the disease’s progression and its impact on driving.
 
The final decision as to whether or not a patient resumes or continues driving is left to the patient’s physician as only he/she can submit a Medical Report form to the Secretary of State/Department of Motor Vehicles asking that a patient’s license be suspended because the patient has a medical condition that renders him/her unsafe to operate a motor vehicle.   

To schedule an evaluation contact Neuropsychological Services at 847-438-4530 ext 190. 

Epilepsy and Seizures

An evaluation conducted by a neuropsychologist as a formal assessment of cognitive abilities, including attention, memory, processing speed and problem solving. The evaluation also includes assessment of mood. Doctors utilize this information to help determine cognitive and emotional functioning as a result of seizures.

Long Term Effects of Events

A neuropsychological evaluation is often able to identify long-term effects of events including:
 
  • Birth Trauma
  • CNS Cancer
  • Low Birth Weight/Prematurity
  • Prenatal exposure to drugs and/or alchohol
  • Early Environmental Deprivation
 

Memory

  1. Pay Attention-Memory problems often come from poor concentration.  To remember something you have to pay attention to it first.  If you do not concentrate long enough the information is never stored in your memory.  Give undivided attention when learning new information and concentrate only on those details of information one needs to remember.
  2. Get adequate rest-Being tired can reduce one’s concentration and result in difficulties in learning.
  3. Eat a “pro-memory” diet-low in saturated fats and high in fruits and vegetables.  The same dietary regime designed to keep cholesterol and triglycerides in check for coronary arteries will bestow the same benefits upon the blood vessels supplying your brain.
  4. Exercise-Aerobic fitness has been linked to improved mental function though the reasons for this are not entirely clear.  Increased blood flow to the brain during exercise has not been found to be the sole reason for this improvement in mental functioning.  It may be that regular workouts stimulate the release of natural compounds that stimulate brain cell growth.  Exercise can also reduce stress levels, lower blood pressure, improve lipid profile, and enhance glucose tolerance. In a study reported in the Archives of Neurology, 4600 older adults were followed for 5 years.  It was found that those with the highest level of physical activity were 40 percent less likely to suffer any dementia or mental impairment than the most inactive people.
  5. Use it or lose it may also be true for brain functions as it is for muscle function.  Participation in mental challenging activities may improve memory skills and enhance the ability to remember.  Activities that exercise mental skills include working crossword puzzles, playing thought-provoking games like bridge, Jeopardy, or chess, learning computer skills, or participating in other older adult education classes or Elderhostels
  6. Written Instructions-One of the most common and useful memory joggers is to use written lists, calendars or appointment books, or a pocket-tape recorder
  7. Use Repetition-rehearse information to be remembered.
  8. Sound Triggers-Use of alarms, buzzers, watches to remind one to perform a particular activity such as keeping an appointment, making a call, taking one’s medication at a specified future time.  If not at home and you want to remember something to do upon returning home leave a message on your home answering machine.
  9. Organize Information-Use electronic memory devices and computers-designate a specific place for often used items such as keys, checkbook or important papers
  10. Use Associations-Associate new information with information that is already known and make a mental link, a mental picture of a filing system.  Place new information in a familiar existing file where it can be retrieved later.
  11. Visualization-Create a mental picture or image.  For example, to help remember the location of your car in the mall parking lot, make a mental picture of its location.  Note the car parked next to it or other surrounding landmarks.
  12. Change of Environment-Changing something in the environment to jog memory-place clothes to take to cleaners in front of door.
  13. Group First Letter of Words-Sometimes one wants to remember a list of items.  Take the first letter of each item and arrange them to form a word/words.  Or use the first letter of each word and form a sentence that is easy to remember.  For example, the 5 great lakes (Huron, Ontario, Michigan, Erie, Superior)HOMES or Henry Often Misses Eating Supper
  14. If you have having trouble recalling something, go through the alphabet to job your memory

If a selected strategy does not work, try another.  If some information is particularly difficult to remember and causes undue stress ask yourself – Does it Really Matter?  Go easy on yourself.  Don’t berate your self when you forget.
 
Relax-Worrying about remembering things that you would normally forget can make your memory seem worse to you.  If you can remember your memory problems, you probably do not have much of a memory problem.  The more severe your worries about having a memory problem, the less likely that you actually have a serious problem.  The typical individual with AD generally does not worry about their memory at all, their friends and family do.
bindependent – Tips and Resources
 
About Memory: Learning about Memory for Permanent Memory Improvement
 
National Academic Advising Association: Resources to Assist with Memory Improvement
 
UAB Home Based Cognitive Stimulation Program
 
Mind Tools – memory techniques
 
Memory Principles – study skills

Movement Disorders

Post Traumatic Stress Disorder

An evaluation conducted by a neuropsychologist as a formal assessment of cognitive abilities, including attention, memory, processing speed and problem solving. The evaluation also includes assessment of mood. Doctors utilize this information to help determine cognitive and emotional functioning as a result of seizures.

  • The Body Awareness Workbook for Trauma by Julie Brown Yau,Ph.D.

Stroke

A significant number of stroke victims exhibit cognitive impairment, neuropsychological assessments can enhance post stroke management by identifying pertinent cognitive sequelae and providing salient care recommendations such as treatment plan, rehabilitation recommendations. A neuropsychological assessment can help clarify whether or not you are able to return to work, study, drive and what support you might need. Also over time many stroke victims face cognitive decline. So stroke victims may require multiple assessments over time so as to help clarify the changes in their abilities and support needs.