Written by Dr Gil Suzin, Head of Neurocognitive unit AHMC
A neuropsychologist is a psychologist who specializes in brain pathology, human cognition and cognitive impairments. They are trained to administer assessment protocols aimed at measuring cognitive function to assist in the diagnosis of neurological ailments. They are also trained in the treatment of cognitive impairment as well as the emotional and behavior complications that sometimes result from it.
An assessment begins as soon as a patient enters a clinic’s door. Cognitive impairment could be expressed in the patient’s first interactions with staff and a skilled neuropsychologist will make use of all of the information they can glean from first impressions. The way the patient dresses could indicate their organizational skills and independence. Hygiene could shed light on their emotional state or possible signs of apathy (i.e. bad odor if they aren’t showering).
The neuropsychologist listens to the way a patient talks to family members as this could reflect the person’s orientation to time/place and biographical memory. Patients with memory problems may repeat questions (i.e. where are we? What is the time?) or seeking help when asked a question they can’t retrieve the answer for (i.e. what is the name of your grandchildren?).
The clinical interview is an important source of information about the patient’s cognition even before commencing the assessment itself. The next step is to collect information about the patient’s background. Are they well educated? Are they successful? Do they have a special skill or craft?
Current cognitive functioning or cognitive complaints will be referred against the background to understand the depth of impairment. For instance, a difficulty reading a topographical map would be interpreted differently if the patient was previously a professional pilot than if they were a coal miner. A difficulty with operating the new smartphone would be interpreted differently if the patient was an electronic engineer or a painter.
Others things that will be looked for include past substance abuse, exposure to acute or chronic traumatic events and long-term medication usage as these can have an effect on the brain.
Finally, the neuropsychologist should inquire about the patient’s lifestyle factors such as how regularly they exercise and whether or not they smoke. The goal is to paint an overall picture of the patient’s health to understand factors that may drive cognitive decline. For example, it has been proven that diabetic patients are more prone to experiencing cognitive decline in older ages and that patients with high cholesterol levels are more prone to suffer from minor, sometimes undetectable strokes.
Only once the neuropsychologist has considered all of this does the process turn to the assessment itself. Having a vast amount of data on the patient and several assumptions about their current cognitive state, the assessment entails a set of tests directing the patient to display their cognition in a controlled and standardized procession. Usually, the cognitive tests will try to capture a ‘snapshot’ of the patient’s attention span, memory and higher order thinking processes (i.e. task switching or planning).
In the end, the neuropsychologist’s job is to integrate the information collected from the interview and the data from the testing. This integration requires expertise in order to reach the right conclusion and administer the appropriate clinical recommendations.