by Tom Miller, Ph.D.
A neuropsychological evaluation is a method for examining the quality of brain function and for determining a patient’s cognitive strengths and any limitations. It involves several steps:
- a clinical interview to obtain information from the patient and his or her spouse or other family members about daily functioning, details of ongoing problems, and any concerns about cognitive functioning (e.g. problems with attention, memory, mental processing, etc.);
- obtaining additional background information from medical records and reports, review of any previous testing, and other relevant information;
- the administration of various tests to examine cognitive functioning in a number of areas, including intellectual abilities, attention, language, learning and memory, visuospatial abilities, sensory-motor functioning, executive function, emotional status, and personality.
These areas of cognition involve different regions of the brain, and a person’s performance on testing can reveal the relative efficiency or impairment in these brain regions.
A neuropsychological evaluation is scheduled before a deep brain stimulation procedure (DBS) for several reasons:
- to establish of pre-surgical baseline of functioning in these areas of cognition;
to determine whether there are any difficulties that may be exacerbated by surgery; - to determine whether there are any difficulties that may interfere with adjustment after surgery.
DBS involves implanting electrodes into brain regions that regulate attention, aspects of language, and memory retrieval. Parkinson’s disease can contribute to difficulties in these areas of functioning. It is important to determine the extent of any difficulties before making a decision whether to proceed with DBS.
Memory impairment can make it difficult for a patient to follow recommendations and adhere to a medication schedule, and significant memory impairment may indicate early signs of dementia.
It is important to determine whether problems with memory are beyond the ordinary occasional memory lapses that many of us encounter from time to time. Testing is necessary to determine the nature and extent of memory problems: distinguishing between:
- “ordinary” and occasional lapses of memory (no interference with functioning);
inefficiencies in memory (may be annoying at times but without much interference); - mild memory impairment (difficulties with remembering details of events occurring in recent weeks or months);
- moderate memory impairment (inability to recall many details of events, conversations, appointments occurring more recently; needing frequent reminders, increasing interference with daily functioning);
- severe memory impairment (inability to recall information within minutes, requiring multiple repetition of instructions or requests, inability to follow conversation, etc);
- lapses of attention and memory (difficulties with memory may actually be related to lapses of attention, distractibility, or inability to concentrate effectively).
Memory testing helps to determine whether difficulties are related to initial encoding of new information; the process of storing new information; or the retrieval of information from memory. These stages of memory involve different areas of the brain – and information about performance provides your doctor with information about functioning in specific brain regions.
It is also important to examine emotional status and personality functioning. Acute anxiety or deep depression interferes with thinking, planning, and problem solving. An inability to function effectively in these areas might impair judgment to an extent that the process of managing DBS becomes overly complicated and the advantages of DBS become difficult to see. Personality functioning itself may suffer, and a person may find themselves overly anxious and worried, or without interest or motivation in their lives.
It is possible to master bouts of anxiety or hopelessness by learning and practicing various mental or behavioral strategies – sometimes referred to as cognitive-behavior therapy, or CBT. The use of these tools can help restore emotional balance along with a sense of confidence and ease. If significant emotional distress is a factor, a referral can be made for therapy to help improve overall functioning.
Dr. Tom Miller practices at Maine Medical Center Department of Psychiatry, Geriatric Outpatient Psychiatry, 66 Bramhall Street, Portland, ME 04102
