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Cognitive Testing

Cognitive Testing

Neuropsychological Testing
Clinical neuropsychology assesses brain functioning through standardized behavioral tests and observation. Intelligence, memory, language, attention and concentration, and other mental activities are assessed. This evaluation can be part of a pre-surgical or post-surgical epilepsy work-up, to test a patient’s reported problems with thinking, or to diagnose dementia, an attention deficit disorder, or a learning disability, among others. Testing sessions usually last 3-5 hours and are performed by a neuropsychologist (a licensed psychologist with special training in pediatric and/or adult assessments). Once testing is completed, the neuropsychologist interprets the results and writes a report that will be made available to the patient and the referring doctor.  A feedback session at a later date is also included as part of the evaluation, in which results, diagnostic impressions, and suggested recommendations are discussed with the patient. Neuropsychological evaluations in our program are offered in English and Spanish. Types of evaluations conducted include, but are not limited to:

Pre- and Post-Surgical Epilepsy Evaluations (for both pediactric and adult patients)
If an individual is considered a possible candidate for epilepsy surgery, a presurgical neuropsychological evaluation is performed as part of a comprehensive presurgical workup in order to assess the patient’s cognitive strengths and weaknesses and provide a baseline with which to compare postsurgical functioning.  Results of the presurgical evaluation may also shed light on localization and lateralization of seizures (i.e., whether the findings are consistent with a right or left hemisphere seizure focus and is consistent with all other obtained data).  Results are also used to help neurosurgical planning to attempt to avoid cognitive decline postoperatively. In addition to standard neuropsychological testing, Wada and/or cortical brain mapping procedures are sometimes performed to help decrease the likelihood of postoperative cognitive decline.Six to 12 months following epilepsy surgery, these individuals are then referred for a postsurgical neuropsychological evaluation to assess for any changes in cognitive functioning that may have occurred as a result of the surgery.  The results of the postsurgical evaluation can be used to determine the need for cognitive rehabilitation, academic accommodations, and/or vocational counseling.

Memory Disorder Evaluations
At the Northeast Regional Epilepsy Group, our neuropsychologists are specialized in the assessment of adults and older adults with memory complaints.  It is common that “memory complaints” is the primary reason for an adult individual to initially see a neurologist and be referred for neuropsychological evaluation.  As with all of our neuropsychological assessments, a thorough clinical interview with the patient (and preferably someone who knows the patient very well and can report on possible changes in functioning), a review of medical records, and formal testing is performed to evaluate these complaints.  Results of undergoing this evaluation will reveal whether an individual’s complaints regarding their memory are normal (i.e., age-related changes), whether they might be due to an underlying neurological condition (e.g., epilepsy, dementia, Mild Cognitive Impairment, etc.), or whether there is another likely explanation for their complaints (e.g., psychological stressors, clinical depression, medication side effects, metabolic or endocrine functioning abnormalities, etc.).

Brain Injury Evaluations
An impact to the head can result in a traumatic brain injury (TBI) that affects a person's cognitive abilities. Frequent causes of TBI include motor vehicle accidents, injuries involving a blunt object to the head, sports injuries, or falls from a significant height. However, any situation in which the head is traveling at an accelerated pace and meets with an abrupt deceleration upon impact or is struck by another object can be sufficient enough to cause an injury to the brain.  A TBI may be mild, moderate, or severe. These classifications are derived from several different factors, including length of post-traumatic amnesia (PTA), length of loss of consciousness (LOC), and initial score on the Glasgow Coma Scale (GCS). One of the physical consequences of TBI is post Traumatic epilepsy (PTE).  The incidence of PTE accounts for about 20% of epilepsy in the general population and 5% of all epilepsy cases.  Many individuals report persistent difficulties with cognitive functioning (memory, attention/concentration, problem-solving, speed of information processing, etc.) long after their physical status has stabilized. There are also often personality changes, typically involving moodiness, sensitivity, irritability, and reduced frustration tolerance. Neuropsychological assessment can be useful in determining the nature and extent of cognitive difficulties post-TBI. Once the problem areas can be identified, the neuropsychologist can help determine residual functioning (i.e., post TBI strengths and weaknesses) and prognosis, as well as make recommendations for treatment. Recovery to the highest possible level of functioning is often facilitated with cognitive rehabilitation and other therapies, and undergoing a neuropsychological evaluation is the first step in beginning this treatment process.

Autism-Spectrum Disorders
Epilepsy occurs in about 10-30% of patients who are diagnosed with autism.  Autism-spectrum disorders (i.e., Pervasive Developmental Disorders) consist of a pattern of significant and pervasive impairment in social interaction and communication skills, and the presence of stereotyped behaviors, interests, and activities.  A diagnosis is made on the basis of a structured interview and standardized assessment using both behavior rating scales and direct testing.  Neuropsychological assessment, using standardized measures and other tests of cognition, academic, and social-emotional functioning, is often used to derive a diagnosis.  Rating scales (i.e., Gilliam Autism Rating Scale, Modified Checklist for Autism in Toddlers), structured interviews (i.e., Autism Diagnostic Interview - Revised), and test measures (Autism Diagnostic Observation Schedule) aid in diagnosis. Specialized neuropsychologists or developmental neurologists/pediatricians typically make the initial diagnosis.  The earlier this diagnosis is made, the sooner adequate behavioral and developmental interventions can be started.

Assessment for Learning Disabilities and Attention-Deficit/Hyperactivity Disorder (ADHD)
A learning disability is a persistent condition of presumed neurological dysfunction which may/may not exist with other disabling developmental and/or neurological conditions such as epilepsy for one. It refers to a varied group of disorders that is manifested as significant difficulties in the acquisition and use of listening, speaking, reading, spelling, writing, reasoning, or mathematical abilities. Oftentimes individuals with learning disorders struggle in academic areas in school and as a result, self-esteem and self-image can suffer. Another type of developmental condition that can co-exist with, or exist independently of, a learning disability is Attention Deficit/Hyperactivity Disorder. This disorder is characterized as a condition in which an individual exhibits signs of developmentally-inappropriate inattention and/or hyperactivity and impulsivity.  Early intervention is key in the remediation of developmental disorders such as LD and ADHD. Intervening early on not only increases the chances for a better outcome in terms of remediation, it also can minimize the negative cycle of academic and personal struggles that are all too commonplace for children and adults with these disorders. One of the first steps toward early intervention is a clinical neuropsychological assessment, which consists of a review of available school and medical records, a clinical interview, observations of the child during a formal testing session, and standardized, objective testing. The evaluation report will provide recommendations that are specifically formulated for each individual.  Many services/therapies are available to individuals diagnosed with LD or ADHD, such as modified assignments/testing at school, behavioral modification plans, use of learning strategies, tutoring, preferential seating, and computer aides.

Spanish Neuropsychological Evaluations
Our neuropsychology group is unique in that we have a Spanish neuropsychology division that can perform comprehensive batteries of tests on Spanish speaking individuals, ranging in age from 3 to 80+ years of age. Two of our team members are native Spanish speakers, who trained both in Latin America and the U.S and who specialize in epilepsy. They are thus well suited to work with this population, both from a cultural and a professional perspective. This allows for patients and their relatives to speak directly to the doctors during the interview and testing phases of the assessment, rather than having to make use of interpreters. In addition to our bilingual personnel, whenever possible, assessment materials with proven reliability and validity are used. Such instruments include measures of general intellectual functioning, academic skills, as well as the typical neuropsychological functions assessed during routine assessments including attention/concentration, language, memory, viusospatial/visuoconstructional, motor, and executive functions. A thorough assessment of emotional complaints is also performed through interviews and self report measures.  Many of these instruments have been developed and published in the U.S. by leader companies in the field. 

Driving Assessment
Medical (visual, cognitive or physical) problems can affect a person’s driving abilities.  While the length of seizure freedom is often used to decide whether a patient can resume driving, there may be other important concerns that affect the driver’s ability to operate a motorized vehicle. These concerns include medication effects (reaction time, mental aptitude), visual acuity, and other aspects of general cognitive function. 
In order for the patient, patient’s doctor and family members to determine if the patient is safe to drive a motorized vehicle, it may be necessary to undergo a formal driving assessment.  This assessment is performed both in our office where measures of visual perceptual skills, attention, memory and reaction time are documented, and in a road test at a driving academy. Based on the final report, the treating doctor can make a rational decision and recommendation to the patient and to the state (if necessary) about whether the patient is safe to resume driving, or will remain restricted from driving. Counseling for alternative transportation modalities is made available as well if this is needed