MY SPECIALTIES
Conditions Commonly Evaluated
NEURODEGENERATIVE DISEASE
This collection of illnesses involve progressive cognitive and physical decline, due to underlying build-up of different types of pathology in the brain. Different pathologies tend to affect different parts of the brain, causing different patterns of cognitive deficits. Neuropsychological assessment distinguishes between patterns, which is critical to diagnosing the cause, e.g., Alzheimer's, Parkinson's, Lewy Body, Huntington's, or Frontotemporal dementias.
CEREBROVASCULAR DISEASE
Stroke injury to the brain can be due to a blockage (ischemic) or due to a bleed (hemorrhagic). After stroke, neuropsychological assessment helps determine how much impairment resulted from the injury, guides treatment planning, monitors the course of recovery, and can justify the need for accommodation to any permanent impairments.
Additionally, slow build up of small or microscopic vascular damage can cause slower or stepwise progressive deficits. Neuropsychological assessment can help determine whether cognitive impairments are due to chronic microscopic vascular changes versus neurodegenerative disease (see above).
BRAIN INJURY
Sudden damage to the brain can be caused by significant head/upper-body impact, with results ranging from mild concussion to severe permanent traumatic brain injury. Another cause of acquired brain injury is sustained no/low blood oxygen (anoxia/hypoxia), which can be caused by heart attack, respiratory arrest, electrical injury, drowning, or certain types of gas exposures (e.g., carbon monoxide). Finally, certain toxic exposures can lead to permanent neurological damage. Neuropsychological assessment helps determine how much impairment resulted from the injury, guides treatment planning, monitors the course of recovery, and can justify the need for accommodation to any permanent impairments.
NEUROPSYCHIATRIC DISORDERS & STRESS
Behavioral and cognitive deficits can arise from a collection of psychiatric conditions thought to likely reflect underlying neuropathological changes in the brain attributed to an interplay of genetics and environment. The conditions can arise in childhood and persist, or spontaneously emerge in adulthood. Examples include schizophrenia, bipolar disorder, severe depression and anxiety, obsessive-compulsive disorders, autism spectrum disorder, ADHD, and eating disorders. While neuropsychiatric disorders tend to be chronic (even if responsive to treatment), significant life stressors can sometimes cause similar symptoms that tend to resolve with reduced stress and/or proper treatment.
Neuropsychological assessment helps delineate whether a neurological disease, neuropsychiatric disorder, or stress-reaction is most likely causing cognitive and behavioral changes. This answer guides treatment planning.
EPILEPSY
Genetic predisposition or injury to the brain can cause seizures (uncontrolled electrical disturbance in the brain causing alterations to consciousness, behavior, emotions, motor control or sensation). Neuropsychological assessment helps with identifying deficits persisting between seizures, monitoring for decline, and treatment planning (e.g., if surgery is being considered).
BRAIN TUMORS & CANCER
Brain cells can become cancerous, causing primary brain tumors; other cancers can spread to the brain causing metastatic brain tumors. Both tumors can cause cognitive and behavioral problems due to their impact to the brain, and the treatments (radiation, surgical resection) can impact brain functioning as well. Neuropsychological assessment helps characterize how the tumors are affecting the brain as well as monitors for treatment-related side effects and disease recurrence.
NEURO-AUTOIMMUNE CONDITIONS
When the body’s immune system attacks healthy cells in the brain, inflammation and associated pathology can cause behavioral and cognitive impairments. Multiple Sclerosis is one of the more common disorders. Neuropsychological assessment helps detect whether the neuro-autoimmune condition is resulting in cognitive deficits, guides treatment planning, and can help monitor for treatment-response or disease recurrence if the condition is fluctuating.
SLEEP DISORDERS
Chronic insomnia, narcolepsy, and sleep apnea are all associated with behavioral and cognitive deficits. Neuropsychological assessment can help delineate between cognitive problems due to sleep disorder versus other neuropathology. Proper diagnosis and treatment of sleep disorders can generally reduce the dysfunction, assessment can monitor for response to treatment. Additionally, certain unusual sleep symptoms can sometimes guide diagnosis of other neurological conditions.
REVERSIBLE V. CHRONIC MEDICAL CONDITIONS
Frequently, reversible/treatable medical conditions that cause behavioral and cognitive problems go unrecognized. These include infections (e.g., UTI), medication side effects or interactions, nutritional deficiencies (e.g., low B12), metabolic disorders (e.g., kidney or liver failure), hormonal dysfunction (e.g., hypo/hyperthyroidism), environmental toxic exposure (e.g., working with solvents), and substance abuse/misuse. Neuropsychological assessment can aid in identification of these conditions, prompting proper treatment, which can improve brain functioning and reduce/eliminate symptoms.
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Chronic non-neurological medical conditions sometimes involve changes in behavior and cognition, even without direct brain involvement. These conditions include fibromyalgia, chronic fatigue syndrome, and functional neurological disorders. Neuropsychological assessment can help delineate whether problems are consistent with these conditions, or whether there might be other neuropathology present.