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Effective treatment begins with comprehensive evaluation

Our neuropsychology program provides assessments and inpatient consultations to people with acquired or developmental and movement disorders.

A neuropsychological evaluation is performed to help understand how the different areas and systems of the brain are working. Examinations are usually recommended when there are symptoms or complaints involving memory or other areas of thinking. Common among adult patients are progressive cognitive changes associated with Alzheimer’s disease, Parkinson’s disease, multiple sclerosis or following an acute event such as traumatic brain injury or stroke. Pediatric clients are often referred for learning difficulties due to developmental disorders such as learning disability, attention deficit hyperactivity disorder and autism.

A neuropsychological evaluation typically consists of an interview and formal examination. During the interview, information that is important for the neuropsychologist to consider will be reviewed. The assessment involves paper-and-pencil tests, computerized tests and answering questions. An interview is typically held at the conclusion of the assessment and a written report is provided to the referring doctor.

A typical neuropsychological evaluation can involve assessment of the following:

  • General intellect
  • Higher level executive abilities (such as sequencing, reasoning and problem solving)
  • Attention and concentration
  • Learning and memory
  • Language
  • Visual-spatial abilities (such as perception)
  • Motor and sensory abilities
  • Academic skills
  • Mood and personality

The evaluation can be used to understand a patient’s situation in a number of ways:

  • Identification of cognitive difficulties—The examination can be used to identify weaknesses in specific areas of cognition. It is very sensitive to mild memory and thinking problems that might not be obvious in other ways.
  • Differential diagnosis—Different illnesses result in different patterns of strength and weakness. Therefore, the examination can also be used to help differentiate among illnesses. This is important since appropriate treatment depends on accurate diagnosis.
  • Establishment of a baseline—Sometimes the examination is used to establish a baseline or to document a person’s skills at the onset or before a cognitive problem arises. This way, later change can be measured very objectively.
  • Documentation of change—Following the establishment of a baseline, successive examination can be used to document change over the progression of a disorder, as well as the effects of surgical, medical and behavioral treatments on the patient’s neurocognitive status.
  • Treatment planning—The examination can be used to identify target problems to plan treatments that use a patient’s cognitive strengths to compensate for weaknesses.

Diagnosis

Diagnosis of movement disorders are made based on a clinical exam and history. We also use a variety of screening tests to determine an accurate diagnosis:

Brain scans are imaging techniques used to diagnose tumors, blood vessel malformations, or hemorrhage in the brain. These scans are used to study organ function or injury or disease to tissue or muscle. Types of brain scans include computed tomography, magnetic resonance imaging, and positron emission tomography.

Computed tomography (CT scan) is a noninvasive, painless process used to produce rapid, clear two-dimensional images of organs, bones, and tissues. Neurologic CT scans are used to view the brain and spine. They can detect bone and vascular irregularities, certain brain tumors and cysts, herniated discs, epilepsy, encephalitis, spinal stenosis, a blood clot or intracranial bleeding in patients with stroke, brain damage from head injury and other disorders.

Magnetic resonance imaging (MRI) uses computer-generated radio waves and a powerful magnetic field to produce detailed images of body structures including tissues, organs, bones and nerves. Neurologic uses include the diagnosis of brain and spinal cord tumors, eye disease, inflammation, infection, and vascular irregularities that may lead to stroke. MRI can also detect and monitor degenerative disorders such as multiple sclerosis and can document brain injury from trauma. A functional MRI (fMRI) uses the blood’s magnetic properties to produce real-time images of blood flow to particular areas of the brain. As with CT scans, MRI findings generally become more evident with disease progression, showing atrophy over time in select areas.

Positron emission tomography (PET) scans provide two- and three-dimensional pictures of brain activity by measuring radioactive isotopes that are injected into the bloodstream. PET scans of the brain are used to detect or highlight tumors and diseased tissue, measure cellular and/or tissue metabolism, show blood flow, evaluate patients who have seizure disorders that do not respond to medical therapy and patients with certain memory disorders, and determine brain changes following injury or drug abuse, among other uses. PET may be ordered as a follow-up to a CT or MRI scan to give the physician a greater understanding of specific areas of the brain that may be involved with certain problems. Scans are conducted in a hospital or at a testing facility, on an outpatient basis.

Neuroscience Research Center

Research at the Susan and Leonard Feinstein Center for Neurosciences is focused on many aspects of movement disorders, from making improvements in diagnosis to understanding the underlying causes of the diseases and assessing emerging therapies. There is an emphasis on clinical trials, including those targeting Parkinson’s disease, Huntington’s disease and other movement disorders.

Other areas of research include the study of how novel therapies for movement disorders can improve brain function in individual patients, using the latest imaging techniques. This unique knowledge has contributed to a better understanding of the underlying causes of these disorders and has been instrumental in testing new options.

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