Neuro Psychology

The Department of Neuro Psychology provides a broad range of services as below
  • Neuro Psychology Department

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    The Department of Neuropsychology at Neuro Foundation is well organised and being managed by full time senior consultants with more than 10 years of experience with wide variety of neuropsychological diseases.

    The Neuropsychology Service provides comprehensive assessment services for child, teenage, adult, and geriatric patients in whom impairments of cognitive, neuropsychiatric, or developmental functioning are evident or suspected. Our services include outpatient evaluation and inpatient consultation services.

    Neuropsychological assessment involves a systematic evaluation of higher cognitive abilities such as intelligence, academic skill, memory, language, attention, problem solving ability, executive abilities and visual motor skills, as well as sensory/motor and personality/emotional functioning.

    We also provide specialty Clinic services:

    Adult Neuropsychology Clinic

    Focuses on comprehensive evaluations for teenagers and adults. Referral questions focus on clarifying cognitive and psychological functioning, as well as assisting with differential diagnosis and treatment planning in adults with known or suspected brain dysfunction.

    Pediatric Neuropsychology Clinic

    Focuses on the comprehensive assessment of infants, children, adolescents, and young adults with a wide range of medical, neurodevelopmental, genetic, psychiatric, and learning disorders. Evaluation and treatment planning emphasize the integration of neurocognitive, social, emotional, and behavioral aspects of these disorders to help families better understand and manage complex presentations.

    Adolescent Mood Disorders Clinic

    • Focuses on evaluations in adolescence and young adulthood, where a mood disorder may be interfering with functional independence, including difficulty meeting educational and vocational goals.

    Memory and Aging Clinic

    • Focuses on evaluations in mid and late life
    • Referral questions focus on degenerative and reversible causes of cognitive problems in this age range
    • Specializes in co-morbid medical and emotional conditions that may also contribute to cognitive problems in the aging.

    Multiple Sclerosis Clinic

    • Provides brief as well as comprehensive cognitive and psychological assessments for the patients with multiple sclerosis (MS) and offers treatment recommendations for improvement in everyday functioning.


    Conditions Treated

    The Neuropsychology Service and Clinics can provide assessment and treatment recommendations for a wide range of conditions that may affect cognition and/ or behavior, including

    • Cognitive and emotional effects of various neurological conditions, including, for example, Alzheimer’s disease, stroke, epilepsy, multiple sclerosis (MS), leukemia, brain tumors, Parkinson’s disease, and chromosomal disorders
    • Traumatic brain injury and electrical shock injury
    • Cognitive decline in elderly patients
    • Changes in thinking abilities associated with various medical conditions, including: metabolic disorders, HIV infection, cardiac complications, liver disease, toxic exposures, and autoimmune disorders (e.g., Lupus) among othersty
    • Attention-deficit disorders
    • Learning disorders
    • Psychiatric and emotional disorders and symptoms

    Services Offererd

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    Awake
    Craniotomy

    An awake craniotomy is an operation performed in the same manner as a conventional craniotomy but with the patient awake during the procedure.

    Neuropsychology provides comprehensive assessment for patients being considered for awake craniotomy including assessing suitability for awake neurosurgical procedures, pre-operative fMRI (Magnetic Resonance Imaging), baseline cognitive assessment, preparation of patients for awake neurosurgery and functional assessment in theatre as part of the intra-operative functional mapping assessment.

    Brain
    Tumour

    The service accepts patients with any type of tumour affecting the brain. This includes pituitary tumours and neurofibromatomas

    Community
    Rehabilitation

    A clinical neuropsychologist is attached to each of the Neuro Foundation Community neurorehabilitation Team.

    Diagnostic
    Neurology

    This involves referrals by Neurology Consultants where neuropsychological assessment is a component of making a neurological diagnosis.

    Epilepsy
    Surgery

    The well-established epilepsy surgery programme at our Hospital comprises a multidisciplinary group of health care professionals who specialise in investigation and treatment of epilepsy.

    General Clinical
    Neuropsychology Service

    This covers a wide range of patients who have a neurological condition that does not fall within the remit of established and more specialised neuroscience centre based neuropsychology services.

    Neuropsychology
    Inpatients

    Inpatient referrals are accepted from any neuroscience ward within Salford Royal Hospital and from any health professional involved in the care of the patient.

    Surgery for
    Movement Disorder

    Surgery for movement disorders including Parkinson's disease, tremor, and dystonia. Although medications are the mainstay of therapy for movement disorders, neurosurgery has played an important role in their management for the past 50 years. Surgery is now a viable and safe option for patients with medically intractable Parkinson's disease, essential tremor, and dystonia.

    Neurological
    Rehabilitation

    The Clinical Neuropsychology Service in our Wards, the Stroke Rehabilitation Unit and the Trauma Assessment Unit provides support to patients who are in the early stages of recovery following traumatic brain injury, Stroke, neurosurgery or neurology treatment.

    Non-Epileptic
    Attack Disorder (NEAD)

    The well-established Non-Epileptic Attack Disorder (NEAD) Service at Salford Royal Hospital offers assessment and therapy for patients who are experiencing attacks (seizure like events) that are psychologically triggered.

    Subarachnoid
    Haemorrhage (SAH)

    Subarachnoid hemorrhage is sudden bleeding into the subarachnoid space. The most common cause of spontaneous bleeding is a ruptured aneurysm. Symptoms include sudden, severe headache, usually with loss or impairment of consciousness.

    Traumatic
    Brain Injury (TBI)

    Traumatic Brain Injury (TBI) is any injury that affected the brain and was caused by a trauma, that is, by a physical force (e.g. a fall, road traffic accident, or assault).

    Video
    Telemetry

    Video Telemetry is an assessment used to further investigate conditions such as epilepsy and non-epileptic attack disorder.

    What is the purpose of a neuropsychological evaluation?

    Neuropsychological evaluations provide detailed information about an individual’s functioning across multiple domains that can help guide recommendations and strategies to improve functioning at home, at work, in school, and in the community.

    Often, an evaluation is requested by a physician or specialist to help localize possible areas of brain damage or dysfunction and/or to clarify a differential diagnosis. An evaluation also might be requested to help monitor for any changes in cognitive abilities, behaviors, and emotional functioning over time. The information obtained from the evaluation can provide important information and recommendations to the client and family members, as well as to doctors, therapists, or other specialists working with the individual.

    Key areas examined in a neuropsychological evaluation often include:

    • Intellectual reasoning capacity, or IQ
    • Executive functioning (skills like planning, organizing, problem- solving, etc.)
    • Concentration and attentional capacity
    • Language abilities
    • Visual-perceptual and spatial abilities
    • Memory abilities
    • Sensory/perceptual and motor abilities
    • Social and emotional functioning
    • Academic skills (although, these are typically assessed only if there is a specific questions of a possible learning disorder)

    Who would benefit from a neuropsychological evaluation?

    Individuals who have known or suspected brain dysfunction. Often individuals who have experienced cognitive changes in the context of a traumatic brain injury, neurodegenerative disorders, or other medical conditions that affect neurologic functioning can benefit from a neuropsychological evaluation. Similarly, those with long-standing cognitive issues since childhood or complex psychiatric histories involving mood, anxiety, trauma, or other mental health concerns often seek out neuropsychological evaluations to rule out other causes of their cognitive/behavioral symptoms to target more effective treatments and intervention strategies.

    In some cases, individuals have experienced challenges that have been difficult to sort out since childhood. It is not uncommon, for example, to meet with clients who have consulted with many doctors, specialists, therapists, and/or school personnel over the years and still not have a clear understanding of their issues. Neuropsychologists synthesize information from a variety of sources, including cognitive/behavioral test data, structured assessment of social and emotional functioning, as well as collateral report from family members, teachers, or others who know the client well to help provide some clarity and guidance around these issues.

    Why might a student want a comprehensive neuropsychological assessment?

    Common reasons why a student might seek out a neuropsychological evaluation often include any combination of these concerns:

    • Struggling to pay attention in class
    • Not following through or completing assignments
    • Problems completing reading assignments because it takes too long or not understanding what was read
    • Low frustration tolerance
    • Taking too long to organize their thoughts
    • Needing extra time for examinations
    • Lack of motivation
    • Declining grades in school
    • Being easily distracted or finding that impulsive behaviors are interfering in completion of tasks
    • Experiencing anxiety and/or depression related to school performance
    • Disparity between grades in school and scores on standardized tests
    • Experiencing particular difficulty with a subject, such as math, reading, writing.

    Those who are frustrated by sub-optimal school performance often seek out a comprehensive neuropsychological evaluation to (a) help clarify the cause(s) of their difficulties and (b) to obtain recommendations for academic accommodations when indicated. Assessment of academic skills (e.g., reading, writing, arithmetic) certainly is useful (and necessary) information, but it often is insufficient. There are any number of reasons why one might struggle in school. Sometimes an underlying reading disorder (e.g., dyslexia) represents the root cause of the difficulty. For others, their school problems might be circumscribed to math or there might be some issue related to poor motor control/speed or dysgraphia that interferes with academic success. Some students struggle primarily with attentional or executive functioning weaknesses, suggestive of a primary attentional syndrome, such as ADD/ADHD. Still others may encounter complicating psychosocial factors or co-occurring psychiatric disorders that disrupt several areas of daily life, including school performance. Thus, it is critical to understand the “whole picture” as much as possible to characterize the reason(s) underlying these struggles so as to best target recommendations that foster greater academic success and improvements in overall daily functioning.

    Can a neuropsychological evaluation help to diagnose ADD/ADHD?

    Yes. Neuropsychological assessments are appropriate for targeting specific learning disorders in reading, math, and writing, as well as identifying other sources of interference with learning and academics, such as Nonverbal Learning Disorders, Asperger’s disorder, psychiatric conditions, among many others.

    How long does a neuropsychological evaluation take?

    A comprehensive neuropsychological evaluation is comprised of three separate appointments and is described in more detail here. Keep in mind each client is unique and designing an appropriate assessment will be individualized based on your needs and the questions you want answered. Broadly-speaking, however, a typical evaluation involves three appointment dates, including (1) a one-hour initial interview, (2) the testing appointment, which can last 2-6 hours, and (3) a one-hour feedback appointment to review the results and recommendations from the evaluation.

    How do I prepare for my evaluation?

    • It is important that you eat before your evaluation appointment. It is strongly recommended that you bring snacks and/or a lunch, as the evaluation may last several hours.
    • Bring a current list of your medications and their dosages.
    • Please take your regularly prescribed medications, as scheduled. However, consult with your physician about optional medications that might cause drowsiness (like pain killers, anti-anxiety, allergy medications), as these can affect your test results.
    • Bring your reading glasses or hearing aids.
    • Bring a valid photo ID and health insurance card.
    • Please arrive on time and allow for extra time for traffic, parking, and check-in. Late arrival may result in rescheduling your appointment.

    What happens during a neuropsychology evaluation?

    The evaluation involves a clinical interview that lasts about an hour with you and, when possible, a family member (or someone who knows you well). The interview is designed to understand your history and how the cognitive and emotional difficulties you have experienced have impacted your life and daily functioning.

    On a separate date, you will then complete a number of computerized and paper/pencil tests that can last anywhere from between 2-6 hours. You will be tested alone in a quiet room. If you are accompanied by family members or friends, they will be asked to wait in the waiting room.

    Who receives the results of the evaluation?

    Once the evaluation is completed, the findings will be summarized in a written report that will be sent to your referring physician or specialist. In addition, you will be provided a copy of your report, which can either be picked up in person at the office, delivered to your home via standard mail, or emailed to you, based on your preference.

    Special Disorders

    Attention-Deficit/Hyperactivity Disorder (ADHD)

    ADHD (also sometimes referred to as “ADD”) is a developmental disorder characterized by symptoms of inattention and/or restlessness. These symptoms first emerge in childhood and result in substantial disruptions in daily functioning.

    Neuropsychological evaluations can be very helpful in guiding ongoing treatment planning for individuals with suspected ADHD. First, ADHD is not a “one size fits all” diagnosis; individuals tend to differ markedly with respect to how—and in what situations—symptoms are expressed in daily life. Also, comprehensive neuropsychological assessments often can identify other conditions that might be mimicking the symptoms of ADHD, but require an entirely different treatment approach. Likewise, it is not uncommon for other conditions to co-occur with ADHD, effectively making an individual’s symptoms—and level of impairment—even worse. Thus, there is significant clinical value in neuropsychological assessment approaches to help target the most effective interventions and/or remediation strategies in individuals with suspected ADHD.

    Dementia

    The term ‘dementia’ typically refers to chronic medical conditions that cause progressive declines in memory and other cognitive/behavioral skills. Alzheimer’s disease, for example, is the most common cause of progressive cognitive decline, accounting for more than two-thirds of all dementia cases. Still, there are many other medical conditions that can result in dementia, including, but not limited to:

    • Vascular dementia
    • Dementia with Lewy bodies
    • Frontotemporal dementia
    • Semantic Dementia
    • Parkinson’s disease
    • Huntington’s disease
    • Creutfeldt-Jakob disease
    • Corticobasal degeneration
    • Progressive supranuclear palsy

    Neuropsychological evaluations can be very helpful in terms of evaluating for possible dementia and ruling out other causes for an individual’s cognitive difficulties. First, it is important to consider that at least some cognitive declines are to be expected as we get older. Specialized neuropsychological assessments can help differentiate between what would be considered a normal, healthy aging process versus difficulties that are suggestive of something else going on that is more pronounced. Also, formal neuropsychological assessment can help discriminate between potential causes of difficulties an individual is experiencing and clarify a diagnosis that will inform potential treatments or supports. Finally, repeated assessments often are requested to monitor an individual’s functioning over time to determine the rate of decline, what areas are remaining stable, and hopefully, which areas have been responsive to treatment.

    Frontotemporal Dementia

    The core features of frontotemporal dementia (FTD) typically involve cognitive and behavioral changes that emerge from degeneration of the frontal and temporal lobes of the brain. Although the initial presentation and course can be quite variable, three main subtypes of FTD generally are recognized:

    • Behavioral variant – Deterioration of social decorum and self-regulation, often characterized by impaired judgment, insight, disinhibition, apathy, and other personality changes.
    • Semantic dementia – Impaired knowledge of word meaning, deficits in word-finding (particularly for nouns)
    • Progressive non-fluent aphasia – Demonstrating pronounced impairments in speech production, including decreased output for words, shortened phrases, and/or deficits in articulation.

    Given the variability in presentation seen in FTD and the fact that many of the initial clinical symptoms and behaviors overlap with other neurological and psychiatric syndromes, referrals for neuropsychological evaluation are commonly requested to clarify (or corroborate) an initial diagnosis, make recommendations for treatment planning, and provide a baseline assessment to monitor the course of progression.

    Alzheimer’s Disease

    Alzheimer’s disease (AD) is the most common degenerative disease of the brain. Inside the brain, the hallmark feature of AD is the aggregation of microscopic plaques and tangles in/around nerve cells that disrupt their functioning, ultimately leading to the widespread neuronal loss and brain atrophy. As the physical changes inside the brain evolve, individuals may experience gradual mental changes, often involving memory decline and forgetfulness as the most prominent initial symptom. As the memory problems become more pronounced, changes in other cognitive areas tend to emerge, such as declines in language or visuospatial functioning.

    Although there is no cure for AD at present date, some treatments are available that may help slow down symptom progression. A neuropsychologist can contribute valuable information as part of an individual’s health care team to help clarify a diagnosis of AD, while considering other potential conditions that might be causing mental declines. In addition, a comprehensive neuropsychological evaluation can yield valuable information for the patient and treatment providers to monitor progression over time and guide personalized behavioral modifications and strategies that enhance the quality of life for those who are living with Alzheimer’s disease and their family members.

    Concussion

    A concussion is mild traumatic brain injury (mTBI) caused by a direct blow to the head (or elsewhere in the body that generates abrupt movement of the brain inside the skull). Although concussions only infrequently result in loss of consciousness, it is not uncommon for individuals to experience a range of symptoms post-injury, including headache, dizziness, balance problems, nausea, fatigue, confusion, memory difficulties, mental “fogginess,” low attention span, sleep disturbance, increased anxiety, and/or depressed mood. Fortunately, rapid improvement of these symptoms should be expected within the first 3 days, and the vast majority of individuals (~85%) report complete resolution of symptoms within the first week following injury.

    Still, there are rare occasions when symptoms can persist for weeks or longer after the initial injury. In these instances, formal neuropsychological testing should be obtained to characterize any objective cognitive deficits, screen for other contributing factors, and make personalized recommendations for ongoing management that support a patient’s recovery and resumption of normal daily activities (e.g., work, school, physical activities).

    Parkinson’s disease

    Parkinson’s disease is a progressive movement disorder caused by the death of cells in areas of the brain that control movement and coordination. The core symptoms of Parkinson’s disease include tremor, slowness in initiating and executing movements, muscle stiffness, and poor balance/unsteadiness. Some individuals with Parkinson’s disease also experience other neurobehavioral changes, including depression and cognitive alterations. A neuropsychologist can play an important role in evaluating these mood and/or cognitive changes over time to help guide possible directions for optimal treatment and management of Parkinson’s disease.

    Vascular Cognitive Impairment /Vascular Dementia

    Individuals with a history of high cholesterol, hypertension, obesity, atherosclerosis, and smoking are at increased risk for developing cerebrovascular disease and changes in the structure of blood vessels inside the brain. At one end of the continuum, vascular cognitive impairment can emerge from these risk factors and manifest in subtle cognitive problems with learning and memory, attention, and/or information processing. At the other end of the spectrum, more severe cognitive dysfunction may be present, suggestive of vascular dementia, which often can evolve out of a history of large vessel strokes, isolated cerebral infarctions affecting critical brain regions, cardiac arrest (and resulting depletion of blood supply to the brain), and/or widespread small-vessel disease. Neuropsychological evaluations can provide essential information to individuals, family members, and treatment providers who are seeking clarity in terms of diagnostic considerations. In addition, formal assessment will explore emotional factors and what supports and individual has to inform appropriate referrals for treatment and ongoing management. In addition, neuropsychological evaluations are necessary to accurately monitor for changes in cognitive and functional status over time.




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