So I’d been waiting essentially a whole year to see a neuropsychologist. The one my primary doc originally referred me to last November had actually just left her job to work in the private sector. It took several months before the office got back to me with the neuropsychologist who thought could best help me. I finally saw Dr. L this week, and it wasn’t at all what I’d expected.
I’d had to Google what a neuropsychologist does because it sounds so fake, but that’s the case for more than one actual treatment I’m getting that makes a real difference. I thought this was going to include the tests I did end up doing during my visit, but I also thought he was a diagnostic professional who would look at my collection of symptoms and say, “You should get tested for this, this, and this, because patients I see with similar symptom presentation tend to get these diagnoses.” That part didn’t happen.
Anyway, I got notified that my after-visit summary was available on MyChart, and I want to keep it in my own “records” here on my blog.
BACKGROUND INFORMATION & REASON FOR REFERRAL:
Christina Gleason is a 43 year old, right-handed, Caucasian female [note: there was no field for gender in my new patient paperwork, but they did ask for sex assigned at birth] with a variety of physical and psychiatric debilities who has described significant and apparently worsening cognitive difficulties in recent years.
The patient was referred for neuropsychological assessment to clarify the nature and extent of her current deficits, and to assist in selection of any appropriate rehabilitation interventions.
RESULTS OF EVALUATION:
The patient is maintained on a variety of psychotropic medications by her treating psychiatrist, is reportedly under the care of a cardiologist, and is currently in Physical Therapy addressing fibromyalgia, small fiber neuropathy, and polyarthritis. She characterizes herself as ‘bed-bound’ in recent years by her ongoing physical difficulties.
The patient performs quite well in structured cognitive assessment, however. She scores in the Very Superior range in a composite measure of her verbal intellectual abilities (Verbal Comprehension Index; 130), displays adequate confrontational naming, and displays adequate comprehension for even complex task instructions within the quiet testing environment.
The patient scores at the upper end of the average range in her ability to duplicate even complex model designs through an arrangement of constituent blocks. She also displays good organization and planning when required to duplicate a complex geometric design involving multiple part-whole relationships (Rey-Osterreith Complex Figure), and displays a notably adequate incidental recall for that design immediately following its reproduction.
The patient scores in the High Average range in a composite measure of her ability to retain and actively manipulate verbally encoded information within consciousness (Working Memory Index; 111). She is consistent in repeating sequences of 7 digits in length, and is able to successfully reverse a 5 digit sequence at times. The patient scores significantly above average in completing difficult mental calculations.
The patient also scores in the High Average range in a composite measure of her processing speed in completing novel graphomotor and perceptual tasks (Processing Speed Index; 117).
The patient displays adequate scanning and speed in a rote sequencing task (Trails A; 24”), displays no difficulty adopting and sustaining an unfamiliar task set in order to connect an array of numbers and letters in an alternating sequence (Trails B; 43”), and displays no difficulty discovering the appropriate concept to guide her responses within the Wisconsin Card Sorting Test.
The patient describes severe and increasing forgetfulness in her daily routine, but displays a notably well-preserved ability to deliberately memorize both verbal and nonverbal materials within the quiet testing environment. The patient freely recalled 14 of 16 words following a single presentation of a lengthy stimuli list (CVLT), recalled all 16 of those words following the 2nd presentation of that list, and freely recalled 15 of the target stimuli following a delay. She recognized the remaining item in a multiple-choice format.
The patient displays notably good immediate recall for paragraph length stories (WMS-R Logical Memory), and freely recalled nearly all of that material following a half hour delay (95th percentile). She displays good immediate recall for geometric designs under conditions of intentional memorization (WMS-R Visual Reproduction), and freely recalled all 4 of those designs without distortion following a half hour delay (81st %ile).
IMPRESSION & RECOMMENDATIONS:
The patient displays no difficulty completing structured tasks administered sequentially within the quiet testing environment. Experienced forgetfulness seems most closely associated with a reduction in incidental learning secondary to pain and psychiatric co-morbidities, and likely needs to adopt a slower, more deliberate approach to individual activities in her daily routine.
Feedback briefly encouraged an increased reliance on external memory and organizational aids. The patient might benefit from brief instruction in an increased reliance on external memory and organizational aids with Occupational and/or Speech Therapy if her independent compensatory efforts prove insufficient over time.
The patient was seen in 3 hours of neuropsychological assessment on the date cited above as delineated below. Those charges included review of records, test administration, scoring, and report preparation.
The upshot of our conversation before the visit ended, the part that didn’t make it into the report, is that Dr. L told me he could see that I was “very smart,” and that the tools of his profession are blunt instruments with no nuance and cannot provide an accurate picture for people who are already on the higher end of the bell curve. He also explained that brain fog literally never gets indicated when he sees patients for testing. Being in a still, quiet environment removes the stimuli that contribute to our brain fog. It doesn’t mean that the brain fog doesn’t exist; it just means that it can’t be measured with existing tools.
So this testing will now serve as a baseline for future testing, like it did for a patient he described to me as having an IQ of 135. (I know that IQ is not a meaningful measurement in general, but for the specific skills the IQ test evaluates, mine is 147, give or take a point or two. My mom told me what it was once, and I know it was above the standard deviation signifying “genius” but it wasn’t as high as 150. This led to a lot of my mom’s exasperation over me being “so smart” but having “no common sense.” I bet this was common for other Former Gifted Kids who hadn’t yet been diagnosed as autistic.) My testing showed that I did average or above average in all the tasks, but would I have tested better a few years ago? The tests don’t work on people considered conventionally intelligent until or unless earlier testing exists to serve as a baseline.
This was not as productive a visit as I’d hoped, but it may be important in the future to measure progressive cognitive dysfunction.
The treatment the doc recommended was to get a certain kind of day planner (Daytimer was recommended) to write down what happens each day so I can go back and look to help with memory and recall. The one he showed me was from 2011, and I can’t find one like it in my initial searches, but I’m going to keep looking.
Hey people!!!!!
Good mood and good luck to everyone!!!!!