Shrinking health care dollars have sharply reduced the number of patients undergoing neuropsychological testing.

Individuals with psychiatric disabilities often report reduced levels of cognitive functioning. Excluding cases of profound mental illness (schizophrenia, psychotocism, etc.), these symptoms are often transient and relatively mild in nature, and can be attributed to psychiatric and psychological factors or to side-effects from various medications.

Testing Cutbacks
Some individuals, however, have more profound cognitive difficulties (i.e., problems with short and long-term memory, attention span and concentration, word and name retrieval and association, language comprehension, etc.) which persist or even worsen over time. When this happens, it's time to consider a referral for neuropsychological testing.

Unfortunately, shrinking health care dollars and profit-oriented managed health care have sharply reduced the number of patients undergoing neuropsychological testing. While it could be fairly argued that 10 years ago too much testing (both psychological and neuropsychological) may have been performed, today the exact opposite is true. This trend is deeply troubling and disturbing, since an absence of clinical information on the origins and scope of cognitive decline can directly undermine rehabilitative efforts.

An Important Diagnostic and Rehabilitative Tool
Substance abuse treatment facilities, which have many patients with drug and alcohol-related cognitive deficits, have been particularly hard-hit by cut-backs in insurance reimbursements for neuropsychological and psychological testing. Such austerity on the part of health insurers is penny wise but pound foolish. The inability to identify and quantify cognitive weaknesses in recovering substance abusers may seriously hamper vocational progress towards an eventual return to gainful employment.

For example, a recovering alcoholic is an accountant for a major Wall Street firm. He's extremely anxious about going back to work because he seems to "space out" when adding or substracting numbers. Without more objective data on where the problem lies and how severe it is, the care giver is forced to make "an educated guess" as to which, if any, therapies may need to be applied.

Another example of the rehabilitative importance of neuropsychological testing sometimes involves patients with major depression, who typically experience problems with attention span, concentration, and short-term memory. Patient concerns about these problems often leads to chronic anxiety and worry that that a more serious underlying condition may be present.

The effects of such stress should not be underestimated or dismissed. I know of one case which nearly ended in suicide. The patient was a 48 year-old woman with a history of Alzheimer's Disease in her family. Upon testing, her impairments were found to be mild and not the kind normally associated with an organic problem. In point of fact, the patient had been distraught over a broken romance and her level of depression and cognitive complaints were greatly reduced once she was informed of the results.

On the flip side of the coin, persistent cognitive complaints sometimes do have organic origins. Certain patterns of impairment detected in a neuropsychological evaluation can suggest malfunctions in specific areas of the brain, paving the way for referral for further medical investigation. More than a few cases like these have led to the early discovery and successful removal of life-threatening tumors.

Formulating a Successful Treatment Regimen
While it cannot always identify the precise cause, neuropsychological testing provides essential clinical information on the parameters and scope of cognitive decline. With reliable cognitive data in hand, care givers can construct an efficacious and appropriate treatment regimen which builds on the patient's cognitive strengths and addresses any existing weaknesses.

Given the right targeted therapies and retraining, the mind and brain have a tremendous capacity for healing and recovery. Attempting to develop a cognitive rehabilitation regimen without the essential data generated by the neuropsychological testing process is like driving cross-country without a road map. It's a handicap we as professionals cannot and should not accept.

For More Information . . .
For basic information on neuropsychological testing, please visit the links below and/or consult our special on-line guide, The ABCs of Managing Psychiatric Disability Cases. For details on forensic applications for neuropsychological testing in head injury cases, see my article entitled Neuropsychological Testing, Brain Damage, and Malingering.

If you need to arrange a neuropsychological evaluation anywhere in the continental United States, please contact us toll free at (888) 779-2524.

Sincerely,

Leonard Grossman Ph.D.,
President, The Forest Hills IPA Inc.
Diplomate, The American Board of Forensic Examiners

Links to Sites on Neuropsychological Testing and Rehabilitation

Neuropsychological Rehabilitation A widely-respected international journal.

Psychology Press Journals A good source of books and journals on psychology and neuropsychology.

Links to Other Links Assorted links on neurospsychology and neuroscience.

Cognitive Rehabilitation More books and articles on cognitive rehabilitation and neuropsychological testing.

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