If you read my post last week, then perhaps you noticed that there are benefits to a teamwork approach when it comes to mental health treatment. Just as psychology and psychiatry complement one another in promoting the emotional wellbeing of a patient, you will discover that neuropsychology and neurology often go hand-in-hand as well.
NEUROLOGY. A neurologist is a medical doctor (M.D. or D.O.) who has completed both medical school and a 4-year residency to specialize in the diagnosis and treatment of neurological disorders. Neurological disorders are diseases that affect the brain, spinal cord, nerves, and muscles. Symptoms may include, but are certainly not limited to: problems with balance, fainting, confusion, tremors, pain, and dizziness. Many neurologists seek additional training to cultivate further expertise with particular conditions (e.g. sleep disorders, headaches and migraine, epilepsy) and/or to work with special populations (e.g. pediatrics, geriatrics).
What should you expect when you schedule an appointment with a neurologist?
Your initial visit with a neurologist should be similar to most other doctor appointments. You’ll be asked to provide information about your medical history and encouraged to describe the symptoms that are troubling you. It would be helpful to bring a family member or close friend to assist you in providing information, especially if you are experiencing any cognitive problems (i.e. confusion, memory loss, trouble concentrating). Your neurologist will then conduct a physical examination to check for any muscle weakness, impaired reflexes, or problems with coordination. At this point, (s)he will likely have a couple of diagnoses in mind and will probably order a few procedures that will either confirm or rule out those diagnoses. Examples of procedures that a neurologist might order include: blood tests, magnetic resonance imaging (MRI), computed tomography (CT) scan, electroencephalogram (EEG), sleep study, and neuropsychological evaluation. Once you have undergone these recommended procedures, you will then return to your neurologist for visit number two. By that time, (s)he will have collected and reviewed all of your test results and will be ready to discuss your diagnosis and treatment recommendations. Treatment could involve a prescribed medication, dietary changes, physical therapy, surgical intervention, etc. Depending on your diagnosis, you may be asked to follow-up with your neurologist on a regular basis to monitor your condition and your response to treatment, or you may only need to return as needed.
NEUROPSYCHOLOGY. A neuropsychologist is (…wait for it…) a psychologist who specializes in neurological conditions. A neuropsychologist has completed a 4-5 year doctoral program (Ph.D. or Psy.D.), followed by a one-year post-doctoral internship, and a 2-year fellowship (also known as a post-doctoral training program or residency). A neuropsychologist’s education and training experiences are geared towards learning about medical disorders and understanding the interplay between your brain and your behavior. Neurological conditions that can affect your mood, personality, and behavior include: dementia, epilepsy, Multiple Sclerosis, movement disorders, and brain injuries that are induced by a stroke, concussion, or tumor.
What should you expect when you schedule an appointment with a neuropsychologist?
You should anticipate some degree of repetition when it comes to your initial visit with any medical or mental health provider. In other words, you will be asked to describe your background and history, physical and emotional symptoms, and the reason that you were referred for an evaluation. The most common reasons that people are referred for neuropsychological evaluations are to provide diagnostic clarity, to assess level of functioning before and/or after an intervention, or to monitor a condition over time. Then again, some people are not referred by a doctor at all. Rather, some people seek neuropsychological evaluations to obtain a baseline assessment of their functioning, to better understand their cognitive strengths and weaknesses secondary to a learning disability or ADHD, to provide documentation (for disability benefits, a pending legal case, or academic accommodations), or to answer specific questions such as, “Can mom still manage her own finances?”
Following the initial interview, your neuropsychologist will schedule a block of time to conduct the evaluation itself. This block of time can vary between a couple of hours to a full day, depending on your ability level, stamina, and referral question. You will be asked to do a number of things, such as answer vocabulary questions, solve puzzles, and remember stories. The tasks that you are asked to complete correlate with different areas of your brain and provide information about your cognitive skills and the way that you approach activities and respond to challenges. Most people would agree that this testing process is mentally challenging but otherwise non-invasive.
The final appointment takes place when your neuropsychologist provides you and/or your physician with a report that includes a description of your background, test results, diagnoses, and recommendations. Your test results are based on normative data, meaning that your scores will be compared to scores that have been obtained by your same-age peers with a similar level of education. This helps to even out the playing field, so to speak, and better determine what falls within normal limits and what does not. During this last appointment, your neuropsychologist will explain your test performance and what your pattern of scores means in terms of a diagnosis. At that time, you will have the opportunity to ask questions and discuss the next steps that should be taken.
You mentioned something about “diagnostic clarity.” What does that mean?
Picture, if you will, a man who is in his early-80’s. His wife tells me that she is worried about his memory because he recently forgot the name of his favorite Italian restaurant. She says that he also stopped contributing to conversations, seems irritable in the evenings, and sleeps more than he used to. Based on this information alone, there are a few diagnoses under consideration: Mild Cognitive Impairment, Dementia, and Depression. A fourth consideration is that his wife is overly concerned and the man’s symptoms are actually within normal limits for his age! A neuropsychological evaluation can be used to identify a diagnosis when there is more than one possibility.
Since there is currently no cure for Alzheimer’s disease, what is the point of a neurological exam and neuropsychological evaluation?
Alzheimer’s disease is the most common type of dementia, but it is not the only one. Understanding your diagnosis is important for several reasons. First, there are treatment options available that could reduce your symptoms and/or slow down the progression of your disease. Second, knowing what to expect will enable you to make plans for your future and the future of your family. Third, there may be resources available to assist you and your family that you were previously unaware of. And last, some types of dementia have a genetic component. This knowledge could help your children and grandchildren, who would have the opportunity to take preventative measures and seek early treatment if they begin to notice symptoms.
Let’s cut to the chase. How much is all of this going to cost me?
Depending on your insurance coverage, you might only be looking at standard co-payments. Some of the procedures that will likely be ordered by your neurologist, however, will require pre-authorization. This includes the neuropsychological evaluation. If your insurance will not cover the requested procedure (OR the provider you selected does not accept insurance- which is becoming increasingly more common with recent changes in healthcare), then you can anticipate the cost of a neuropsychological evaluation to vary between $1,000-$5,000 depending on the city that you live in and scope of the assessment. In other words, a brief cognitive screening in Boise, Idaho will cost less than a comprehensive evaluation in New York City. The cost of neuroimaging (CT scan, MRI, PET scan) can vary anywhere from $1,000-$10,000.