Neuropsychological Assessment
A neuropsychological evaluation is an integral component when evaluating the effects of brain dysfunction and is one of the methods of diagnosing neurodegenerative, neurodevelopmental, and acquired disorders of brain function. A neuropsychological evaluation is comprised of valid and reliable tests designed to evaluate the cognitive functions, as well as mood and personality. A thorough evaluation also includes a clinical interview with the client, and the client's family if available, and a review of medical records and related collateral information. The length of a neuropsychological evaluation can vary significantly depending on the referral questions.
At PARS, Dr. Pachet sees a variety of clients presenting with concerns related to their cognitive status. Many of our clients have sustained a head injury in a motor vehicle accident, a fall at work, or some other incident involving a blow to the head. Other clients seen may suffer from neurological disorders such as epilepsy, stroke, encephalitis or other brain condition. Neuropsychological testing can be valuable in assessing cognitive decline in neurodegenerative conditions such as Alzheimer's and other types of dementia. In addition, a neuropsychological evaluation can highlight the cognitive strengths and weaknesses of individuals with neurodevelopmental disorders like autism, Attention Deficit Disorder, language disorders, or learning disabilities.
Dr. Pachet's practice provides expert clinical judgment, professionalism, as well as short wait lists, and brief report turnaround times.
Questions often asked about Neuropsychological Assessments include:
- Has the client sustained an acquired brain injury, and if so, what is the severity of the brain injury or concussion? What impact will their brain injury have on their functional abilities?
- Is the pattern of findings consistent with what you would expect given the injury? Consistent with the client's complaints?
- What is the severity of the symptoms the client is currently experiencing?
- Does the client's current functioning reflect the effects of pre-injury, injury, or post-injury factors? Exacerbation of pre-injury limitations?
- Prognosis for further recovery? Treatment needs? Does the client have any employment restrictions?
Capacity Assessment
Capacity is a complex socio-legal construct frequently used to describe decisions about a client's medical, social, and financial decision-making abilities. If triggers exist that suggest a person's decision-making capacity has deteriorated, which is placing that person safety at risk, a capacity assessment may be necessary. A capacity assessment is the formal assessment of a person's mental capacity to make decisions about personal and / or financial matters. Assessing a person's knowledge and understanding of certain issues and his or her ability to understand and appreciate the consequences of the choices made around these issues is vital. The ability to follow through with chosen options (initiation) is also integral to capacity. Decision-making capacity is a multi-factorial concept with multiple integrated domains.
Completion of a semi-structured clinical interview to assist in the determination of patient's decision-making capacity is typically viewed as the gold standard when making a capacity determination. However, it is also common practice for Dr. Pachet to use cognitive tests to assist in the assessment of a person's decision-making capacity. The length of time of the interview and testing varies case by case.
Some of the most common questions Dr. Pachet addresses regarding decision-making capacity include:
- Does the client require an alternate decision-maker? For example, does the client need a guardian or does his / her Personal Directive or Enduring Power of Attorney need to be activated?
- If the Personal Directive needs to be activated, in what domains does the client lack capacity? Does the client lack capacity globally or are there pockets of capacity remaining?
- Is the client able to write a Personal Directive and / or an Enduring Power of Attorney?
- Is the client able to amend an existing Personal Directive or an existing Enduring Power of Attorney?
- My client wants to change his will. Does he / she have testamentary capacity?
- Does this individual have capacity to make this donation to charity?
- My daughter has a long standing development disability and she / he is turning 18 years old soon. Can you please assess his / her decision-making capacity?
- This individual changed their will six months before their death and only days after having surgery. Can you please complete an assessment of retrospective capacity?
Comprehensive Psychological Assessment
A comprehensive psychological assessment gathers information from a variety of sources to evaluate an individual's overall psychological functioning. The goal of this type of evaluation is to investigate an individual's current emotional functioning, personality style and areas of concern to understand how these issues may be impacting their ability to function in everyday life, including work.
During this evaluation, an individual would initially meet with Dr. Pachet for an interview. During this interview, the client will be asked a variety of questions regarding their social, psychological, and health history. If the reasons regarding this assessment revolve around a recent trauma, illness, or injury, he / she should be prepared to discuss how this injury / illness / trauma occurred and any problems experienced as a result. All of this information helps in completing an accurate assessment. After the initial interview, the client will complete a variety of test instruments that further examine the individual's psychological functioning (e.g. mood and personality). These measures typically include questionnaires and symptom inventories and instruments that assess self-perception of disability, functional limitations, general health and pain concerns, and coping strategies. Cognitive tests, designed to assess thinking and memory skills, may be employed depending on the individual's complaints. An important aspect of this assessment is an evaluation of potential response biases, including tendencies to over-report or misrepresent concerns. This assessment is usually scheduled over one day and a feedback session to discuss the results and recommendations of this assessment is typically completed a week or two after the evaluation is finished.
A psychological evaluation is an important first step in the diagnostic process and yields valuable information that can be used to guide the treatment process. Interview information and test findings are contained in a detailed psychological report, the content of which also includes a diagnostic formulation and recommendations for further treatment.
Individuals likely to benefit from this type of evaluation include those suffering emotional trauma relating to an accident or injury (e.g. Post-Traumatic Stress Disorder as a consequence of a motor vehicle accident), those having difficulty coping with chronic pain, and people experiencing stress, depression, anxiety or similar adverse emotional reaction as a consequence of life events.
Some of the common questions addressed by a comprehensive psychological assessment completed with Dr. Pachet include:
- What is this person's current psychological status?
- Does this individual's psychological difficulties meet formal criteria for a diagnosable condition? If so, what is the etiology of this diagnosed condition?
- Does this individual have any functionally based limitations or restrictions secondary to their psychological difficulties?
- What is the recommended treatment plan to address this individual's psychological difficulties?
- Are there any environmental modifications that can be made to improve the individual's level of functioning?
- With the provision of treatment, what is the prognosis for improvement of this person's psychological status?
- What are the main barriers affecting this person's ability to make psychological improvements?
- Are psychotropic medications negatively affecting this person's cognitive abilities?
Dementia Assessment
A decline in cognitive functioning, including memory, is a normal part of the aging process. When cognition deteriorates beyond age related expectations, it might be an indication that an individual is suffering from dementia. In other cases, the deterioration in mental functioning is related to some other, potentially reversible, underlying cause (e.g., an untreated medical condition that is impacting cognitive functioning). Standard neuropsychological tests with appropriate age norms are used to assess current cognitive status. Repeat assessment at some future date is valuable in assessing potential decline with time.
Questions commonly addressed by Dr. Pachet in this assessment include:
- Is the person suffering from dementia or is the person's cognition within normal limits for their age?
- If cognitive decline is present, what type of dementia is the person suffering from?
- What is the impact of the person's cognitive limitations on their ability to function in day-to-day life?
- Are there any treatment options that might ameliorate the observed deficits?
- Are there any concerns with the individual's decision-making capacity? Is a formal assessment of capacity warranted?
Vocational Assessment
When an individual's ability to work competitively is compromised, potentially by accident related injuries, a vocational assessment can be an important step in identifying appropriate employment options. A vocational assessment is the process of determining an individual's interests, abilities and aptitudes and skills to identify vocational strengths, needs and career potential. A vocational assessment consists of the administration of a battery of objective tests designed to assess intellectual functioning, work related aptitudes, academic skills, vocational interests, personality traits and self-reported physical / functional limitations. In addition to formal test findings, consideration is given to an individual's medical, vocational, and academic background, as well as other pertinent information. The goal of this evaluation is to identify specific employment barriers, which may encompass cognitive, physical or emotional factors, and to guide recommendations for suitable employment alternatives if necessary. Dr. Pachet completes stand-alone vocational assessments and he also completes vocational assessments as part of a comprehensive neuropsychological assessment. For example, it is common after experiencing a trauma, be it trauma secondary to brain injury or an emotional trauma, to have difficulty returning to work and a change in vocational direction is needed.
Some of the common questions Dr. Pachet will address in the Vocational Assessment context include:
- Does this person have the cognitive capability to return to work?
- Will this person be able to complete pre-injury duties? If not, what types of workplace modifications does this person require?
- What community and employment supports does this person need to return to a competitive employment position?
- Does this person require a job coach, supported employment services, or vocational rehabilitation services?
- Can this person participate in skills training or education upgrading?
- Is this person able to articulate a realistic vocational goal?
- What type of employment is most suitable for this individual's skill and ability level?
- What is this person's current work tolerance from a cognitive perspective?
- If this person cannot return to their pre-injury employment, does a potential new job of interest require additional training? If so, what type of training?
- Is retraining or further education a reasonable goal for this individual?
- Will this person experience a loss of earnings because of their employment restrictions?