Our goal at C2it Health is to demystify medical care and help people find the right care and resources they need at the right time. In this article, we introduce readers to Brenda Austin, PhD. Brenda is a neuropsychologist, a key member of a geriatric care team or any medical team taking care of someone with a brain injury.
Brenda, can you tell the C2it Health community about your professional experience as a neuropsychologist? What exactly does a neuropsychologist do?
I’ll start with the easy part. A neuropsychologist is a doctoral-level clinical psychologist with specialized training in brain behavior–based disorders. We perform assessments, diagnose, and treat individuals of all ages. A neurocognitive assessment includes a detailed series of questions and puzzles that evaluates a person’s ability to process different types of information and remember it. A person may be referred to a neuropsychologist for an evaluation when they are experiencing a medical, neurological, developmental, or psychiatric condition that impacts their thinking, behavior, and/or emotions. We use standardized measures in addition to interview, observation, and history to identify a person’s strengths and weaknesses as compared to normal and abnormal brain function. With that information, we assist the individual, their families, physicians, and health care teams to educate and implement treatment so the person can improve or compensate for their neurologic condition.
I work with adults and older adults. In addition to assessment, I conduct cognitive rehabilitation and see people for psychotherapy.
What are the most common reasons for people to be referred to a neuropsychologist? When should a family member seek to have a neuropsychologist involved in their loved one’s care?
A referral for neuropsychological evaluation should be considered any time there is a question about a person’s memory or mental abilities. Family members or friends may notice:
- Memory problems including forgetfulness, getting lost or losing items, or even a failure to recognize familiar people or places
- Poor attention and concentration may initially show up as confusion in conversation or difficulty following a movie or television show
- Changes in visual-spatial skills are often revealed by car accidents or getting lost in familiar neighborhoods
- A change in personality could be seen as unexplained apathy, anxiety, or depression
- Poor decision-making and difficulty solving problems seen in a person with prior abilities
- A failure to understand or care for finances, pay bills, or budget monthly funds
- An inability to grasp medical information and recommendations
- Language difficulties such as significant trouble finding words or loss of understanding spoken language
- Unexplained neurologic complaints or fluctuations in mental state
In addition, a neuropsychological evaluation should be considered if there is a question about a person’s capacity to make significant life decisions such as medical, financial, or legal decisions.
How does a person obtain the services of a neuropsychologist if they think they might need one?
A person or their family may self-refer for an evaluation. However, the majority of referrals are made by physicians, often a neurologist or a psychiatrist who has noticed changes in a person’s cognition. Internists frequently use the Mini Mental State Exam (MMSE) that was developed to screen for an Alzheimer’s-type dementia. This is a great screening tool but scoring above the cutoff score of 24 doesn’t mean that there are no cognitive problems. It’s much more complicated than that. Similarly, imaging studies such as CT and MRI show us brain structure but cannot accurately predict how a person might be functioning. Imaging cannot tell us about a person’s ability to remember new information, think through a problem, or make a decision.
… the majority of referrals are made by physicians, often a neurologist or a psychiatrist who has noticed changes in a person’s cognition
Family members would want to consider obtaining a referral for a neuropsychological evaluation to help clarify a diagnosis and to assist in developing a plan of care. An evaluation can help determine:
- Whether there is cognitive loss or the symptoms are related to a mood disorder
- Clearance to return to school or work after a neurologic injury or illness
- If there is cognitive impairment, what are the current strengths and weaknesses?
- Does the person have a dementia, and if so what type?
- Strategies to maintain or boost cognitive abilities and enhance daily function
- The type of support a person may need in order to remain in their home or whether home is the best option
- The efficacy of a new medication
- Whether a driving assessment is needed
- Whether the person can make important medical decisions, an advance directive, or a new will
- Whether a conservatorship is needed
… imaging studies such as CT and MRI show us brain structure but cannot accurately predict how a person might be functioning
How long does a full cognitive assessment by a neuropsychologist take? Is it covered by insurance and/or Medicare?
The length of time it takes to complete a full cognitive assessment varies based on the individual’s condition, whether we are in a hospital or outpatient setting, and the referral question. A comprehensive outpatient evaluation can take six hours of face-to-face time; however, when a person is ill and in hospital an evaluation is often shortened and targeted, often taking one to two hours.
Insurance and Medicare cover neuropsychological evaluations under specific conditions and coverage depends on the insurance company as well as the particular product the individual is covered by. Again, depending on the insurance company a pre-authorization may be required. Most companies cover neuropsychological evaluations when a person is known to have a neurologic disorder. Sometimes they cover one evaluation per illness incident and sometimes more, such as in the case of stroke or traumatic brain injury where the person is improving and changing through the recovery process. It’s always best to call your insurance company and request information in writing. Your doctor may be able to help you with information about coverage as well.
What is the one thing you wish more people understood about your field?
Many people confuse clinical neuropsychology with clinical psychology. A neuropsychologist works in the area of physical health and neurologic disorders, not in the area of mental health. While we may evaluate a person to determine whether they are suffering from a dementia versus depression, we are generally not performing assessments on people primarily because of depression, bipolar disorder, or schizophrenia. Working with people who are living with mental health disorders is really the realm of clinical psychology.
A neuropsychologist works in the area of physical health and neurologic disorders, not in the area of mental health
Thank you, Brenda. If readers have more questions about neuropsychologists, please email them to us at info@C2ithealth.com
More about Brenda:
Brenda Austin, PhD, has been a member of numerous interdisciplinary medical teams in specialty areas such as physical rehabilitation, brain injury, HIV/AIDS, and general skilled nursing. She directed a clinical neuropsychology training program for advanced graduate students at one of the San Francisco Health Network’s hospitals (SF-DPH). She has served on several hospital committees including bioethics, bariatric care, and admissions. She is a fellow of the National Academy of Neuropsychology, and a past president of the Northern California Neuropsychology Forum.