Author: NRS Lifespan

Lately, neuropsychology has continued to advance with groundbreaking discoveries and technologies. For example, brain-computer interfaces (BCIs) are being developed to help individuals with paralysis regain communication and mobility. While these innovations offer life-changing potential, they also raise ethical questions about privacy, autonomy, and consent.

Alongside these innovations comes the growing need for neuroethics—a field dedicated to addressing the ethical implications of neuroscience. Neuroethics lies at the intersection of neuroscience, psychology, and philosophy. It explores questions about how emerging technologies and research in the brain sciences impact society, individuals, and our understanding of human identity. In neuropsychology, neuroethics ensures that clinical applications, research methodologies, and therapeutic interventions respect human rights and dignity.

The partnership between neuropsychology and neuroethics ensures that scientific progress remains ethical and just. By fostering interdisciplinary dialogue and prioritizing ethical frameworks, neuropsychologists can navigate the challenges posed by rapid advancements while safeguarding human welfare. Neuroethics serves as a compass, guiding neuropsychology toward an innovative future.

Julianna Greco
Student at Seton Hall University

The article below discusses the important of primary care working with neuropsychologists. Neuropsychologists assists in diagnosing, providing
treatment recommendations, and information to the patient and his/her family with their primary care doctor.

Improving the Effectiveness of Collaboration Between Neuropsychology and Primary Care
Lynn A. Schaefer, PhD, ABPP; Thomas J. Farrer, MHS, PhD, ABPP; Dennis J. Dowling, MA, DO, FAAODistPrim Care Companion CNS Disorder. 2024;26(5):24nr03766.

Abstract:

Importance: When patients present with cognitive impairment, consults to neuropsychology can assist internists and psychiatrists in diagnosis, treatment planning, and determination of functional status. Neuropsychological evaluation and treatment have been shown to improve health outcomes and patient and family satisfaction. The objective of this narrative review is to explore the role of neuropsychologists in their collaboration with care teams to improve patient outcomes.

Observations: Neuropsychologists have specialized education and training in brain behavior relationships and neurocognitive functioning. The consultation process for neuropsychology can be made more efficient by the referring physician clearly delineating the reason for the referral, ordering relevant laboratory tests and imaging studies, performing screenings for treatable conditions, and providing historical records to the neuropsychologist prior to the consult. Neuropsychological assessment can assist in diagnosis, identification of neuropsychological status, establishing a baseline, treatment planning, determination of functional ability, and monitoring the effectiveness of treatments.

Conclusions and Relevance: Primary care teams and psychiatrists can benefit from collaboration with neuropsychologists. The most effective process for engaging neuropsychologists in the care of patients is through full communication, including properly placed consults.

Primary Care Companion CNS Disorder 2024;26(5):24nr03766

Neuropsychological conditions such as autism spectrum disorder (ASD), ADHD, dyslexia, and other cognitive disorders have led to critical discussions regarding the intersection of neuropsychology, education, employment, and anti-discrimination laws. Neuropsychology plays a vital role in these cases, providing insights and empirical evidence necessary to support diagnoses and develop accommodations such as Section 504 plans, Individualized Education Programs (IEPs), and other legal protections.

Section 504 of the Rehabilitation Act of 1973 prohibits discrimination against individuals with disabilities in programs that receive federal funding, including public schools. Similarly, the Individuals with Disabilities Education Act (IDEA) provides for IEPs, which are specialized plans designed to support students with disabilities who require individualized instruction. Both frameworks aim to ensure equitable access to education.

Neuropsychological assessments are essential for identifying cognitive differences, documenting their impact on daily functioning, and recommending specific accommodations. Neuropsychological evaluations identify strengths and weaknesses in cognitive domains such as attention, learning, academic achievement, memory, spatial, language, executive functioning, etc. The findings inform specific interventions to address barriers to learning, ensuring that the student’s rights under Section 504 and IDEA are upheld and that they can succeed in school.

At NRS|LS, we provide neuropsychological evaluations to address cognitive, intellectual, and academic concerns. Call our office for more information or to schedule an appointment at 732-988-3441.

Julianna Greco
Seton Hall University

Pediatric neuropsychologists are an integral part of the multi-disciplinary team within a children’s hospital. Pediatric neuropsychologists address the complex interplay between brain development, medical conditions, and behavior in the pediatric population. Pediatric neuropsychologists can offer a child’s medical team integral information about their current functioning, ensuring that cognitive and psychological factors are integrated into treatment plans.

One key reason why a pediatric neuropsychologist’s presence is essential is to provide comprehensive assessments of cognitive and behavioral functioning. Why is this important in a hospital setting? These assessments are vital for understanding how medical conditions, treatments, or neurological injuries impact a child’s development and current functioning. For example, in a child with a brain tumor, a neuropsychologist can assess cognitive functioning before and after surgery or radiation. This helps to guide further treatment and educational planning for the child once they return to school.

Pediatric neuropsychologists also help to differentiate between medical, neurological, and psychological contributors to behavioral or cognitive difficulties. Neuropsychologists specialize in conditions like epilepsy, traumatic brain injury, genetic disorders, congenital heart disease, and neurodevelopmental disorders. For example, a child with epilepsy may experience difficulties with attention and focus due to both seizure activity and medication side effects. A neuropsychologist can help to discern these factors.

Additionally, pediatric neuropsychologists can monitor the developmental trajectory of children with chronic or progressive conditions. Regular evaluations (often done yearly) help detect subtle changes in functioning. Neuropsychologists may first see a child in the hospital setting and monitor them over time in an outpatient setting to ensure they are receiving the appropriate interventions. Moreover, neuropsychologists can act as the liaison between schools and educators. For example, they can translate medical findings into actionable educational accommodations (i.e., for a child’s 504-Plan or IEP).

Lastly, pediatric neuropsychologists offer emotional and behavioral support for the child, as well as their family members. Being admitted to the hospital can take an emotional toll on the entire family. A neuropsychologist can help families understand their child’s condition and provide coping skills to manage the emotional and behavioral changes associated with the child’s diagnosis.

Overall, a pediatric neuropsychologist can offer an abundance of information and support to the child, their families, and other medical staff.  The presence of a neuropsychologist enhances patient care by addressing the cognitive, emotional, and behavioral needs of the child and are thus an important member of a child’s treatment team.

For additional information or to schedule a consultation, please contact our office at 732-988-3441.

Natalie Angelo, Psy.D.
Temporary Permit # 243-090
Neuropsychology Post-Doctoral Fellow

In this third blog post on the menopause transition (MT), we focus on the numerous physical changes that affect the cognitive and emotional health of women. This topic is complex and, therefore, this article is just a drop in the informational bucket, designed to be a launching point of productive conversations between women and their doctors. The main point here is to name some common health issues that arise when a woman is in her 40s-50s that are often treated as disparate “age-related” problems which may be, in fact, rooted in hormonal changes. The goal, then, is to treat such issues with a more integrated approach rather than prescribing separate medications for each of these independent symptoms and conditions.

The emerging scientific consensus is that menopause has direct links to the following — gut and digestive problems; cardiac risk; weight gain; muscle loss and osteoporosis; autoimmune conditions; and diabetes. Real-time complaints look like this: Hot flashes, joint pain, fatigue, feeling weak, dizziness, vertigo, pain in lower legs, dry and itchy eyes, diarrhea and constipation, urinary incontinence, eczema and psoriasis, leaky gut syndrome, heart palpitations, blood pressure changes, weight gain with no changes in diet or exercise, inability to lose weight even with healthy nutrition and exercise.

Here’s the short and sweet explanation for the above. Estrogen and progesterone decrease significantly during the menopause transition. They both have anti-inflammatory properties so any health issue that is drive by inflammation (what isn’t these days?) gets worse. Estrogen also affects cholesterol levels, blood sugar levels, the gut microbiome, bone and muscle mass metabolism, circulation and blood flow, and collagen and moisture levels. Again, lot of instability in these areas once estrogen drops off. Women lose bone density and lean muscle mass and gain visceral fat (a 2-4 fold increase in fat, on average). Most of these changes start during perimenopause (late 30s-40s), rear their ugly heads during menopause (late 40s-50s), and then taper off in the post-menopause apocalypse.

Unfortunately for many women, the damage that is sustained during MT means that their sense of identity, mental health, and happiness with their bodies takes a big hit. Also, many women get sucked up into the medical vortex of doctors appointments, new medications, confusion, judgment, etc. at the time of life when they are simultaneously working (peak career for some) and caring for others (kids, aging parents). There are several lifestyle interventions and pharmaceutical approaches that can offset this biologically inevitable process. Most involve shifting perspective on nutrition, exercise, and stress management. These approaches are science-driven and doable with the right type of support. If you or someone you know are interested in counseling support on this topic, call our office at 732-988-3441 to consult with a clinical health psychologist.

The term or diagnosis of functional cognitive disorder is a relatively new condition and one that requires additional research and longitudinal studies.  Functional cognitive disorder is primarily reported by individuals as a condition interfering with various levels of attention and concentration as well as memory.  These problems often interfere with and adversely affect an individual’s ability to function on a daily basis.  These individuals often complain that they are less capable or competent as they were in the past.  Common self-reported symptoms may include:

·        Daily forgetfulness

·        Cognitive/mental fatigue

·        Misplacing things around the house

·        Word finding or speech hesitancy

·        Losing track during general conversation

·        Having difficulty recalling past events

Obviously, these concerns are often described as being “frightening” to the patient, family members, friends, and coworkers.  In contrast with other neurological conditions (e.g., dementia, stroke, traumatic brain injury), there is no underlying neurological condition or brain structure abnormality.

As noted above, an individual with a diagnosis of functional cognitive disorder often experiences attentional difficulties and lapses in memory as a result of other factors.  These may include, but not be limited to family issues, general health concerns, chronic pain, work or school-related stress, and other emotional variables.  As discussed, it is imperative that a specific neurological condition be ruled out prior to considering a clinical diagnosis of functional cognitive disorder.  This is often based on the results of laboratory tests, neuroimaging, and medical consultation (e.g., primary care physician, neurologist, endocrinologist, etc).

In addition, clinical neuropsychologists are consulted in order to gain a better understanding of the individual’s strengths and weaknesses and overall level of neurocognitive functioning.  This will often include the administration and interpretation of a standardized battery of neuropsychological tests to evaluate an individual’s general level of intellectual functioning, memory, levels of sustained attention/concentration, auditory processing, sensorimotor abilities, executive functions, as well as personality variables.  From a behavioral perspective, it is imperative to assess the individual’s level of daily stress and to either rule in or rule out depression and/or anxiety, which are known to be important factors contributing to functional cognitive disorder.

In conclusion, it is imperative that an individual with concerns regarding attentional difficulties and memory loss without a formal neurological diagnosis should consider an additional neurocognitive work up through a neuropsychologist.  Following the successful completion of a neuropsychological evaluation, an accurate diagnosis can be made in conjunction with the implementation of specific treatment recommendations.  These results will be vitally important to the patient, family members, referring physicians, and allied health professionals.  An accurate diagnosis with appropriate treatment recommendations will undoubtedly result in a more favorable prognosis based on increased daily cognitive capabilities and reduced life stressors.

For additional information or to schedule a consultation, please contact our office at 732-988-3441.

Michael J. Raymond, Ph.D., ABN, FACPN
Board Certified Neuropsychologist #232
Licensed Psychologist #35S100252900

The American Board of Professional Neuropsychology (ABN) has been granting board certification in clinical neuropsychology since 1982. ABN encourages the pursuit of excellence in the practice of clinical neuropsychology by offering a credentialing process while also offering consumers and the healthcare community a means of identifying well-qualified professional neuropsychologists.

Starting in January 2014, the Academy of the American Board of Professional Neuropsychology (AABN), a division of the ABN, began offering the opportunity for post-doctoral neuropsychology training programs to become a recognized training site. This innovative development emerged in response to: (a) the lack of adequate formal post-doctoral recognized training programs across the United States in comparison to the high number of graduates interested in formal, quality training programs, and (b) the fact that other agencies recognizing post-doctoral training programs require the Director of Training to have obtained board certification from only one board certifying agency (ABPP). These circumstances unfairly limit the programs available in the United States to the great detriment of large numbers of graduates seeking quality, recognized formal post-doctoral neuropsychology training.

The development and implementation of AABN was designed to strengthen the field of clinical neuropsychology by setting standards for post-doctoral training, to ultimately encourage board certification (without discrimination to any board) and thereby foster education and confidence in the public in the field of clinical neuropsychology.

At NRS|LS, our board certification process is unique in that upon completion of the two-year program, you automatically qualify to sit for the examination at no financial expense and have mentorship throughout the process.

Having achieved board certification in our neuropsychology fellowship, your professional status is unique is the following areas:

Expertise Development:  Your fellowship provides advanced training in neuropsychology, allowing fellows to develop specialized skills in assessment, diagnosis, and treatment of neurological and psychological disorders.
Credibility and Recognition:  Your board certification signifies that a neuropsychologist has met rigorous standards and is recognized by peers and institutions as having achieved the highest level of competency.
Clinical Experience:  Your fellowship program typically offers hands-on clinical experience, which is crucial for developing practical skills in a supervised environment.
Research Opportunities:  Your fellowship may include a research component, enabling you to contribute to the advancement of neuropsychological science and remain updated with the latest findings.
Career Advancement:  Your board certification can enhance job prospects, as many employers prefer or require it for clinical positions, especially in academic or specialized settings.
Professional Network:  Your fellowship provides access to a network of professionals, which can be beneficial for collaboration, mentorship, and career opportunities.
Ethical Standards:  Board certification entails adherence to ethical guidelines and ongoing education, ensuring you are committed to high standards of care.

A board-certified fellowship is essential for ensuring quality of care in the neuropsychological field while enhancing the professional development of neuropsychologists.

Please see our website at nrslifespan.com for further information regarding enrollment for the 2025 to 2027 fellowship.

This information is shared with our readers in order to alert you about recent legislation that will affect the care of patients with brain conditions in need of neuropsychological examination (NPE) and care.

The ASPPB Regulatory Task Force and the American Psychological Association proposed Master’s level providers to engage independently in administering psychological tests to patients, though they will not be permitted to identify themselves as neuropsychologists or accept referrals for NPEs. However, there is no system in place to assure the Master’s level provider from administering and interpreting tests traditionally reserved for neuropsychologists. The Master’s level provider could merely use different language calling the NPE a “cognitive screener”, “cognitive assessment” or some other obscure term.

State licensing boards and professional organizations do not have the resources and time to monitor such restrictions placing you, the patient, at risk of harm from these providers who ignore these restrictions. Some Master’s level providers engage in test interpretation beyond their competencies. Complex NPEs involving memory, reasoning, language, personality tests should be specifically excluded for Master’s level providers. This is a standard of care in NPEs administered by doctoral level neuropsychologists due to their in-depth training, education, clinical rotations above and beyond the Master’s level provider.

To be assured you are in the right hands, check and ask whether you are being treated by a legitimate neuropsychologist, preferably board certified.

If you have any concerns, give us a call and we are willing to answer your questions and concerns and guide you in the proper direction.

NRS|LS

Marrying the past and present neuropsychology: Is the future of the process-based approach technology-based?
Frontiers in Psychology (2020). 11.

Standardized neuropsychological tests have historically been focused on ecological validity.  Many non-cognitive variables, such as physical, behavioral and emotional factors, and levels of premorbid functioning could be responsible for a deviation from real-world behavior. Throughout these tests, three main factors emerge that have the potential to hamper the ecological validity of neuropsychological test performances: a relatively sterile testing environment in which cognitive tests are conducted (a distraction-free environment that isolates sensorial modalities and controls environmental conditions like noise or temperature), a limited sample of behavior (neuropsychological tests performed over a relatively limited period of time, bestowing less information as opposed to complex cognitive processes that require a larger amount of time to complete), and a lack of agreement regarding the specific cognitive constructs (a lack of consensus makes it difficult to align any particular cognitive test scores to an appropriate cognitive skill in a real-world setting). In an effort to overcome these limitations, new methods of assessing cognitive functions have been proposed in recent years. Future research is focused on performance-based tests that will be administered in realistic environments accompanied by the usage of technology and Virtual Reality (VR).

A few of the most common standardized neuropsychological tests include the Clock Drawing Test, the Trail Making Test, the Block Design, and Digital Span. It has been proposed to implement machine-learning algorithms with advanced technology.  For example, on the Clock Drawing Test, the patient is asked to draw the face of a clock and the corresponding numbers.  Factors such as drawing time, pauses and hesitations in drawing, and time spent holding the pen but not drawing, are recorded with 12 milliseconds accuracy in this research. This machine can automate time-consuming and subjective processes, analyzing difficult data for clinicians to interpret manually and helping detect cognitive impairment at an earlier stage than is currently possible. For the Trail Making Test (TMT), throughout the process, they are monitored for speed for attention, sequencing, mental flexibility, visual search, and motor function. As time went on, an introduction of a computerized version of the TMT reduced the influence of the examiner, automatically corrected errors, equated Trails A and Trails B path lengths, and presented a standardized TMT display throughout the test that is consistent across subjects. For the Block Design, subjects are required to assemble red, white, or red-and-white blocks in three-dimensional space based on a presentation of a two-dimensional stimulus card, which assesses their visual-spatial ability, constructional praxis, motor skill, and problem-solving skill ability. Recently, haptic VR systems or augmented reality systems have been implemented, allowing the use of real blocks while capturing performance more accurately. These technological devices permit the registration of the full sequence of performance while capturing and documenting the different types of errors and performance: stimulus bound, broken configurations, rotations, completion times, think-time, psychomotor slowing, etc. For Digital Span, subjects are required to keep in mind and then recall increasingly lengthy series of digits for a short time period, which assesses auditory span and working memory. Within the past few years, the development of computerized error analysis in the DS, identifying two general types of errors (item errors and order errors) was implemented into Digital Span. Item errors relate to an omission, addition, intrusion, or substitution in the string of numbers, whereas, order errors relate to an incorrect order or permutation error in the string of numbers. This computerized error analysis improves test sensitivity, as it improves the accuracy of the assessment of list length and serial-position effects, error analysis, and detection of idling. With all this being said, the technological aspect of each analysis possibly can enhance the standard version, thus increasing ecological validity and more suitable rehabilitation processes.

With all this evidence, the question that arises is whether we could take advantage of computer-based technologies to improve error analysis? Specifically, can we identify disease-specific error patterns and behaviors more accurately than what can currently be achieved manually by clinicians? In relation to this question, we would argue that VR technology might allow neuropsychology to reach this next level. Today, the amount of technology we possess has the potential to show an immersive interactive virtual environment at a reasonable cost. With the implementation of VR, a new paradigm of human-computer interaction becomes more prevalent, where external observers are able to view progress and images on a computer screen, while the active participant is immersed in a computer-generated virtual 3D world. Nevertheless, we are able to find the possibility to show dynamic and interactive 3D stimuli systematically within a virtual environment, which is impossible by other means. With the ability to create an evaluation environment that can increase ecological validity, immediate feedback through sensorial modalities, capture test performance, and other forms of feedback, a safer environment is generated, which leads to more accurate judgments and results. Performing more accurate judgments and predictions of a patient’s daily life, including such things as school or work performance, could ultimately support the development of more personalized rehabilitation programs. Although VR and technology are not the remedies for all types of behavioral analysis and continue to be perfected, they represent a great opportunity in the future in terms of usability and usefulness in the neuropsychology arena.

Joseph Young
Psychology Intern

Here at NRS|LS, we believe understanding the interface between technology and neuropsychological advancements is critical in order to provide the best patient care.

This blog focuses on cognitive changes that commonly occur during the menopausal transition. See the first blogpost on menopause on our website for a recap of foundational menopause information. Here, we will describe some real-life examples of these cognitive changes as they appear on the surface. These illustrations are important because cognitive changes can be misinterpreted as neurological or emotional problems when they are, in fact, hormone-driven and modifiable if taken seriously by medical and mental health professionals.

Scenario 1: Woman in 50’s — “I think I have undiagnosed ADD. I’m distracted easily, having a hard time concentrating at work, and messing up things that I didn’t used to. It’s hard for me to multi-task and I’m struggling to juggle work, kids, life, etc.”

Scenario 2: Woman in her early 60’s — “I’m scared I have early onset dementia. I’m getting forgetful, I feel slower, and it takes me longer to remember names and information that I used to spit out and recall quickly.”

Scenario 3: Woman in late 40s — “I just feel like something’s wrong. I feel foggy all the time. I don’t have energy. I don’t sleep well and don’t know if it’s anxiety or life stress or some underlying medical condition.”

It may seem hard to believe that hormonal changes can be at the root of these symptoms, but the neuroscientific literature paints a pretty convincing picture that there are several ways that menopause has direct and indirect effects on the brain and quality of thinking, including:

(1)   There are cellular and structural changes to the brain due to declining levels of estrogen, especially in the hypothalamus, prefrontal cortex, hypothalamus, and amygdala;

(2)   Estrogen supports the healthy functioning of many crucial processes in the brain; estrogen loss is associated with increased systemic inflammation, mitochondrial dysfunction, and negative changes in the cholinergic and dopaminergic systems;

(3)   Sleep disruptions from vasomotor symptoms (hot flushes, night sweats), which affect 50-80% of women, contribute to acute cognitive problems and magnify already elevated levels of depression and anxiety.

Lastly, it is believed there’s a “critical window” of opportunity, potentially right before estrogen starts to drop, where hormone replacement interventions may alter the trajectory of cognitive symptoms. Many variables play into this equation and the most logical place to start is by discussing cognitive concerns with your doctors. If you relate to one of the above scenarios, a comprehensive neuropsychological and/or psychological examination can be helpful for proper diagnosis and treatment options, including counseling with one of our health psychologists to explore lifestyle and behavioral protocols for menopause-related cognitive, emotional, and physical changes.

Lauren Gashlin, PsyD
Clinical Health Psychologist