Author: NRS Lifespan

As clinical neuropsychologists, we are often asked to identify the cause of thinking changes. Many conditions can cause thinking and memory problems, ranging from neurodegenerative diseases like Alzheimer’s to vascular disorders that reduce blood flow to the brain. Understanding the underlying process is crucial, as different conditions require different approaches to treatment and management. Some disorders present with clear patterns, while others are rare and often overlooked.

Recently, I evaluated a patient whose cognitive profile and symptom timeline were consistent with Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL), a rare genetic disease affecting small blood vessels in the brain. This condition leads to strokes, cognitive decline, and migraines. It usually starts between the ages of 30 and 60. The disease can also cause mood and behavior changes, such as depression, anxiety, irritability, and difficulty controlling emotions. Some people may act impulsively or, in rare cases, experience psychotic symptoms. These issues tend to get worse over time (months to years), making it harder to manage emotions and social interactions. Specifically, my patient reported migraines, impaired gait, apathy, and incongruent affect to mood, common early indicators of CADASIL.

My patient’s cognitive pattern of findings was consistent with a broad range of deficits in the form of attention-concentration, information processing, cognitive flexibility, multitasking, verbal reasoning, language, visuospatial/constructional reasoning, memory, and daily efficiency problems.

Complex neuropsychological examination programs were applied to the patient’s test results further supported a CADASIL diagnosis, revealing correlations linked to small vessel disease affecting deeper brain structures.

These findings, along with the timeline and progression of her decline, required my recommendations to follow up with neurology for genetic testing, skin biopsy, neuroimaging, and blood-based biomarkers for further evaluation.

This case makes our role in the diagnostic process even more critical, as early identification can help guide appropriate medical interventions, genetic counseling, and patient education to slow progression and improve quality of life.

Early detection is crucial in conditions like CADASIL. If you or a loved one are experiencing unexplained cognitive or neurological symptoms, a comprehensive neuropsychological examination can provide valuable information. Contact our office to learn more about next steps.

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Zachary T. DiPasquale, Psy.D.
NJ Temporary Permit # 243-059
Neuropsychology Post-Doctoral Fellow

In our fourth and final blog post on the menopause transition (MT), we focus on the emotional well-being challenges – specifically, depression, anxiety, and low stress tolerance – that can show up during this time period. An estimated 4 of 10 women report mood symptoms such as tearfulness, low self-worth, feeling hopeless or numb, losing interest in formerly pleasurable activities, worry, and irritability. A changing hormonal landscape means unpredictable cycles –  there’s no clear-cut “PMS days” and many women struggle to know whether or not depression, anxiety, or stress symptoms are connected to their hormones. In modern day medicine and psychology, we generally believe that there are three contributing factors of any emergence of symptoms or conditions: (1) biology/genetics; (2) social/environmental; and (3) psychological/personality. With that said, let’s breakdown how menopause and emotions intersect:

(1)   Biological factors: Hormones are messengers. Some hormones steer the course of reproduction, some direct the physical growth of the body and cells, and some produce neurotransmitters which influence how you think and feel. Estrogen (a hormone) regulates serotonin (a neurotransmitter). As estrogen changes, serotonin receptors become less responsive and effective. Brain regions that are serotonin dominant (like the hippocampus, the brain’s memory center) will struggle the function the same way they did when estrogen was at it’s peak.

(2)   Social factors: These decades of life (40-50s) are like a stress squeeze point – aging and/or dying parents, raising and launching kids, trying to maximize career earnings and promotions, dealing with new age-related health issues or crises (like increasing cancer rates, chronic pain), potential of divorce or marriage difficulties, etc. All contribute to high baseline levels of stress, sleep disruption, more emotional eating, and sedentary lifestyles that are not conducive to emotional well-being.

(3)   Psychological factors: Having a history of depression, premenstrual dysphoria disorder (PMDD), trauma, poor coping mechanisms, fixed mindset, and low stress tolerance are risk factors for a poor adjustment to menopause. “The window of vulnerability” model suggests that certain women are predisposed to hormonally-driven mood symptoms in connection with “sensitive” periods of fluctuations, notably the onset of menarche (puberty), in the perinatal and postnatal phases, and menopause transition.

With this information in mind, what are some tips to navigating emotional changes that can accompany menopause?

(1)   Be proactive versus reactive. Attend doctors appointments, start asking for hormone bloodwork panels in your late 30s-early 40s to identify baseline levels and changes. Let your doctor know if you had depression or anxiety that started around puberty and/or prenatal or postpartum depression/anxiety/OCD/etc. so that it can be monitored as you enter into perimenopause and menopause.

(2)   Get serious about healthy lifestyle routines. Sleep is paramount in steadying emotions and optimizing stress tolerance. Taking control of controllable factors (like, how much time do I spend on my phone before bed? Can I start lifting weights instead of just doing cardio only?) related to sleep hygiene, eating habits, physical activity, and quality of relationships can offset hormonally-driven emotional changes.

(3)   Alter the mindset towards menopause. We have other messengers inside our brains besides hormones. Our own narrative (aka, “self-talk”) about menopause and beyond influences health behavior, mood, and biology. For instance, scenario A: “I’m a captain of a ship sailing in stormy waters but I know the waters will calm and I know the route I have to take to get there quicker” versus scenario B: “I’m a passenger of a boat sailing into a storm and I can’t control the weather so it’s just going to be what it is and I hope I survive.” Those statements hit differently, right? Choose your mindset and the behaviors follow.

If you are concerned that the menopause transition is harming your emotional well-being and would like strategies to manage symptoms of depression, anxiety, and stress with support, contact this office at 732-988-3441 to schedule a consultation with a clinical health psychologist.

Lauren Gashlin, PsyD

Clinical Health Psychologist

A subset of traumatic brain injury (TBI) cases involves “mild” injuries which are often termed mild traumatic brain injury (MTBI) or concussion.  As is well documented in medicolegal literature, many of these cases are litigated.  The forensic neuropsychological evaluation, often referred to as an independent neuropsychological evaluation (e.g., INE) are valuable in cases of MTBI.

Traumatic brain injury (TBI) constitutes a major medical problem despite its high visibility and changes in state law (e.g., seat belts, speed limits, blood alcohol levels).  Millions of individuals sustain TBI’s annually throughout the United States.  Fortunately, the vast majority of these individuals are considered “mild” and symptoms often improve spontaneously within the first few weeks or months post-injury.  Despite this, many individuals who were diagnosed with a MTBI or possible misdiagnosed find themselves involved in some form of litigation (e.g., personal injury).  These individuals might be “labeled” neurotic or even as a malingerer or symptom exaggerator.  The latter concerns (e.g., malingering, symptoms exaggeration) and patient effort (e.g., response bias) must always be considered and be part of a formal evaluation especially in litigated cases.  It is in these cases where a well-trained and competent neuropsychologist might prove beneficial in rendering an expert opinion regarding the consequences of such injuries and subsequent claims.

An individual’s ability to be successful in activities of daily living (ADL), is vitally important during personal injury litigation.  Plaintiff and defense attorneys undoubtedly are interested in determining how an individual is functioning post-injury.  Plaintiff and defense attorneys have different roles and view assessment outcomes according to their client representation (e.g., maximize deficits; minimize deficits).  The neuropsychologist will assist the attorney, referral sources, and the trier of fact in answering specific questions related to an individual’s pre and post trauma status (e.g., level of functioning).  Neuropsychological test results provide information to assist in childhood, adult, and geriatric neurocognitive and behavioral conditions, particularly when neurologic, radiologic, and laboratory data are inconclusive (e.g., MTBI, post-concussive syndrome).  A neuropsychological evaluation also establishes an objective baseline of function, which can be later compared with re-assessment results, that is invaluable in determining the course of cerebral dysfunction.  The contribution of a patient’s personality and mood to his or her symptoms is also estimated via formal assessment.  Neuropsychological test data also help predict a patient’s short and long-term prognosis which is important during litigation.

A comprehensive neuropsychological evaluation (INE) is not limited to formal testing.  The neuropsychologist also interviews the patient and others (e.g., spouse, family member, friend) to obtain collateral information, assess the patient’s behavior throughout the interview and testing phases, document all findings, and if the test results are deemed valid, render an opinion with a reasonable degreed of neuropsychological certainty.  An INE does not afford the usual degree of confidentiality inherent in clinical evaluations and a doctor-patient relationship is not established.

Overall, neuropsychological evaluation (e.g., INE) of individuals with suspected or documented MTBI is of the utmost important in both clinical and forensic settings.  Moreover, in legal proceedings, the neuropsychologist as expert will assist both plaintiff and defense attorneys, as well as the trier of fact, in understanding neuropsychological evidence.

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

Somatic Symptom Disorder (SSD) is diagnosed when an individual experiences significant level of distress in response to physical symptoms and struggles coping. The symptoms may or may not be explained by a medical condition, or represent normal bodily sensations such as pain or discomfort. The reaction is often extreme and out of proportion to the symptoms, affecting person’s daily functioning. SSD occurs in about 5-7% of the general adult population. In addition, it often co-occurs with other disorders such as depression and anxiety.

Symptoms of SSD

·        Excessive, persistent, and disproportionate thoughts about the seriousness of one’s symptoms.

·        Persistently high level of anxiety about health and symptoms.

·        Excessive time and energy devoted to the symptoms/health concerns.

·        Avoidance behaviors due to irrational beliefs about seriousness of the condition or potential to cause harm.

Possible causes of SSD

·        Genetic or biological factors (e.g., high pain sensitivity)

·        Personality characteristics (e.g., negativity)

·        Reduced awareness/difficulty processing emotions

·        Trauma

·        Learned behavior

Somatic Symptom Disorder (SSD) is treated by properly managing any medical condition (if present) as well as psychological symptoms. Here at NRS|LS, we offer comprehensive psychological assessment and treatment. If you or someone you know struggles with symptoms of SSD, please contact our office for a consultation.

Basia Andrejko-Gworek, Ph.D
Clinical Psychologist
License # 35SI00767400

In our field of neuropsychology, significant changes are occurring affecting you, the applicant, you the patient, and as the treating/training doctors.  This movement of managerial control began in 1997 with the Houston Conference, a self-proclaimed group of neuropsychology experts deciding what the curriculum should consist of leading to defining what a legitimate neuropsychologist is and the skills the student should possess in order to treat patients. This has carried over currently to the Minnesota Conference, an extension and elaboration of the Houston Conference.

What the two conferences have distilled down to is managerialism – The unfounded belief that everything can be deliberately designed and controlled from the top down.  To rephrase this concept, we now call it “evidence-based practice.”  In neuropsychology, this manifests through “guidelines” imposed upon neuropsychologists in the treatment of patients.  These “guidelines” affects the training academic curriculum of the aspiring neuropsychologist, which has been declining in terms of practical clinical skills entering residency/fellowship programs and also we as teaching/treating doctors as to what we believe is most important for the student to succeed in the real clinical professional world, be it hospital or private practice.

Clinical skills come from what we do, including failures, adaptations, and gradually getting better with our clinical habits.  Without hands-on experience across the neuropsychological spectrum, all the academic book knowledge, rote – memorization, and Zoom lectures, will not inoculate you, the aspiring doctor, from the significant changes occurring in neuropsychology, now a discipline in the medical community.  The conventional clinical psychology model taught in universities or carried over into hospital neuropsychology residency/fellowship programs, will not fully prepare you for the clinical demands made upon us by physicians in their various disciplines.

Here at Neuropsychology Rehabilitation Services|LifeSpan, our 45-year history has done just that – preparing our applicants for hospital or private practice, or a combination of both.  Our graduates have gone on to successful achievements in a variety of areas in society.

If our clinical environment meets your aspirations, give us a call and we will be happy to answer all your questions.

Dr. Robert Sica, PhD, ABN
Principal Partner, Founder of NRS|LS

Cognitive rehabilitation is a therapeutic approach that is aimed at improving cognitive impairments and is often used for individuals recovering from brain injuries, strokes, and other neurological conditions. The goal is to enhance a person’s ability to think, learn, and function in their daily life. Some strategies that are used in cognitive rehabilitation are exercises that target impaired functions, such as memory or attention-focused tasks, along with using planners or breaking tasks into smaller steps to work through cognitive challenges.

One of the most substantial benefits of cognitive rehabilitation is its ability to improve quality of life. By focusing on specific skills, it empowers individuals to regain independence and handle daily activities more effectively. Whether it’s managing household tasks or engaging in social interaction, cognitive rehabilitation helps people reclaim control over their routines and responsibilities, leading to a more fulfilling life.

In addition to improving an individual’s daily functioning, cognitive rehabilitation enhances emotional well-being. Struggling with cognitive impairments can be frustrating and isolating, which can often lead to anxiety or depression. Addressing these challenges with cognitive rehabilitation not only boosts confidence but also reduces emotional stress, allowing individuals to feel more capable and optimistic about their future.

Ultimately, cognitive rehabilitation has a holistic impact on a person’s life, as improvements in cognitive skills often lead to better social interactions, enhanced work performance, and a greater sense of overall well-being.

For more information on cognitive rehabilitation or to schedule a consultation, please contact our office at 732-988-3441.

Gianna Scimemi, M.A.
Psychometrician & Doctoral Student

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