Category: News

Dr. Steven Greco Presents at Academy of Allied Health and Sciences (AAHS)

NRS|LS acknowledges Dr. Steven Greco’s presentation on Brain Health on 4/12/24.  Dr. Greco presented for Wellness Day at the Academy of Allied Health and Sciences (AAHS).   Dr. Greco’s presentation focused on how the field of neuropsychology is a critical aspect in understanding and improving brain health.  Dr. Greco reviewed the recent literature about supplements and their effects on the brain, neurogenesis, case presentation, and presented on current trends improving brain health.    NRS|LS is an affiliated organization with AAHS and Dr. Greco has served as a mentor for the students at AAHS.

If you would like more information about Dr. Greco’s presentation, please call 732-988-3441.

Dr. Steven Greco is a board certified neuropsychologist serving Monmouth County for 20 years.  He specializes in clinical treatment and is a clinical professor in the department of neurology at Hackensack Meridian Health, Jersey Shore campus.

ADHD vs Autism in Children

With continued research and more information published, we are learning that ADHD and autism have many overlapping characteristics, especially in children. Though the two are very different neurological disorders, there are many attributes that children present that could easily be mistaken as one of the two conditions. However, small nuances may allude to the other conditions. It is also very common for children to have both ADHD and autism together, but there are certain signs to differentiate what the child might be dealing with.

Similarities between ADHD and Autism:

  • Attention difficulties – Children with ADHD have trouble paying attention or holding attention, and children with autism struggle to pay attention when they lack interest in something.
  • Hyper Behavior – Children with ADHD typically struggle to sit still and are constantly moving, and children with autism are often seen stimming, or creating self-stimulation with repetitive, rapid movements.
  • Impulsivity – Children with ADHD will often talk over others, interrupt, and act without thinking, and children with autism may interrupt, say inappropriate things at inappropriate times, and lack self-regulation tactics.

Characteristics more specific to ADHD:

  • Fidgeting
  • Hyperactivity/inability to sit still
  • Difficulty following directions
  • Acting/speaking without thinking
  • Easily distracted by different stimuli

 

Characteristics more specific to Autism:

  • Avoiding eye contact
  • Lack of social reciprocity
  • Highly fixated interests
  • Sensory-seeking behavior/sensory sensitivity
  • Scripting/repeating phrases, words, and/or songs on a consistent basis

 

Though the characteristics listed to differentiate the two are strong indicators of what a child might be dealing with, there is still high likelihood of overlap. Some of the signs might not be as prevalent as others, and it may be difficult to realize certain behaviors when they are viewed often in everyday life. If you feel your child may be presenting any of these issues, schedule a consultation with our office and let our professionals provide your child with the tools they need to excel.

 

Joshua Tice
Psychometrician and Behavioral Technician

 

Protective Factors of Marriage in Dementia

The US statistics indicate that married people have a lower risk of developing dementia than adults who were never married, cohabited, divorced, or widowed. The reasons include the benefits of a close relationship for stimulating thinking abilities, reduced engagement in unhealthy behaviors, and higher income. Marriage also results in better social support and serves as a buffer against loneliness and related anxiety and depression. However, even when one spouse develops dementia, a strong marital relationship benefits both the patient and the caregiving spouse.

For instance, strong marriages help patients with dementia remain at home longer and transfer to a nursing facility at a later stage of the disease, while healthy spouses experience a reduced caregiver burden. Social support from a caregiving spouse and access to social support systems in the community because of the marriage can help slow cognitive decline in the spouse with dementia. Thus, focusing on maintaining a close relationship and the quality of life together is essential for individuals with dementia and their spouses.

Multiple factors contribute to maintaining a strong marriage while dealing with dementia-related problems. A history of communicating with each other with respect and helping each other during challenging times is a good predictor of better communication when one of the spouses develops dementia. Looking at dementia-related problems as a shared experience based on mutual commitment versus a healthy spouse focusing predominantly on the caregiving burdens benefits the patient and helps reduce the caregiver burden. Access to activities that can still be enjoyed together, staying connected with close and extended families, and participation in counseling and support groups also help preserve the relationship and its benefits.

At NRS|Lifespan, caregivers can learn strategies to adjust to dementia-related symptoms in their family members as part of Medical Adjustment Counseling®.

If you have any questions, give call our office.

 

Eleonora Gallagher, Psy.D.
Licensed Clinical Psychologist #7297
Neuropsychology Post-Doctoral Fellow

 

 

 

 

 

TUBEROUS SCLEROSIS ASSOCIATED NEUROPSYCHIATRIC DISORDERS (TAND): A PEDIATRIC CASE STUDY

Congratulations Dr. Greco for his recent publication in the American Academy of Pediatric Neuropsychology! 

Introduction: TAND is an autosomal dominant
disorder from mutations in either the TSC1 or TSC2
genes. These genes are responsible for encoding
hamartin and tuberin, respectively, and are proteins
which function as tumor suppressors. TAND causes
the growth of benign tumors on the brain and across
other parts of the body, such as the spinal cord, eyes,
heart, and kidneys.
Objective: To reintroduce Tuberous Sclerosis
Complex as TAND, from a comprehensive
biopsychosocial perspective.
The acronym TAND was introduced in 2012 to unify
the neurobiological, psychological, and social aspects
of Tuberous Sclerosis Complex, and to encapsulate
all possible functional manifestations, complications,
and consequences as they relate to
neurodevelopmental, neurocognitive,
neurobehavioral, and a host of adaptive abilities.
Furthermore, to discuss the neuropsychological
analysis of differentiating co-occurring conditions as
a result of TAND.
Method: This patient is a 5-year-old, Caucasian,
right-handed female who was referred by her
neurologist as a result of delayed speech and
difficulties with fine motor, short-term memory, and
language.
The patient continues to experience uncontrolled
seizures. A cerebral MRI was noteworthy for
“multiple benign tumors.” Diagnostic clarity was
recommended to differentiate this child’s
neuropsychological strengths and weaknesses.
Initial diagnostic impression was consistent with
ADHD (acquired), and diffuse neuropsychological
impairment secondary to TAND.
Results: This patient was administered the Reitan
Indiana Neuropsychological Battery.
Neuropsychological test results were consistent with
deficits in attention, visual spatial analysis,
receptive-expressive language, and gross/fine motor
abilities.
Conclusion: Patients with TAND commonly develop
neurological symptoms. These include: epilepsy,
autism spectrum disorders, intellectual disabilities,
attention-deficit/hyperactivity disorder, mood
disorders, anxiety, sleep disorders, and other
behavioral problems.

Steven P. Greco, PhD, ABN

NEUROPSYCHOLOGICAL CONSEQUENCES OF CEREBRAL ANOXIA

Individuals sustaining cerebral anoxia, hypoxia, or an associated anoxic encephalopathy, often experience a myriad of neurocognitive, neurobehavioral, and adaptive changes/limitations.  Cerebral anoxia occurs following oxygen deprivation to the brain.  The extent and duration of potential deficits are contingent upon a specific etiology and period of oxygen deprivation.

Most noteworthy causes of cerebral anoxia occur following cardiac arrest (e.g., heart attack), as well as cerebrovascular accidents (e.g., stroke), drug overdose, near drowning, strangulation, electrocution, and adult respiratory distress syndrome (ARDS) are other potential contributing events.

The pathophysiology of cerebral anoxia is such that generalized cognitive deficits occur; this is the result of reduced blood flow and oxygenation to the entire brain and not one specific area.  Cerebral anoxia is due to oxygen deprivation and hypoventilation as noted above.  Physiological and neurochemical changes occur especially with regard to the cessation of blood flow and results in general circulatory collapse.  Immediate loss of consciousness may occur within seconds which is often accompanied by severe brain trauma.  Areas of the brain most vulnerable to damage are those that require sustained oxygenation.  In part, the hippocampus, cerebellar cortex, parieto-occipital cortex, and bifrontal regions are most susceptible.  Clinically, symptoms often manifest with cortical blindness, extrapyramidal involvement, cerebellar ataxia, and profound amnesia (e.g., memory impairment).

Initially, individuals are treated by multi-specialty physicians including, but not limited to cardiologists, neurologists, neurosurgeons, physiatrists, pulmonologists, to name a few.  Often patients require both inpatient acute hospitalization and rehabilitation.  Inpatient and outpatient rehabilitation is generally provided by a multi-disciplinary team including physical, occupational, speech, and respiratory therapists.  Nutritional and psychological support is often part of the rehabilitation team.  Furthermore, neuropsychological consultation is required throughout the patient’s treatment to monitor the individuals’ neurocognitive strengths, weaknesses, and overall level of adaptive functioning.  Serial neuropsychological evaluations, possibly completed at 3-6 months intervals, is imperative to assist the medical specialists, patient, and family members in developing additional diagnostic impressions and treatment recommendations.

From a neuropsychological perspective, patients, as described above, often demonstrate a myriad of neurocognitive and neurobehavioral difficulties on formal neuropsychological assessment.  Primary deficits may include:

·        Recent/delayed memory (often profound)

·        Sustained levels of attention/concentration

·        Executive dysfunction

·        Language difficulties

·        Slowed processing speed

·        Sensorimotor limitations

·        Disorientation

Within the realm of neurobehavioral alterations, patients are often described as having noteworthy personality changes including, frustration, impulsivity, restlessness, indifference, amotivation, and emotional lability.  Often these individuals experience organically induced depression (organic affective disorder/frontal lobe syndrome) as well as variable levels of anxiety.  When diagnosed, psychiatric and psychological consultation and treatment is imperative.

In summary, the effects of cerebral anoxia is multifaceted based on an array of potential causes and clinical manifestations (e.g., physical, neurocognitive, neurobehavioral).  Treatment is often prolonged at the acute and post-acute stages, frequently warranting both inpatient and outpatient brain injury rehabilitation.  Serial neuropsychological assessment is often recommended to assist in the monitoring of the patient’s overall level of adaptive functioning.

For additional information or a clinical consultation regarding the consequences of cerebral anoxia, please contact our office at 732-988-3441.

 

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

Learning Disabilities in Children: The Importance of Neuropsychological Evaluation

Learning disabilities are neurodevelopmental conditions that are characterized by impairments in reading, written expression, and mathematics. Specific skills that may be impacted by learning disabilities are word reading accuracy, reading fluency and comprehension, spelling, grammar, and math calculation. Impairment in these skills often goes unnoticed until a child reaches school age, where these skills begin to be utilized. During this period, early intervention is critical to providing children with learning disabilities with the assistance and support that they need to guide their education.

Following the identification of learning-related difficulties, the child and family would benefit from seeking out a neuropsychological examination (NPE) in order to receive diagnostic clarification, recommendations, and a treatment plan. The NPE is able to identify the child’s strengths and weaknesses relating to their academic achievement, along with pinpointing criteria that align with a learning disability. Additionally, if abilities are within the normal range, those at NRS|LS will be able to confidently conclude this as well. If a learning disability is diagnosed, the results of the NPE should be utilized by the child’s school and special services team to begin implementing individualized instruction and accommodations. These interventions are highly beneficial for children, as they can improve the child’s schoolwork and possible behavioral-related difficulties.

If you are concerned about your child having a learning disability, please call our office for a consultation.

Gianna Scimemi, M.A.
Psychometrician

The Benefits of Ecotherapy and Your Mental Health

Before exploring the benefits of ecotherapy for your mental health, it helps to understand what specifically is ecotherapy. Ecotherapy is simply a form of therapeutic treatment that involves outdoor activities while in nature. Instead of focusing on your health, ecotherapy allows you to focus on an activity while out in greenery. Examples are, but not limited to gardening, hiking, working with animals, water-based activities, etc. By taking place in these activities, clients have reported fewer depression symptoms, attention problems, anger, and lowered stress levels.

Not only does ecotherapy help with mental health, it also can create a space for individuals who are looking to increase relationships and connections with others. Joining a gardening group or a water sport (i.e., paddleboarding, surfing, etc.) for example, are not only ways to incorporate ecotherapy but ways to improve relationships. Ecotherapy can also go well with talk or trauma therapy. Overall, this type of therapy is best suited for clients looking to work on easing depression or anxiety symptoms. Veterans, or anyone experiencing PTSD, and children with ADHD may also benefit from a nature-based therapy.

If interested, please call our office for more information.

Behavioral and Psychological Changes in Dementia

Caregivers are often unprepared to deal with problematic changes in behavior and mood in their family members diagnosed with dementia. These problems are common and occur in most dementia patients living in the community. They include but are not limited to increasing agitation, aggression, depression, apathy, hoarding, leaving the house without telling anyone, wondering, and getting lost. These changes occur due to disruption of the pathways between neurons responsible for memory, communication, and regulation of behavior.

Some factors have to do with pre-existing anxiety, depression, and irritability that unfortunately intensify in dementia. The good news, however, is that with the help of a trained neuropsychologist, caregivers can learn adjustment strategies to help their family members with dementia reduce problematic symptoms and behaviors and improve their own well-being. Several examples of common causes of problematic symptoms and behaviors in dementia and adjustment strategies are listed below.

First, physical discomfort due to chronic medical conditions, medications’ side effects, pain, constipation, or urinary problems can trigger a worsening mood and problematic behaviors. Regular medical check-ups and proper medication management can help.

Second, identifying and addressing an ineffective communication style between caregivers and a patient is essential. Ineffective communication occurs when caregivers unintentionally pressure patients to do something they can no longer do (e.g., asking them to remember something, expecting them to take care of their personal hygiene or communicate their needs). Another example of ineffective communication is reacting to the patient’s discomfort only after they “act out,” which unintentionally “teaches” patients to behave in a problematic way to get help.

Third, knowing what the patient needs to be comfortable in their environment is critical. A comfortable room temperature, access to preferred food and drinks, reduced clutter, and companionship are common needs that, if not met, can cause problems for people living with dementia.

Finally, patients do better when they have a balance between staying active and getting enough rest, and it is important to avoid sensory overstimulation. For instance, giving family members with dementia the opportunity to complete some easy household chores, engage in gardening, listen to their favorite music, or look at old photo albums can help. On the other side, loud noises, too much TV, and crowded environments can create overstimulation and contribute to problematic behaviors.

At NRS|Lifespan, caregivers can learn adjustment strategies to decrease problematic behaviors due to dementia in their family members as part of Medical Adjustment Counseling®.

If you have any questions, give us a call at 732-988-3441.

 

_________________________________
Eleonora Gallagher, Psy.D.
Licensed Clinical Psychologist #7297
Neuropsychology Post-Doctoral Fellow

 

The Importance of Serial Neuropsychological Assessment

Serial neuropsychological assessment refers to assessing a patients neurocognitive and adaptive abilities at different intervals over time.  For example, baseline neuropsychological assessment occurs during the first time a patient is neuropsychologically evaluated and establishes a “baseline” of functions.  This may occur shortly after a patient had sustained a traumatic brain injury, had undergone neurosurgical resection of a brain tumor, or treatment or rehabilitation following a stroke or other neurological diagnoses (e.g., multiple sclerosis, cerebral aneurysm, neurotoxic disorder, etc.).  Baseline neuropsychological assessment may also be instituted prior to the development of symptoms or a specific diagnosis.  This is particularly seen in athletes who undergo an assessment prior to the start of the season (e.g., football, hockey, soccer).  This type of baseline assessment is also strongly recommended in individuals who are reporting or experiencing subtle changes in cognitive efficiency (e.g., reduced memory, transient confusion, personality changes).  This might occur in individuals who are experiencing the early signs or symptoms of mild cognitive impairment (MCI).

In essence, serial neuropsychological assessment is paramount for the monitoring of possible neurocognitive and behavioral changes over time.  This often occurs at 6-12 month intervals.  This is particularly beneficial in identifying an individual’s strengths and weaknesses, treatment efficacy, including rehabilitation treatment modalities, medication, or psychotherapeutic strategies.  In part, this compares to an individual undergoing annual bloodwork, having periodic medical checkups, or even going to the dental hygienist.  All of these examples for serial testing and medical follow up should enhance the understanding of the patient’s needs, concerns, as well as implementing timely recommendations and interventions which may result in a more favorable outcome and overall prognosis.

CASE STUDY EXAMPLE

A 60-year-old female with 18 years of formal education reportedly was experiencing a gradual progressive decline of memory functions over the course of a few years.  Initially, she had undergone a cerebral MRI which identified probable microvascular cerebrovascular disease.  She was being followed medically per her primary care physician and neurologist.  She was referred for baseline neuropsychological evaluation which suggested a reduction in cognitive efficiency and adaptive abilities.  This appeared to be neurologically mediated as opposed to the questionable history of ADHD or exacerbation of post-traumatic stress (PTS).  Primary deficits were in general memory and executive dysfunction.  It was recommended that she continue to be followed medically and return in one year for follow up neuropsychological assessment.

As recommended above, serial and repeat neuropsychological assessment was completed one year later.  She denied interval adaptive changes.  However, her husband indicated that she was experiencing “more memory issues” despite utilizing compensatory strategies (e.g., daily routine of activities).  Neuropsychological test results demonstrated some neurocognitive deterioration over the past year.  This was particularly true in areas of general memory, verbal fluency, information processing speed, sustained levels of attention/concentration, and executive functions.  Her general intellectual abilities were essentially unchanged (e.g., average range but below premorbid expectations).  Overall, the patient appeared less cognitively efficient than she was a year ago despite utilizing and implementing compensatory cognitive strategies.  The patient met the diagnostic criteria for mild cognitive impairment (MCI) which is known to be a precursor toward a possible progressive dementia.  At this juncture, it was once again recommended that she undergo repeat neuropsychological assessment in one year.

The above noted case study example reflects the importance of serial neuropsychological assessment.

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

Medical Adjustment Counseling®, a New Approach

Today with the dramatic gains made in medicine, particularly, ER trauma, neurology, neurosurgery, it comes with a price in the form of cognitive residuals and behavioral adjustments problems. The medical community is aware of this and refers the medical patient for counseling assuming they will receive the proper treatment. Unfortunately, many of these patients are inappropriately referred to traditional behavioral mental health professionals. This, in turn, leads to patients being treated by the incorrect provider. Also, our behavioral health colleagues with good intentions are treating brain conditions with strategies that are inappropriate and potentially harmful, requiring a totally different approach in care.

The association between clinical psychology and conventional psychotherapy with neuropsychology is the degree of emphasis based upon brain related manifestations of behavior. Testing procedures in neuropsychology have a known relationship and dependance upon cognitive brain systems whereas in clinical psychology and conventional psychotherapy approaches, behavior is treated at face value and the biological bases are not of immediate concern.

Thus, the relationship and difference between these two approaches focuses upon behavior rather than an overlap upon cognitive brain functions.

Therefore, the basis for neuropsychological care vs. conventional psychotherapy systems is the neuropsychological examination (NPE) which serves as the “blueprint” for the counseling/rehabilitation process, and not merely the patient’s behavioral emotional changes.

To do this, we at Neuropsychological Rehabilitation Services|Life Span (NRS|LS) employ medical adjustment counseling (MAC)® which is a different approach based upon the NPE findings converted into a rehabilitative clinical pathway starting with validation of symptoms with explanation/education of their cognitive deficits manifesting in their daily functioning, accommodation, i.e., the necessary changes needed to be made, and finally, re-integration, the possession of a practical understanding of what they have, and what changes to make in daily functioning.

The traditional mental health approach merely allows a venting of their emotions (no less important), but the patient will never benefit from the strategies mitigating their cognitive inefficiencies through neuropsychological data driven adjustment strategies.

NRS|LS has a registered national trademark on MAC® and is the only program in the nation that offers training and certification.

Mere good intentions by our behavior health colleagues focusing upon emotions will not improve the larger picture of their neuropsychological impairment. Thus, mediating their daily efficiency unless the full spectrum of cognitive brain systems is integrated into counseling. This begins with a completed NPE “blueprint” converted into valid ecological application with MAC® directional treatment.

An in-depth explanation of this type of counseling can be found on Dr. Sica’s two journal publications:

The Integration and Application of Neuropsychology into the Treatment and Care of Patients with Brain Conditions (nrslifespan.com)

20200821_Medical-adjustment-counseling_-An-evidence-based-neurop.pdf (nrslifespan.com)

 

Dr. Robert Sica,
Principal Owner, Director