Neuropsychology Central

[Stef1975]

Hello, I have recently undergone neuropsych assessment. I had a benign brain tumour in the frontal lobes (golf ball sized), relatively symptom free. This was successfully and fully excised 3 years ago. Since then I have suffered with a number of symptoms: daily headaches, chronic migraines and daily mental fatigue (leading to word finding difficulties, incorrect word order in sentences, easily distracted, low attention span, slower at mental arithmetic, slower at learning new concepts, etc). As all preventative drugs have been stopped and I was still noticing the above I was referred to a neuropsychologist. After good effort and 3 hours of testing, I was exhausted! The results have come back all within average. The consultant said that at a qualitative level she noticed problems with my attention. I was easily distarcted during testing, and she could see me drift in and out of "awareness" especially towards the end (when she was explaining things I could not follow or understand all she said). Malingering has been excluded. No previous tests were carried out to use as a benchmark for my cognitive skills prior to the surgery/tumour.
My history indicates I would have scored higher than average: graduated in Economics & Sociology aged 19, whilst studying in a foreign language acquired after age 12; high performance within a financial services auditing career.
In the consultant's view I have a cognitive deficit in the area of attention, measured at a qualitative rather than quantitative level.
I have 2 questions:
1. Is a cognitive deficit in the realm of neurological deficit, and why?
2. My neurologist interpreted my results as "normal" as I fell within average scores. How can this be?

[drejb]

Please not no individual advice can be offered. Your question does highlight what the definition of normal is. Normal for the average person does not always mean normal for the individual. Attention has many components, including frontal subcortical. Neuropsychological testing probably is underutilized - who would think that in a bright individual one would not get pre and post surgery testing for comparison.

Finally 3 hours is not particularly long for a neuropsychological examination except maybe in hospital consults or dementia exams where time, insurance, and stamina really limit what one can do.

Consider this: the gold standard Wechsler IQ and Memory tests can take that long, and are certainly not considered a full neuropsychological evaluation. Some clinics may take 2 days to complete a comprehensive eval. Insurance and finances often lead to shortcuts, which often means people get what they or the insurance company will pay for.

In short evals, one also sometimes sees short-form tests, or some measures that are designed to screen rather than full assess functions. These are usually gross measures and may not pick up on problems of higher functioning folks.

One also must be wary of individuals who have no graduate level training or supervision in neuropsychology or post-doc training who may perform neurospychological evaluations after attending a few seminars.

Not saying that any of this is so in your case. A second opinion by someone who does more comprehensive neruopsychological evaluations may be helpful. If one has unanswered questions, returning to the individual who did the evaluation for more clarification would not be inappropriate. Speaking to whoever referred you for testing may also help in terms of noting your dissatisfaction and asking if a second opinion might give more answers.

Lots to think about.

For a description of commonly used neuropsychological tests see:

http://cpancf.com/articles_files/Common_Tests_Neuropsychological_Assessment.asp.

while forensic neuropsychology requires a much higher standard, the www.forensicneuropsychology.comwebsite gives a description of a pretty comprehensive approach to evaluation.
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