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Bedside Approach to Neuropsychological Assessment [Clinical Neuropsychological Assessment OP Basis]

Bedside Approach to Neuropsychological Assessment [Clinical Neuropsychological Assessment on OP Basis] This video presents a clinically useful approach to obtaining the history, performing the mental status examination and bedside neuropsychological assessment. A thorough history and collating information from multiple informants are necessary to get the complete picture of the patient's illness, disability, deficits and functionality of the patient. Assessment revolve around the cognitive domains of executive function, attention, memory, visuospatial function, emotional, language, and behavior. While the history inquires about the patient’s abilities related to these domains as they pertain to his or her life, the neuropsychological examination tests the integrity of these domains in a clinical setting and is, therefore, a formal part of the neurologic examination. The overall goal is to determine if performance on each domain is normal or impaired. Longitudinal assessments provide additional information to determine if a change has occurred. Over the years, neuro-psychological tests have evolved from simple screening measures to more in-depth evaluations that are reflective of the increased understanding of the clinical and cognitive features of the various types of brain lesions. Laboratory and imaging biomarkers are being developed for accurate diagnosis of neurobehavioral disorders, yet few are currently available for clinical use. Moreover, not all centers have access to these potential tools. Practicing clinicians are therefore left primarily with their skills of history taking and examination. With limitations on both time and resources, an efficient deductive process is required to obtain and distill the key elements from the history, elemental neurologic examination, bedside neuro-psychological assessments and ancillary investigations to determine the etiology of a patient’s cognitive impairment. The neuropsych assessment may be required for a variety of reasons, including issues relating to capacity (competency) for informed decision making, prognosis, rehabilitation, pre & post intervention assessment, capacity for independent living versus the need for assisted living, or an elucidation of cognitive strengths and weaknesses for purposes of treatment planning (be they medical, rehabilitative, pharmacological, or other). The documentation must contain elements that indicate the timing of the onset, type of progression, presenting symptom, and duration. The history should expand on this and obtain the chronologic progression of the patient’s abilities in other cognitive domains, including changes to his or her personality or behavior and ability to function in both instrumental and basic ADLs. Administration of the neuro-psychological assessment requires that the chosen assessment tool adequately examines the patient’s primary symptom in addition to the other cognitive domains. If not, additional bedside tests should be added to the assessment. Alternatively, the clinician can administer a single test that includes a more in-depth assessment than the brief screening measures.