Debunking the Myth: Can You Fail a Neuropsychological Evaluation?

As a psychologist who does neuropsychological evaluations (neuropsych evals, for short), I often encounter misconceptions about neuropsychological testing. One of the most common questions I hear is, "Can you fail a neuropsych eval?" The answer? No, in the traditional sense of getting a passing or failing grade, you cannot.

However, there are some nuances to understand. Let's delve deeper into the purpose and process of a neuro-psych eval to clear up this confusion.

What is a Neuropsychological Evaluation?

A neuro-psych eval is a comprehensive assessment of your cognitive functioning. It's like a detailed map of your brain's strengths and weaknesses across various areas of function, including:

• Attention and concentration: How well can you focus and sustain attention?

• Memory: How well do you encode, store, and retrieve information?

• Language: How effectively do you use language to communicate and understand?

• Learning: How well do you acquire new information and skills?

• Executive functioning: How well do you plan, organize, and problem-solve?

• Processing speed: How quickly can you process information?

The Neuropsychological evaluation typically involves a combination of:

• Clinical interview: Discussing your social, medical, and mental health history, symptoms, and everyday challenges.

• Standardized cognitive testing: Administering specific tests designed to assess different cognitive domains.

• Review of medical records: Understanding any relevant medical conditions that might impact your brain function.

Why Don't You "Fail" a Neuropsych Evaluation?

The primary goal of a neuro-psych evaluation isn't to judge your performance but to create a detailed picture of your cognitive profile. This information is crucial for:

• Diagnosis: Helping identify underlying neurological or psychological conditions that might be impacting your thinking and behavior.

• Treatment planning: Informing the development of treatment strategies to improve your cognitive skills or compensate for weaknesses.

• Monitoring progress: Assessing the effectiveness of treatment interventions.

• Eligibility determination: Providing evidence for eligibility for educational support services or disability programs.

There's no single "correct" answer on any test. Everyone performs differently based on factors like age, education, and cultural background. Your scores are compared to “norms,” which means a large number of scores from people that let us know what scores we should expect on a given test. These tests are often adjusted for age, education, and other factors, so that you are compared to others similar to you in important ways. That gives us the best sense of where your scores fall in comparison to what we expect from others in your same age group.

The Importance of Effort and Validity

While you can't fail, putting forth a genuine effort is essential. Neuro-psych evals often include effort testing to ensure the results accurately reflect your abilities. Effort measures are built into testing and might involve tests where inconsistent performance raises questions about whether you're trying your best.

If a neuropsychologist suspects you're not putting in good effort based on these measures, they might flag the results as "invalid." This could limit the usefulness of the evaluation, hindering accurate diagnosis and treatment planning. There are many reasons people might not put their best effort into testing, but if that’s the case, we cannot trust the test results actually measure what we were trying to measure, and it would not be ethical to make a diagnosis or plan treatment based on invalid results.

Here are some tips for approaching your neuropsych evaluation effectively:

• Get a good night's sleep beforehand.

• Eat a good breakfast the day of testing.

• Arrive well-rested and alert.

• Ask clarifying questions if you're unsure about instructions.

• Do your best on each test, even if you find it challenging.

• Be honest about your limitations.

What Happens After the Evaluation?

Following the evaluation, the psychologist will analyze all the collected data. This includes your interview responses, test scores, and medical records. They then create a comprehensive report summarizing your cognitive strengths and weaknesses, offering potential diagnoses, and recommending appropriate interventions.

Here are some possible outcomes:

• Normal cognitive functioning: The evaluation may not identify any significant cognitive deficits.

• Specific cognitive impairments: The report might identify specific areas of cognitive deficit that could benefit from targeted interventions.

• Learning disorder: The evaluation might support a diagnosis of a learning disorder, informing educational support plans.

• Neurological condition: The evaluation might point towards a neurological condition, prompting further medical investigation.

Remember, the neuro-psych eval is a collaborative process. Discussing the findings with the neuropsychologist and your doctor allows you to ask questions, clarify results, and understand the next steps.

Start A Neuropsychological Evaluation in Los Angeles, CA

A neuro-psych evals is a valuable tool for understanding how your brain works. They don't involve passing or failing but rather aim to create a comprehensive profile of your cognitive functioning. By approaching the evaluation with a genuine effort, you can contribute to a more accurate and helpful assessment that aids in diagnosis, treatment, and ultimately, improved well-being. Start the evaluation process with Dr. Reger by following these simple steps:

1. Contact (424) 262-1925 to schedule your appointment

2. Meet with Dr. Reger for an evaluation

3. Get a better understanding of neurological issues!

OTHER SERVICES OFFERED BY DR. REGER IN LOS ANGELES, CA

Neuropsychological assessments aren’t the only service I offer. I know that you may encounter more than one mental health concern at a time. I offer multiple psychological assessments as well. Other assessments include capacity assessments, cognitive and dementia testing, pre-surgical assessments, and med-legal evaluations. In addition to evaluations, I also provide individual therapy, counseling for older adults, and mental health consultations and presentations. Visit my blog for more helpful support today!

Navigating the Journey: Tips from a Geropsychologist for Living Well After a Dementia Diagnosis

A diagnosis of dementia can be overwhelming, bringing a wave of emotions and uncertainty for both the person diagnosed and their loved ones.

Perhaps you have noticed problems for a while and spoken to a doctor, perhaps you suspect cognitive decline, or perhaps you have had neuropsychological testing and received a diagnosis of dementia. As a psychologist with a specialty in assessment of cognitive change and capacity in aging, I've witnessed firsthand the challenges and triumphs people face on this journey. While there's no cure for dementia, there are strategies to maintain quality of life, maximize independence, and create a supportive environment.

Here are some key tips to navigate this path:

1. Educate Yourself:

Knowledge is power. Familiarize yourself with the specific type of dementia diagnosed. It’s always a good idea to talk to your doctor or psychologist, if you have one. Resources like the Alzheimer's Association, the National Institute on Aging, and dementia-specific support groups can provide valuable information about its progression, available treatments, and ways people cope. It’s also important to remember that there are many types of dementia, and while they all come with difficulties, they also have unique features that are important to understand so you can navigate your situation. For example, some dementias can involve personality changes or symptoms like hallucinations. These types of symptoms can be very confusing and scary, so preparing yourself and your family for these types of possibilities can make it easier to understand what’s going on.

2. Consider Neuropsych Testing:

If you haven’t had neuropsychological evaluation as part of your dementia diagnosis, it is worth considering, especially if you are in the early stages of cognitive change. This testing can give you, your loved ones, and your medical providers information about your strengths and areas where you need more support, as well as recommendations for ways to manage going forward based on your cognitive profile. 

3. Embrace Open Communication:

An open and honest dialogue is crucial. Discuss the diagnosis with your loved ones, including your wishes and concerns regarding care and decision-making. Talk to your doctor about treatment options, potential side effects, and future planning. Communication empowers everyone involved to navigate the journey together.

4. Prioritize Brain Health:

Just because you have dementia doesn't mean your brain can't be stimulated, or that you should give up trying to maintain your brain health. Engage in activities that keep your mind active, such as reading, puzzles, playing games, or learning a new skill. 

5. Maintain Physical Activity:

Regular exercise is vital for both physical and cognitive health. Aim for moderate-intensity exercise most days of the week. Try to keep the mindset that any movement that you enjoy is good for you; exercise should not be a punishment! Walking, swimming, dancing, biking on a stationary or hand bike, tai chi, or gentle/chair yoga are excellent options. Exercise can be adapted to any level of physical ability, and if you need help finding adaptive exercises, you can search online or find a disability-knowledgeable trainer, a kineosiotherapist, or a disability-friendly gym to support your physical activity. Exercise promotes blood flow to the brain, which can help maintain cognitive function. This is the number one most important thing any of us can do to preserve brain health over our lifetimes!

6. Structure and Routine are Key:

Create a consistent daily routine that provides structure and predictability. This can include regular mealtimes, sleep schedules, and established times for medications and activities. I have worked with many folks with dementia who are able to maintain independence well into the illness because they have a routine and don’t have to adapt to new circumstances. Change is harder on a vulnerable brain, so structure and routines can also reduce distress when dealing with dementia.

7. Maximize Independence While Balancing Safety:

As much as possible, maintain independence. Break down tasks into smaller, manageable steps and ask for assistance and support as needed. For example, perhaps managing money has become too overwhelming and you’ve been late on a few bills; asking an adult child you trust to become a joint signer on your bank account might allow them to set up auto pay for bills and help you when you need it, but still give you independence in accessing your own funds. It’s also important to be honest with yourself and your family if you realize there are ways you can’t be independent anymore. For example, driving is a tough one for most people to give up, especially in Los Angeles, where we are so dependent on our cars. But if you’ve got a diagnosis of dementia, or you’ve had a few fender benders or “close calls” while driving lately, it’s likely time to come up with an alternate plan and let go of the keys.

8. Adapt the Environment:

Make your environment dementia-friendly. Install safety features like grab bars in bathrooms, bright lighting, and clear walkways. Label cabinets and drawers for easy organization. Remove clutter that might cause confusion. Again, asking for help here is a good idea, as organizing your space can be overwhelming.

9. Focus on Strengths:

While dementia forces us to acknowledge cognitive limitations, celebrate your strengths and abilities as well. Use your existing skills and interests to engage in things you enjoy, or to adapt new ways of doing things you used to enjoy. This fosters a sense of accomplishment and boosts self-esteem.

10. Engage in Social Activities:

Stay connected to loved ones and participate in social activities. Social interaction helps maintain cognitive function and provides a sense of belonging. Explore volunteer opportunities, attend social events, call friends and family, or engage in hobbies that bring joy.

11. Seek Professional Support:

Don't hesitate to seek professional help from psychologists, therapists, or social workers. They can provide emotional support, guidance on coping strategies, and help manage behavioral changes associated with dementia. This is an incredibly difficult diagnosis that most of us are afraid of; there is no shame in talking to a professional about grieving and coping.

12. Join a Support Group:

Connecting with others facing similar challenges can be empowering. Support groups offer a safe space to share experiences, learn from each other, and find emotional support. These can be great for people with dementia in the early stages, and also for family members and caregivers.

13. Plan Ahead:

Sometimes when we are faced with news of a life-altering diagnosis, our initial reaction is to avoid thinking about it. It’s understandable to experience shock, grief, and even denial. But it’s crucial to discuss the diagnosis and prognosis with loved ones so that you can plan together for the future.

Begin Therapy for Older Adults in Los Angeles, CA

The more you express your wishes and make arrangements now, the easier things will be down the road for you and your loved ones. You deserve to have the best support structures when facing potential changes like this, and Dr. Reger is happy to help offer support with services like dementia testing. You can start your therapy journey by following these simple steps:

1. Contact (424) 262-1925 to schedule your appointment

2. Meet with a Los Angeles Psychologist

3. Start receiving the support you deserve!

OFFERED BY DR. REGER IN LOS ANGELES, CA

Support for older adults and dementia testing aren’t the only services I offer. I’m happy to offer multiple neuropsychological and psychological assessments. Other assessments include pre-surgical assessments and med-legal evaluations. In addition to evaluations, I also provide capacity assessments, individual therapy, and mental health consultations and presentations. Visit my blog for more helpful support today!

Understanding PTSD in Older Adults

Before starting my private practice, I worked at the Veteran’s Affairs hospital for nearly a decade, and in the course of that work, I learned a great deal about treating PTSD (post-traumatic stress disorder) in older adults. We tend to associate PTSD with veterans or survivors of recent accidents. However, the reality is that many older adults carry the weight of past traumas, silently battling symptoms that can significantly impact their lives for many years.

Potential Long-Term Impacts of Untreated Trauma:

Traumatic events, by definition, are deeply disturbing and disruptive. They shatter our sense of security and leave a lasting impact on our psychological well-being. These events can happen at any age, and older adults may have a lifetime of experiences that could contribute to PTSD. Here are some common examples:

• Combat trauma: Veterans and survivors of historical conflicts, like the Vietnam War or World War II, may carry the emotional scars of combat for decades.

• Childhood abuse: Sadly, childhood abuse is a far too common occurrence. For older adults, the trauma of physical, emotional, or sexual abuse in their youth can resurface later in life, particularly during periods of transition like retirement or the loss of a spouse.

• Serious accidents: Accidents can leave not only physical scars but also deep emotional ones. Witnessing the sudden death of a loved one in a car crash or experiencing a life-threatening medical event can trigger PTSD symptoms.

• Witnessing violence: Exposure to violence, whether as a bystander in a crime or during a period of social unrest, can be deeply traumatizing. Older adults who lived through tumultuous historical periods like the civil rights movement or periods of political violence might be affected.

PTSD in Later Life:

The presentation of PTSD in older adults can differ from the classic symptoms often seen in younger populations. This can lead to misdiagnosis or delayed diagnosis, leaving individuals struggling without proper support. Here's what to watch for:

• Physical symptoms: Older adults with PTSD may experience a variety of physical complaints that seem unrelated to any medical condition. These can include fatigue, sleep problems, headaches, and stomachaches.

• Emotional changes: Irritability, anxiety, depression, and feelings of isolation are common signs of PTSD in older adults. They may withdraw from social activities, become easily frustrated, or lose interest in things they once enjoyed.

• Flashbacks or nightmares: Reliving the traumatic event through intrusive memories or vivid nightmares is another key symptom of PTSD. These can be particularly distressing for older adults, especially if they are triggered by seemingly innocuous things. In my experience, people with PTSD for many years may not have nightmares for quite some time, then have nightmares resurge after a time of significant stress, such as retirement or health changes.

• Avoidance behaviors: Avoidance is a way that many people with PTSD cope with trauma. Older adults with PTSD may avoid places, people, or situations that remind them of the trauma. Avoidance can occur for decades and really limit people’s lives. This can significantly limit their daily activities and social interactions.

• Difficulty concentrating or making decisions: The underlying stress of PTSD can affect cognitive function, making it difficult for older adults to focus, remember things, or make sound decisions. These symptoms can be mistaken for cognitive problems in older adults, but may be reversible with treatment. 

Why Recognition Matters:

Identification and intervention are crucial for managing PTSD in older adults. Here's why:

• Improved Quality of Life: Effective treatment of PTSD can significantly reduce symptoms like nightmares, hypervigilance, avoidance, anxiety, mood problems, and sleep problems. This can lead to a significant improvement in an older adult's overall well-being and quality of life.

• Reduced Risk of Other Conditions: Our minds and bodies are connected -- untreated PTSD can exacerbate existing medical conditions like heart disease, diabetes, and chronic pain. Additionally, the social isolation and emotional distress associated with PTSD can increase the risk of substance abuse disorders.

• Strengthens Coping Mechanisms: Therapy equips older adults with tools to manage stress, regulate emotions, and cope with difficult memories. These valuable skills can help them navigate challenges and build resilience.

Seeking Help:

If you suspect an older adult you know might be struggling with PTSD, here are some resources:

• Seek a therapist specializing in geriatric mental health: Geropsychologists like myself have specific training and experience working with older adults and understand the unique challenges they face, including the presentation of PTSD in this population.

• Consider support groups for older adults with PTSD: Connecting with others who share similar experiences can be a source of strength and validation for older adults with PTSD. Support groups can also provide valuable information and coping strategies.

• Consultation with a psychiatrist: There are geropsychiatrists who specialize in managing mental health conditions in older adults with medications. This can be very helpful in PTSD, and finding a psychiatrist with a specialty working with older adults ensures the safest and most tailored medication management. This is a great supplement to therapy for PTSD.

Start Working With a Therapist for Older Adults in LA

Remember, you're not alone. Many older adults experience PTSD, and effective treatments are available. With support and understanding, they can find healing, reclaim a sense of control, and live a fulfilling life. Dr. Reger can offer support and guidance from her Los Angeles, CA-based practice. Start the therapy process by following these simple steps:

1. Contact (424) 262-1925 to schedule your appointment

2. Meet with a Los Angeles Psychologist for an evaluation

3. Start addressing past pain!

Other Services Offered by Dr. Reger in Los Angeles, CA

Counseling for older adults isn’t the only service offered. In addition, I’m happy to offer support with a variety of assessments and testing. Other services offered include capacity assessments, neuropsychological and psychological assessments, and cognitive and dementia testing. Other services offered include pre-surgical assessments, and med-legal evaluations. In addition to evaluations, I also provide individual therapy, and mental health consultations and presentations. Visit my blog for more helpful support today!

California Conservatorships: Navigating the Maze with Capacity Testing

Today I wanted to delve into a complex legal and psychological issue in California: conservatorships and capacity testing. This topic often arises with aging loved ones, and navigating these decisions can feel overwhelming. But there is help and guidance available. I have worked with many families in Los Angeles to understand capacity and conservatorship from a psychological perspective, and have conducted capacity assessments in a wide variety of cases. Here’s how capacity testing can help ensure a fair and informed process if you or a loved one are navigating the possibility of a petition for conservatorship.

What is a Conservatorship?

A California conservatorship is a court-ordered legal arrangement where someone (the "conservator") is appointed to make decisions on behalf of another adult (the "conservatee") who is deemed unable to care for themselves or their finances. This can involve decisions about:

• Personal needs: Food, clothing, shelter, and medical care.

• Financial management: Paying bills, managing investments, making changes to a will or testament, and protecting assets from exploitation.

Why is Capacity Testing Important?

Capacity testing is a crucial component of the conservatorship process. It's a psychological evaluation that assesses an individual's ability to make informed decisions in specific areas. In the context of conservatorship, this typically focuses on two key domains:

1. Personal Needs Management: Can the individual safely manage their daily activities like preparing meals, dressing themselves, and taking medications?

2. Financial Management: Can the individual understand financial statements, avoid undue influence from others, and make sound financial decisions that are consistent with their values and well-being?

The Testing Process:

There's no single "capacity test." Evaluations involve a multi-pronged approach:

• Interviews: This involves gathering information from the individual, family members, and caregivers about their daily lives, decision-making processes, and any concerns.

• Cognitive Assessments: Standardized tests are used to assess memory, attention span, problem-solving skills, and judgment. These tests provide objective data about the individual's cognitive abilities. Just because someone has cognitive deficits or even dementia, does NOT mean they lack capacity. This information is crucial as part of a thorough evaluation, but it’s not the whole story. Many people with dementia maintain their capacity for decision-making, particularly if they have an established routine and support from family.

• Functional Assessments: Here, the psychologist observes the individual performing daily tasks related to finances and personal care, such as paying a bill. This may also involve asking test questions that get at a person’s comprehension and understanding of these tasks. For example, I may ask what someone would do in a hypothetical situation, such as if they accidentally cut their hand while alone at home, or ask them to explain a complex concept, such as health insurance. This helps determine their ability to function independently in real-world situations.

Importance of Capacity Testing in California:

• Accurate Information for the Court: Objective data from capacity testing helps judges make informed decisions about the necessity and extent of a conservatorship. It ensures the least restrictive option is considered to protect the individual's autonomy.

• Focus on Function, Not Diagnosis: California law emphasizes an individual's ability to function in daily life, not just a specific medical diagnosis. Capacity testing helps determine whether they can manage essential tasks independently.

• Protecting Well-Being: A conservatorship can be crucial if someone is vulnerable to financial exploitation, neglect, or self-harm due to impaired decision-making capacity. It provides a safety net until their abilities are restored or a less restrictive alternative is found.

California-Specific Considerations:

• Culturally Sensitive Evaluations: California recognizes the importance of cultural sensitivity in evaluations. Qualified psychologists consider the individual's cultural background, language, and values when conducting assessments.

• Least Restrictive Alternative: The court prioritizes options that allow the individual to retain as much autonomy as possible. A full conservatorship is only considered if less restrictive alternatives, like supported decision-making, are deemed insufficient.

Seeking Help:

If you're concerned about a loved one's ability to care for themselves or their finances, here are some resources to help you navigate the process:

• Consult with an attorney specializing in elder law or conservatorship. They can guide you through the legal aspects of conservatorship and the court process.

• Seek a licensed psychologist with experience in geriatric assessments and capacity testing, like Dr. Reger.  I can conduct a comprehensive evaluation and provide a report for your records, as well as complete any court forms, such as the GC-335 or a notarized declaration regarding capacity if those are needed and appropriate for your case.

• Contact your local Adult Protective Services agency for support and guidance. They can provide information on available resources and advocate for your loved one's well-being.

Remember: Conservatorship is a significant legal decision, and the process can be emotionally charged. Capacity testing ensures that decisions are made based on objective information, protecting the well-being of your loved one while respecting their autonomy to the greatest extent possible.

Let's Talk About a Capacity Assessment in Los Angeles, CA!

Have questions about California conservatorship, capacity testing, or resources for getting help? Feel free to reach out to Dr. Reger for support. You can learn more about the benefits of testing and more by following these simple steps:

1. Contact (424) 262-1925 to schedule your appointment

2. Meet with Dr. Reger for an evaluation

3. Start navigating the complexities of capacity assessments!

Other Services Offered By Dr. Reger in Los Angeles, CA

Capacity assessments are not the only service offered by my Redondo Beach-based practice. I know that you may encounter more than one mental health concern at a time. This is why I’m happy to offer multiple neuropsychological and psychological assessments. Other assessments include cognitive and dementia testing, pre-surgical assessments, and med-legal evaluations. In addition to evaluations, I also provide individual therapy, counseling for older adults, and mental health consultations and presentations. Visit my blog for more helpful support today!