Download 2 Male Patient - Midtown East Neuropsychology, PLLC owned by Dr

Jay A. Seitz, Ph.D., P.C.
Clinical Neuropsychology and Clinical Psychology
321 East 48th Street – Suite 1E
New York, NY 10017
(212) 594-0423 (fax)
(917) 209-9623 (cell)
[email protected]
www.askdrj.com
NEUROPSYCHOLOGICAL EVALUATION
Name:
DOB:
DOE:
Age:
XXXXX XXXXX
03.11.57
05.13.10
53;2
REFERRAL PROBLEM:
Patient has a history of degenerative disk disease and head and neck pain. A colloid cyst
of the third ventricle was operated on in 1991 (craniotomy). He is currently taking Neurotin,
nortriptyline, Lipitor, and other medications (i.e., synthetic opiates) that may be interfering with
his cognitive abilities. He is currently on long-term disability. A neuropsychological workup
was advised to access his current level of cognitive functioning.
INSTRUMENTS ADMINISTERED AND CLINICAL EVALUATION PROCESS:
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Wechsler Abbreviated Scale of Intelligence (WASI, 1999 edition)
Hopkins Verbal Learning Test-R (HVLT-R, 2001 edition)
Wechsler Memory Scale (WMS-III, 1997 edition)
Delis-Kaplan Executive Function System (D-KEFS, 2001 edition)
Boston Naming Test – Warrington Variation (BNT, 2001 edition)
Clinical evaluation of verbal and nonverbal communication; emotional and social
competencies in the intrapersonal and interpersonal spheres; symbolic, cognitive, and
representational capacities; visuospatial abilities, and motor skills and competencies.
Dr Jay Seitz – Neuropsychological Evaluation
BEHAVIORAL OBSERVATION AND RELEVANT MEDICAL HISTORY (Hx):
Informant interview and relevant prior medical history: Patient has a history of
degenerative disk disease and head and neck pain. A colloid cyst of the third ventricle was
operated on in 1991 (craniotomy). There was obstructive hydrocephalus and increased
intracranial pressure and a craniotomy was performed in 1991. Approximately 1% of all
intracranial tumors are colloid cysts and symptoms include vertigo, headache, diplopia (double
vision), behavioral changes, and memory deficits. He is currently taking Neurotin (antiseizure
medication used as a mood stabilizer), nortriptyline (tricyclic antidepressant), Lipitor (statin),
synthetic opiates (Methadone - AM; Percocet - PM; and Oxycontin - HS), and other medications
that may be interfering with his cognitive abilities. XXXXX complains of “forgetting” things
and a lack of mental “quickness.” He is currently on long-term disability. He is a single, male
adult who never married. He is a former product manager at IBM and trained for the Olympic
hockey team in 1992. There is a Hx of basil cell carcinoma and cardiovascular issues (i.e.,
pacemaker) on the paternal side and on the maternal side, a Hx of abdominal cancer. A male
sibling is married with two children is described as in good health.
Clinical examination: XXXXX was cooperative and motivated to succeed during the
examination and he was in reasonably good spirits and garrulous but suffers from head and neck
pain. Overall, XXXXX was friendly and personable and focused and on-task with no evidence
of inattention or distractibility.
NEUROPSYCHOLOGICAL EVALUATION:
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Semantic, narrative (episodic), and nonverbal abilities. Semantic memory for previously
learned verbal lists was slightly below the average range of normal variation for his
chronological age. He attained a T score of 45 (less than one standard deviation below the
mean of 50; SD = 10) on a task of immediate verbal recall (80% retention) but a T score of
38 (more than one standard deviation below the mean) on a task of delayed verbal recall (i.e.,
25 minute delay; a slightly longer delay than usually evaluated). Retention of verbal items
across all four trials was slightly below the average range of normal variation for his
chronological age (T score = 39; more than one SD below the mean). His ability to pick out
correct memory targets from distractors on delayed recall was also slightly below the average
range of normal variation for his chronological age (recognition discrimination index = 9; T
score = 39, more than one SD below the mean). Verbal fluency, however, was within the
average range of normal variation for his chronological age on both tasks of lexical retrieval
using initial letters of words (F, A, S) and on retrieval of lexical categories (animals, boy’s
first names). On letter fluency, he had a scaled score of 11 (mean of 10; two repetition
errors, no set-loss errors) and on category fluency he had a scale score of 10 (no repetition
errors, no set-loss errors). This indicates that his retrieval of verbal items from long-term
semantic memory is within the average range of normal variation for his chronological age
for lexical items (words) and lexical categories and demonstrates adequate ability to monitor
ongoing progress in (verbal) working working memory (i.e., cognitive self-monitoring). On
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Dr Jay Seitz – Neuropsychological Evaluation
a task that required XXXXX to name pictures of objects in six categories based on longterm semantic memory, he was competent at naming letters (100%), numbers (100%),
colors (100%), actions (100%), animals (100%), and tools/utensils (100%). There is recent
evidence that such common, everyday categories are housed in separate areas of the inferior
temporal cortex. On a task of narrative (i.e., episodic) memory, XXXXX had weaker
retention of stories, both immediate (working or short-term memory) (scaled score = 7) and
delayed recall (25”) (scaled score = 8). His ability to remember important thematic content
(scaled score = 14) was on better than his ability to recall individual story components
(scaled score = 7, immediate = 7, delayed = 8) with his overall retention index (67%; scaled
score = 8) within the average range of normal variation for his chronological age.
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Symbolic, cognitive, and representational competence. XXXXX’s psychometric
intelligence (a truncated index of general cognitive abilities) was within one standard
deviation above the mean for his chronological age (psychometric intelligence = 112, mean =
100, SD = 15, 79th percentile, 106-117 confidence interval at 95% level of statistical
significance; visuospatial intelligence, T score = 50, scaled score = 10; nonverbal analogical
reasoning ability, T score = 50, scaled score = 10; verbal analogical reasoning ability, T
score = 64, scaled score = 14). XXXXX’s cognitive-intellective and symbolic abilities were
within the average range of normal variation for his chronological age.
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Visuospatial functioning. Visuospatial and spatial-temporal capacities were within the
average range of normal variation for his chronological age. On a visual design task of
constructional abilities, he was quite adequate at manipulating complex visual patterns using
a modified component-by-analysis strategy to guide visual problem-solving (T score = 50,
scaled score = 10). The latter suggests adequate metacognitive abilities in this cognitive
area, that is, the ability to make effective use of heuristics or strategies in solving a visual
design problem. There also is a gender bias on this task favoring males over females
(Doreen Kimura, Sex and Cognition, 1999, Cambridge, MA: MIT Press). When asked to
draw an analog clock and indicate a specific time, XXXXX included all the numbers of the
clock in the right order and in the correct spatial arrangement, the face of the clock was free
of distortion and completely integral, and the presence and placement of the hands were in
their correct position and the differences in sizes of the hands were respected.
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Executive functions, attention, cognitive flexibility, and organizational abilities. On a simple
test of frontal lobe function, XXXXX had little difficulty subtracting 7 from 100 serially (100
to 0) demonstrating adequate ability in retaining and processing single numerical items in
working memory as well as using this information flexibly and in an organized fashion in
problem-solving (i.e., cognitive self-monitoring).
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Working-, long-term, prospective, and incidental memory. Working memory (i.e., ability
to consciously hold and process symbolic information) was adequate as suggested by
XXXXX’s performance in immediate recall within the domains of semantic, and episodic
memory as well as long-term memory (LTM). Very long-term memory (VLTM) was intact
based an informal assessment of retention of childhood memories. Prospective (i.e.,
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Dr Jay Seitz – Neuropsychological Evaluation
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remembering to do something in the future) and incidental memory (i.e., memory for nontarget items) was also within the average range of normal variation for his chronological age.
Motor skills and sensory behaviors. XXXXX was able to successfully manipulate small
objects suggesting fine motor skills (i.e., ability to manipulate objects skillfully) within the
average range of normal variation for her chronological age. Gross motor behaviors (i.e.,
masterful coordination of whole body movements) also appeared within the average range of
normal variation for his chronological age.
Behavioral, emotional, and social functioning. XXXXX possesses an adequate repertoire of
expressive gestures of the face, voice (i.e., vocal prosody), hands, and body although he
suffers from intractable head and neck pain. Affective range and intensity were somewhat
muted as a result. XXXXX was cooperative and motivated to succeed during the
examination and he was in reasonably good spirits and garrulous. Overall, XXXXX was
friendly and personable and focused and on-task with no evidence of inattention or
distractibility.
SUMMARY EVALUATION:
XXXXX is a 53;2 year old adult, Caucasian male with a history of degenerative disk
disease and head and neck pain. A colloid cyst of the third ventricle was operated on in 1991
(craniotomy). There was obstructive hydrocephalus and increased intracranial pressure and a
craniotomy was performed in 1991. He is currently taking Neurotin (antiseizure medication used
as a mood stabilizer), nortriptyline (tricyclic antidepressant), Lipitor (statin), synthetic opiates
(Methadone - AM; Percocet - PM; and Oxycontin - HS), and other medications that may be
interfering with his cognitive abilities. Generally, both his semantic memory (i.e., memory for
facts) and her episodic or narrative memory (i.e., memory for people, places, and events) were
within or slightly below the average range of normal variation for his chronological age. His
psychometric intelligence (a truncated index of general cognitive abilities) was within the
average range of normal variation for his chronological age. Behavioral, emotional, and social
functioning were appropriate as he was friendly, personable, garrulous, and motivated to
succeed. Very long-term, prospective, and incidental memory were intact. Visual
constructional abilities, computational skills, and fine and gross-motor abilities were also
intact. There were no significant decrements in executive functions (i.e., cognitive selfmonitoring, mental flexibility, initiation and response inhibition) on single-dimensional (i.e.,
numerical) or multidimensional items. Thus, in general, he possesses the ability to retain and
process semantic and episodic items in working memory and use this information flexibly and in
an organized fashion in problem-solving.
DIAGNOSIS:
Axis I:
294.9 Cognitive Disorder, NOS (by history)
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Dr Jay Seitz – Neuropsychological Evaluation
Axis II: None
Axis III: Neck pain, degenerative disk disease, spondylosis, diabetes
Axis IV: Long-term disability
Axis V: 50
CLINICAL RECOMMENDATIONS:
(1) Follow-up in one year to assess any changes in cognitive, social, emotional, and
intellective abilities.
(2) Referral to NYU Institute of Rehabilitative Medicine for pain management including
both medical and psychological intervention.
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Jay A. Seitz, Ph.D.
Neuropsychologist
Licensed in NYS for the Professional Practice of Psychology
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