Download KENNEDY CHILD STUDY CENTER

Jay A. Seitz, Ph.D., P.C.
Clinical Neuropsychology and Clinical Psychology
321 East 48th Street – Suite 1E
New York, NY 10017
(917) 209-9623 (cell)
[email protected]
www.askdrj.com
NEUROPSYCHOLOGICAL EVALUATION
Name:
DOB:
DOE:
Age:
XXXXXX XXXXX
12.30.50
08.07.08
57;8
REFERRAL PROBLEM:
XXXXXX has a history of potential closed head injury after slipping on pavement when
visiting his mother in early December of 2007. He has had numerous cognitive and motor
complaints for which he seen a neurologist initially in January of 2008 and at subsequent 3-4
month follow-ups. He complains that there has been no improvement in his condition.
INSTRUMENTS ADMINISTERED AND CLINICAL EVALUATION PROCESS:








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)
Clock Drawing Test (CDT, 1992 edition)
Prospective & Incidental Memory Measures (PIMM, 2003 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 abilities.
BEHAVIORAL OBSERVATION AND HISTORY (Hx):
Informant interview and relevant prior medical history: MRIs of the brain (without
contrast) in January and July of XXXX were unremarkable. An MRI of the cervical spine in
January of XXXX noted “small degenerative annular bulges C3-4 and C4-5 without spinal cord
Jerome Belson Health Care Center – Neuropsychological Evaluation
2
compression.” Brainstem auditory evoked potentials in January of 2008 were unremarkable. A
videonystagmography also performed on January of XXXX was normal (gaze, tracking/smooth
pursuit, optokinetic nystagmus, head rotation and positional tests were all normal) except for the
possibility of central vestibular dysfunction with possible cerebellar involvement due to saccadic
flutter and intrusions. Targeted balance exercises were recommended. There is a history of
colon cancer (maternal side) and brain tumor and dementia (paternal side) intergenerationally.
Allen is married with two children and employed full-time but complains of problems in
organizing himself and forgetting things at work. There appeared to be no significant
psychological issues at home or work. He takes Lutein for macular degeneration and glaucoma.
Clinical examination: XXXXXX complained of frequent headaches (radiate from back
of head to front), drooping eyelid and numbness of the left side of his face, some vertigo when
standing up, some slightly slurred speech, and insomnia (problems in initiating sleep). He was
somewhat anxious about his current health condition and concerned that his cognitive, memory,
and motor problems have not been addressed. He is right-handed but appeared to have slightly
below average grip strength bilaterally.
NEUROPSYCHOLOGICAL EVALUATION:

Verbal (semantic), narrative (episodic), and nonverbal abilities. Semantic memory for
previously learned verbal lists was significantly below the age range of normal variation for
his chronological age. He attained a T score of 27 (more than two standard deviations below
the mean) on a task of immediate verbal recall and a T score of 20 (three standard deviations
below the mean) on a task of delayed verbal recall (i.e., 20 minute delay). Retention of
verbal items across all four trials was significantly below the average range of normal
variation for his chronological age (percent retention = 57%; T score = 21; more than two
standard deviations below the mean). Moreover, his ability to pick out correct memory
targets from distractors on delayed recall was also significantly below the average range of
normal variation (recognition discrimination index = 5; T score = 20; three standard
deviations below the mean). Verbal fluency was below average 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 9 and on category fluency she
had a scale score of 8 (with few irrelevant memory intrusions) indicating slightly below
average ability to retrieve verbal items from memory as well as the ability to monitor
ongoing progress in working memory (i.e., cognitive self-monitoring). On a task of narrative
(i.e., episodic) memory, XXXXXX had poor retention of stories, both immediate (scaled
score = 3) and delayed (25”) recall (scaled score = 1), including the absence of both
important thematic content and individual story components, although he was better on
details than overall themes.

Symbolic, cognitive, and representational competence. Allen’s general intelligence was less
than one standard deviation below the average range of normal variation for his
chronological age (psychometric intelligence = 90, visuospatial intelligence, T score = 44;
nonverbal analogical reasoning ability, T score = 45, 25th percentile, confidence interval of
Jerome Belson Health Care Center – Neuropsychological Evaluation
3
85 - 94, 95% level of statistical significance). XXXXXX’s cognitive-intellective and
symbolic abilities were marked by decrements in working memory for both language and
nonverbal analogical reasoning ability.

Visuospatial functioning. Visuospatial and spatial-temporal capacities were within the
average range of normal variation for XXXXXX’s chronological age. He drew an analog
clock with appropriate placement of numbers and clock hands indicating no impairment in
visual-spatial abilities (clock score = 10). On a visual design task of constructional abilities,
he was able to manipulate complex visual patterns using a component-by-analysis in using
the visual design to guide problem-solving (T score = 44; less than one standard deviation
below the mean). 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.

Executive functions, attention, cognitive flexibility, and organizational abilities. On tasks of
executive functions, XXXXXX was unable to complete several tasks because of an inability
to retain and process multiple items in working memory (forms, colors, letters, and numbers)
as well as use this information flexibly and in an organized fashion in problem-solving
(composite scale score = 1). He was able to engage successfully in various component
abilities (visual scanning, number and letter sequencing), however, indicating that these
individual component abilities were fully consolidated.

Working-, long-term, prospective, and incidental memory. Working memory (i.e., ability to
consciously hold and process symbolic information) was limited as well as long-term
memory as suggested by decrements in immediate and delay recall within the domains of
linguistic, semantic, episodic, and visual memory. Very long-term memory (VLTM) was
intact based an informal assessment of retention of childhood memories. Prospective (i.e.,
remembering to do something in the future) and incidental memory (i.e., memory for nontarget items) was marked by significant decrements for his chronological age.

Motor skills and sensory behaviors. XXXXXX was able to successfully draw complex
geometric patterns suggesting fine motor skills (i.e., ability to manipulate objects skillfully)
within the average range of normal variation for his chronological age. Gross motor
behaviors (i.e., masterful coordination of whole body movements) appeared below the
normal range of variation for his chronological age given that he has experienced vertigo on
standing and self-reported problems in self-ambulating.

Behavioral, emotional, and social functioning. Allen possesses an ample repertoire of
expressive gestures of the face, voice (i.e., vocal prosody), hands, and body. Affective range
and intensity were broad. XXXXXX was friendly if wry, humorous, and cooperative
throughout the examination.
SUMMARY EVALUATION:
Jerome Belson Health Care Center – Neuropsychological Evaluation
4
XXXXXX is a 57;8 year old adult male with a recent history of cognitive, memory, and
motor problems as a result of a potential closed head injury in December of 2007. With regard
to behavioral, emotional, and social functioning, although there is some anxiety and
understandable concern about his health, he has no reported significant psychological issues at
home or work; he is married with two kids and gainfully employed. Indeed, XXXXXX was
friendly if wry, humorous, and cooperative throughout the examination. He displayed a full
complement of pragmatic, semantic, and syntactic competence in his speech. His general
intelligence, however, was less than one standard deviation below the average range of normal
variation for his chronological age (psychometric intelligence = 90, visuospatial intelligence, T
score = 44; nonverbal analogical reasoning ability, T score = 45, 25th percentile, confidence
interval of 85 - 94, 95% level of statistical significance). There were significant decrements in
working memory as well as semantic and episodic memory for visual and verbal items, as
well as prospective and incidental memory. There were also marked decrements in executive
functions (cognitive self-monitoring, mental flexibility, initiation and response inhibition) and
the ability to retain and process multiple items in working memory (e.g., forms, colors, letters,
and numbers) as well as use this information flexibly and in an organized fashion in problemsolving. There were extensive decrements on tasks of immediate and delayed recall in the verbal
but not visual modality. Of the latter, constructional ability was only slightly below average
and verbal analogical reasoning abilities were intact. Verbal fluency, however, was below
average on tasks of lexical retrieval using initial letters of words and on retrieval of lexical
categories. On a task of narrative (i.e., episodic) memory, Allen had poor retention of stories,
both immediate and delayed, including the absence of important thematic content and individual
story components. There were also decrements in prospective (i.e., remembering to do
something in the future) and incidental memory (i.e., memory for non-target items).
Computational abilities (exact and approximate arithmetic) appeared intact. Fine motor skills
(i.e., ability to manipulate objects skillfully) were within the average range of normal variation
for his chronological age but not gross motor behaviors (i.e., masterful coordination of whole
body movements), which appeared to be below the normal range of variation for his
chronological age given that he has experienced vertigo on standing and self-reported problems
in self-ambulating.
DIAGNOSIS:
Axis I:
294.9 Cognitive Disorder, NOS
Axis II: None
Axis IV: Occupational problems
CLINICAL RECOMMENDATIONS:
(1) Neurological consult and regular follow-ups.
Jerome Belson Health Care Center – Neuropsychological Evaluation
(2) Consultation with a physiatrist. Recommended Dr. XXXXXX particularly for
vestibular signs and motor issues.
(3) Cognitive rehabilitation to address decrements in working, semantic, lexical,
prospective, and incidental memory as well as decrements in episodic memory.
________________________
Jay A. Seitz, Ph.D.
Neuropsychologist
License in NYS for the professional practice of psychology
5