Clinical neuropsychologists assess and treat the cognitive and emotional needs of patients suffering from neurological disorders or conditions such as Alzheimer’s disease, brain injury, or brain tumors.
Elana Farace, Ph.D. joined Penn State Hershey Neurosurgery to assess neurocognitive functioning of patients and to focus on outcomes research in neurosurgical patients.
“As a neuropsychologist, Dr. Farace can critically assess changes in patients’ memory, attention, language, and other functions that help determine the course of treatment and rehabilitation,” said Robert Harbaugh, M.D., F.A.C.S., F.A.H.A., Chair, Penn State Hershey Neurosurgery. “In addition, Dr. Farace brings internationally recognized clinical neuroscience research expertise regarding quality of life issues in patients with neurosurgical disease.”
Neuropsychological assessments help patients and physicians in multiple ways, including:
- Pinpointing mild or subtle neurocognitive deficit;
- Predicting the course of a disease and recovery rate;
- Assisting in determinations about a patient’s return to school or work, and;
- Helping patients and their families understand the effects of the disease process, including coping techniques, which may aid in diagnosis.
Dr. Farace earned her M.A. and Ph.D. in psychology and completed a fellowship in neuropsychology at the University of Virginia.
To schedule a visit, please call 717-531-3828 or Toll-Free 800-243-1455.
What conditions typically prompt the need for a neuropsychological evaluation?
A neuropsychological evaluation is recommended for any case in which brain-based impairment in cognitive function or behavior is suspected. Typical referrals are made to diagnose or rule out the following neurological conditions, and to describe their impact on a person's functioning:
- Traumatic brain injury
- Stroke or other neurovascular problems
- Brain tumors
- Dementia conditions (such as Alzheimer’s disease)
- Parkinson’s disease and other movement disorders
- Attention deficit disorders or other developmental learning disabilities
- Seizure disorders (such epilepsy)
- Multiple sclerosis
- Central nervous system infection
- Effects of toxic chemicals or chronic substance abuse
- Psychiatric or neuropsychiatric disorders
When should someone seek neuropsychological care?
A neuropsychological evaluation may be indicated when an individual displays difficulties or changes in thinking, memory, speech, personality, or other behaviors that are significant enough to interfere with normal daily routines. An individual's impairment or symptoms may be mild to severe.
If patients are planning to undergo neurosurgical procedures, neuropsychological evaluations can be useful to screen for any impairment and to serve as a baseline to help interpret any possible change after the procedure. For conditions in which patients are expected to decline over time, including those with Alzheimer's disease and some brain tumors, a baseline evaluation may be needed to help with interpreting possible changes shown in future evaluations.
Neuropsychological evaluations are useful for tracking progress in rehabilitation.
Neuropsychological evaluations can assist greatly in planning educational and vocational programs.
They can also be invaluable for disability determination or forensic (legal) purposes.
The types of behaviors that may be evaluated include:
- Memory loss (such as forgetting conversations or forgetting names of people you should know, and losing articles around the house)
- Attention and concentration problems (such as difficulty focusing on a task and being easily distractible)
- Difficulty organizing and planning (such as knowing how to do the parts of a task but not being able to accomplish it, having difficulty with flexibility of thinking, and changing plans)
- Difficulty with multitasking (such as no longer being able to do several things at once, including listening to someone speaking to you in person while talking on the phone)
- Difficulty communicating (such as having trouble coming up with the name of a common object, decreased fluency in speech, and using the wrong words)
- Changes in spatial skills or vision (such as not being able to make sense of maps or drawings, having trouble picturing an object as you put it together, and having difficulty making sense of what you see as you drive)
- Difficulty writing or reading (such as not being able to read as well as you could in the past and not being able to read what you have written)
- Disturbed thinking or confusion (such as thinking illogical thoughts, forgetting or not recognizing where you are, and not remembering what day or time it is)
- Increased impulsivity (such as saying things you wouldn't normally say and noticeable changes in patience)
What can be learned from a neuropsychological assessment?
Neuropsychologists assess patients in systematic ways to measure the extent and nature of any behavioral changes due to disease or injury. These assessments help determine the root causes and possible treatments for problems with memory, intellectual and cognitive functioning, daily activities, behaviors, and emotions.
Neuropsychological assessment is helpful in pinpointing the neurological and psychiatric factors in a patient's problems, and in determining the patient's psychological and behavioral strengths and weaknesses related to neurological dysfunction. Information is provided that can contribute to decisions about the patient's:
- Differential diagnosis (distinguishing between different conditions that have similar symptoms)
- Prognosis (how much will the patient improve or decline over time?)
- Rehabilitation potential (will the patient benefit from a referral to rehabilitation services?)
- Ability to return to work or school or playing field (what changes need to be made to get the patient back to work or school or playing sports?)
- Ability to function independently (how can we maximize the patient's independence?)
- Need for specialized school services (does the student need referrals to special education, or adaptations such as unlimited time on tests?)
- Ability to drive
- Forensic issues (is the patient legally competent?)
- Other questions about patient functioning
What is a neuropsychological evaluation?
A neuropsychological evaluation is a comprehensive assessment of cognitive and behavioral functions using a set of standardized tests and procedures. Various mental functions are systematically tested, including, but not limited to:
- Problem solving and conceptualization
- Planning and organization
- Attention, memory, and learning
- Academic skills
- Perceptual and motor abilities
- Emotions, behavior, and personality
Who is qualified to conduct a neuropsychological evaluation?
A neuropsychological evaluation can only be done by a psychologist who has special training and experience in the field, which can include:
- Pre-doctoral training in psychology and neuropsychology
- Ph.D. in psychology with clinical training
- Formal postdoctoral training focusing on brain-behavior relationships and neuropsychological assessment
- Professional board (such as the American Board for Clinical Physiology and the American Board for Psychiatry and Neurology) recognition in the specialized techniques of neuropsychological assessment and interpretation
Are all neuropsychological evaluations the same?
No. A neuropsychological evaluation is not a fixed series of tests that anyone can give.
Specialized training allows the neuropsychologist to select, administer, and interpret the particular tests and procedures that will yield the most comprehensive understanding of an individual's strengths and weaknesses. Each neuropsychological examination is tailored to the needs and history of the individual patient.
What is it like to complete a neuropsychological evaluation?
A neuropsychological evaluation is a way of looking at many different kinds of abilities such as problem solving, attention, memory, language, and motor skills. This involves several different pencil and paper tests and may include some computer-administered tests.
Generally, a neuropsychological evaluation involves a wide variety of tasks, most of them completed while the patient is sitting at a table in the clinic or sitting in bed at the hospital.
Many people find these tests interesting. There are no invasive procedures, pain, needles, or electrodes. The evaluation often takes one to three hours of face-to-face contact, including an interview and the testing, but can vary widely depending on what information is being sought. The testing is broken up into several shorter tasks, so there are plenty of opportunities to stop or take a break if you wish.
The evaluation can be scheduled in a single appointment or in a series of appointments.
What should I do to prepare for the evaluation?
You do not need to study for the evaluation, as there are no right or wrong answers, it is just important to do your best.
It is helpful to get a good night's sleep and to eat a good meal beforehand, so that factors such as fatigue and hunger do not complicate the testing.
Make sure to bring your eyeglasses because you may be asked to read and write in some tasks.
We ask that patients discuss the use of any medicines or other substances that might alter their functioning (such as sleeping pills, anti-anxiety drugs, etc.) with us and with their physician to make sure that they are tested under the best conditions possible.
How are the test results used?
That depends on the reason for the evaluation. Neuropsychological evaluations may:
- Confirm or clarify a diagnosis
- Provide a profile of strengths and weaknesses to guide rehabilitation, educational, vocational, or other services
- Document changes in functioning since prior examinations, including effects of treatment
- Clarify what compensatory strategies ("work-around solutions") would help
- Result in referrals to other specialists such as educational therapists, cognitive rehabilitation professionals, neurologists, psychiatrists, psychologists, social workers, nurses, special education teachers, and vocational counselors
How can I determine whether I would benefit from neuropsychological assessment?
Talk with your doctor. Discuss your concerns. Your doctor will be able to help you know whether a neuropsychological referral is appropriate to help you. Your doctor's office can contact ours to set up the appointment, or you can call directly.
How do I find a neuropsychologist?
- Elana Farace, Ph.D.
Penn State Hershey Neurosurgery
P.O. Box 850, MC H110
Hershey, PA 17033-0850