The Department of Neuropsychology at Neuro Foundation is well organised and being managed by full time senior consultants with more than 10 years of experience with wide variety of neuropsychological diseases.
The Neuropsychology Service provides comprehensive assessment services for child, teenage, adult, and geriatric patients in whom impairments of cognitive, neuropsychiatric, or developmental functioning are evident or suspected. Our services include outpatient evaluation and inpatient consultation services.
Neuropsychological assessment involves a systematic evaluation of higher cognitive abilities such as intelligence, academic skill, memory, language, attention, problem solving ability, executive abilities and visual motor skills, as well as sensory/motor and personality/emotional functioning.
We also provide specialty Clinic services:
Adult Neuropsychology Clinic
Focuses on comprehensive evaluations for teenagers and adults. Referral questions focus on clarifying cognitive and psychological functioning, as well as assisting with differential diagnosis and treatment planning in adults with known or suspected brain dysfunction.
Pediatric Neuropsychology Clinic
Focuses on the comprehensive assessment of infants, children, adolescents, and young adults with a wide range of medical, neurodevelopmental, genetic, psychiatric, and learning disorders. Evaluation and treatment planning emphasize the integration of neurocognitive, social, emotional, and behavioral aspects of these disorders to help families better understand and manage complex presentations.
Adolescent Mood Disorders Clinic
Memory and Aging Clinic
Multiple Sclerosis Clinic
The Neuropsychology Service and Clinics can provide assessment and treatment recommendations for a wide range of conditions that may affect cognition and/ or behavior, including
An awake craniotomy is an operation performed in the same manner as a conventional craniotomy but with the patient awake during the procedure.
Neuropsychology provides comprehensive assessment for patients being considered for awake craniotomy including assessing suitability for awake neurosurgical procedures, pre-operative fMRI (Magnetic Resonance Imaging), baseline cognitive assessment, preparation of patients for awake neurosurgery and functional assessment in theatre as part of the intra-operative functional mapping assessment.
The service accepts patients with any type of tumour affecting the brain. This includes pituitary tumours and neurofibromatomas.
This involves referrals by Neurology Consultants where neuropsychological assessment is a component of making a neurological diagnosis.
A clinical neuropsychologist is attached to each of the Neuro Foundation Community neurorehabilitation Team.
The well-established epilepsy surgery programme at our Hospital comprises a multidisciplinary group of health care professionals who specialise in investigation and treatment of epilepsy.
This covers a wide range of patients who have a neurological condition that does not fall within the remit of established and more specialised neuroscience centre based neuropsychology services.
Inpatient referrals are accepted from any neuroscience ward within Salford Royal Hospital and from any health professional involved in the care of the patient.
Surgery for movement disorders including Parkinson's disease, tremor, and dystonia. Although medications are the mainstay of therapy for movement disorders, neurosurgery has played an important role in their management for the past 50 years. Surgery is now a viable and safe option for patients with medically intractable Parkinson's disease, essential tremor, and dystonia.
The Clinical Neuropsychology Service in our Wards, the Stroke Rehabilitation Unit and the Trauma Assessment Unit provides support to patients who are in the early stages of recovery following traumatic brain injury, Stroke, neurosurgery or neurology treatment.
The well-established Non-Epileptic Attack Disorder (NEAD) Service at Salford Royal Hospital offers assessment and therapy for patients who are experiencing attacks (seizure like events) that are psychologically triggered.
Subarachnoid hemorrhage is sudden bleeding into the subarachnoid space. The most common cause of spontaneous bleeding is a ruptured aneurysm. Symptoms include sudden, severe headache, usually with loss or impairment of consciousness.
Traumatic Brain Injury (TBI) is any injury that affected the brain and was caused by a trauma, that is, by a physical force (e.g. a fall, road traffic accident, or assault).
Video Telemetry is an assessment used to further investigate conditions such as epilepsy and non-epileptic attack disorder.
Neuropsychological evaluations provide detailed information about an individual’s functioning across multiple domains that can help guide recommendations and strategies to improve functioning at home, at work, in school, and in the community.
Often, an evaluation is requested by a physician or specialist to help localize possible areas of brain damage or dysfunction and/or to clarify a differential diagnosis. An evaluation also might be requested to help monitor for any changes in cognitive abilities, behaviors, and emotional functioning over time. The information obtained from the evaluation can provide important information and recommendations to the client and family members, as well as to doctors, therapists, or other specialists working with the individual.
Key areas examined in a neuropsychological evaluation often include:
Individuals who have known or suspected brain dysfunction. Often individuals who have experienced cognitive changes in the context of a traumatic brain injury, neurodegenerative disorders, or other medical conditions that affect neurologic functioning can benefit from a neuropsychological evaluation. Similarly, those with long-standing cognitive issues since childhood or complex psychiatric histories involving mood, anxiety, trauma, or other mental health concerns often seek out neuropsychological evaluations to rule out other causes of their cognitive/behavioral symptoms to target more effective treatments and intervention strategies.
In some cases, individuals have experienced challenges that have been difficult to sort out since childhood. It is not uncommon, for example, to meet with clients who have consulted with many doctors, specialists, therapists, and/or school personnel over the years and still not have a clear understanding of their issues. Neuropsychologists synthesize information from a variety of sources, including cognitive/behavioral test data, structured assessment of social and emotional functioning, as well as collateral report from family members, teachers, or others who know the client well to help provide some clarity and guidance around these issues.
Common reasons why a student might seek out a neuropsychological evaluation often include any combination of these concerns:
Those who are frustrated by sub-optimal school performance often seek out a comprehensive neuropsychological evaluation to (a) help clarify the cause(s) of their difficulties and (b) to obtain recommendations for academic accommodations when indicated. Assessment of academic skills (e.g., reading, writing, arithmetic) certainly is useful (and necessary) information, but it often is insufficient. There are any number of reasons why one might struggle in school. Sometimes an underlying reading disorder (e.g., dyslexia) represents the root cause of the difficulty. For others, their school problems might be circumscribed to math or there might be some issue related to poor motor control/speed or dysgraphia that interferes with academic success. Some students struggle primarily with attentional or executive functioning weaknesses, suggestive of a primary attentional syndrome, such as ADD/ADHD. Still others may encounter complicating psychosocial factors or co-occurring psychiatric disorders that disrupt several areas of daily life, including school performance. Thus, it is critical to understand the “whole picture” as much as possible to characterize the reason(s) underlying these struggles so as to best target recommendations that foster greater academic success and improvements in overall daily functioning.
Yes. Neuropsychological assessments are appropriate for targeting specific learning disorders in reading, math, and writing, as well as identifying other sources of interference with learning and academics, such as Nonverbal Learning Disorders, Asperger’s disorder, psychiatric conditions, among many others.
A comprehensive neuropsychological evaluation is comprised of three separate appointments and is described in more detail here. Keep in mind each client is unique and designing an appropriate assessment will be individualized based on your needs and the questions you want answered. Broadly-speaking, however, a typical evaluation involves three appointment dates, including (1) a one-hour initial interview, (2) the testing appointment, which can last 2-6 hours, and (3) a one-hour feedback appointment to review the results and recommendations from the evaluation.
The evaluation involves a clinical interview that lasts about an hour with you and, when possible, a family member (or someone who knows you well). The interview is designed to understand your history and how the cognitive and emotional difficulties you have experienced have impacted your life and daily functioning.
On a separate date, you will then complete a number of computerized and paper/pencil tests that can last anywhere from between 2-6 hours. You will be tested alone in a quiet room. If you are accompanied by family members or friends, they will be asked to wait in the waiting room.
Once the evaluation is completed, the findings will be summarized in a written report that will be sent to your referring physician or specialist. In addition, you will be provided a copy of your report, which can either be picked up in person at the office, delivered to your home via standard mail, or emailed to you, based on your preference.
Attention-Deficit/Hyperactivity Disorder (ADHD)
ADHD (also sometimes referred to as “ADD”) is a developmental disorder characterized by symptoms of inattention and/or restlessness. These symptoms first emerge in childhood and result in substantial disruptions in daily functioning.
Neuropsychological evaluations can be very helpful in guiding ongoing treatment planning for individuals with suspected ADHD. First, ADHD is not a “one size fits all” diagnosis; individuals tend to differ markedly with respect to how—and in what situations—symptoms are expressed in daily life. Also, comprehensive neuropsychological assessments often can identify other conditions that might be mimicking the symptoms of ADHD, but require an entirely different treatment approach. Likewise, it is not uncommon for other conditions to co-occur with ADHD, effectively making an individual’s symptoms—and level of impairment—even worse. Thus, there is significant clinical value in neuropsychological assessment approaches to help target the most effective interventions and/or remediation strategies in individuals with suspected ADHD.
The term ‘dementia’ typically refers to chronic medical conditions that cause progressive declines in memory and other cognitive/behavioral skills. Alzheimer’s disease, for example, is the most common cause of progressive cognitive decline, accounting for more than two-thirds of all dementia cases. Still, there are many other medical conditions that can result in dementia, including, but not limited to:
Neuropsychological evaluations can be very helpful in terms of evaluating for possible dementia and ruling out other causes for an individual’s cognitive difficulties. First, it is important to consider that at least some cognitive declines are to be expected as we get older. Specialized neuropsychological assessments can help differentiate between what would be considered a normal, healthy aging process versus difficulties that are suggestive of something else going on that is more pronounced. Also, formal neuropsychological assessment can help discriminate between potential causes of difficulties an individual is experiencing and clarify a diagnosis that will inform potential treatments or supports. Finally, repeated assessments often are requested to monitor an individual’s functioning over time to determine the rate of decline, what areas are remaining stable, and hopefully, which areas have been responsive to treatment.
The core features of frontotemporal dementia (FTD) typically involve cognitive and behavioral changes that emerge from degeneration of the frontal and temporal lobes of the brain. Although the initial presentation and course can be quite variable, three main subtypes of FTD generally are recognized:
Given the variability in presentation seen in FTD and the fact that many of the initial clinical symptoms and behaviors overlap with other neurological and psychiatric syndromes, referrals for neuropsychological evaluation are commonly requested to clarify (or corroborate) an initial diagnosis, make recommendations for treatment planning, and provide a baseline assessment to monitor the course of progression.
Alzheimer’s disease (AD) is the most common degenerative disease of the brain. Inside the brain, the hallmark feature of AD is the aggregation of microscopic plaques and tangles in/around nerve cells that disrupt their functioning, ultimately leading to the widespread neuronal loss and brain atrophy. As the physical changes inside the brain evolve, individuals may experience gradual mental changes, often involving memory decline and forgetfulness as the most prominent initial symptom. As the memory problems become more pronounced, changes in other cognitive areas tend to emerge, such as declines in language or visuospatial functioning.
Although there is no cure for AD at present date, some treatments are available that may help slow down symptom progression. A neuropsychologist can contribute valuable information as part of an individual’s health care team to help clarify a diagnosis of AD, while considering other potential conditions that might be causing mental declines. In addition, a comprehensive neuropsychological evaluation can yield valuable information for the patient and treatment providers to monitor progression over time and guide personalized behavioral modifications and strategies that enhance the quality of life for those who are living with Alzheimer’s disease and their family members.
A concussion is mild traumatic brain injury (mTBI) caused by a direct blow to the head (or elsewhere in the body that generates abrupt movement of the brain inside the skull). Although concussions only infrequently result in loss of consciousness, it is not uncommon for individuals to experience a range of symptoms post-injury, including headache, dizziness, balance problems, nausea, fatigue, confusion, memory difficulties, mental “fogginess,” low attention span, sleep disturbance, increased anxiety, and/or depressed mood. Fortunately, rapid improvement of these symptoms should be expected within the first 3 days, and the vast majority of individuals (~85%) report complete resolution of symptoms within the first week following injury.
Still, there are rare occasions when symptoms can persist for weeks or longer after the initial injury. In these instances, formal neuropsychological testing should be obtained to characterize any objective cognitive deficits, screen for other contributing factors, and make personalized recommendations for ongoing management that support a patient’s recovery and resumption of normal daily activities (e.g., work, school, physical activities).
Parkinson’s disease is a progressive movement disorder caused by the death of cells in areas of the brain that control movement and coordination. The core symptoms of Parkinson’s disease include tremor, slowness in initiating and executing movements, muscle stiffness, and poor balance/unsteadiness. Some individuals with Parkinson’s disease also experience other neurobehavioral changes, including depression and cognitive alterations. A neuropsychologist can play an important role in evaluating these mood and/or cognitive changes over time to help guide possible directions for optimal treatment and management of Parkinson’s disease.
Vascular Cognitive Impairment /Vascular Dementia
Individuals with a history of high cholesterol, hypertension, obesity, atherosclerosis, and smoking are at increased risk for developing cerebrovascular disease and changes in the structure of blood vessels inside the brain. At one end of the continuum, vascular cognitive impairment can emerge from these risk factors and manifest in subtle cognitive problems with learning and memory, attention, and/or information processing. At the other end of the spectrum, more severe cognitive dysfunction may be present, suggestive of vascular dementia, which often can evolve out of a history of large vessel strokes, isolated cerebral infarctions affecting critical brain regions, cardiac arrest (and resulting depletion of blood supply to the brain), and/or widespread small-vessel disease. Neuropsychological evaluations can provide essential information to individuals, family members, and treatment providers who are seeking clarity in terms of diagnostic considerations. In addition, formal assessment will explore emotional factors and what supports and individual has to inform appropriate referrals for treatment and ongoing management. In addition, neuropsychological evaluations are necessary to accurately monitor for changes in cognitive and functional status over time.
M.Sc; M.Phil (Neuropsychology)
Senior Consultant Neuropsychologist