http://metrowestneuropsych.com Standing For Excellence in Neuropsychology, Boston, MA and Metro West Boston Area. Thu, 05 Apr 2012 00:46:20 +0000 en hourly 1 http://wordpress.org/?v=3.3.2 Standing For Excellence in Neuropsychology, Boston, MA and Metro West Boston Area. Metrowest Neuropsychology no Metrowest Neuropsychology shari@metrobostonweb.com shari@metrobostonweb.com (Metrowest Neuropsychology) Copyright © Metrowest Neuropsychology 2012 Standing For Excellence in Neuropsychology, Boston, MA and Metro West Boston Area. http://metrowestneuropsych.com/wp-content/uploads/powerpress/podcast-mini2.png http://metrowestneuropsych.com http://metrowestneuropsych.com/living-alone-with-dementia/ http://metrowestneuropsych.com/living-alone-with-dementia/#comments Fri, 23 Mar 2012 13:55:15 +0000 Shari http://metrowestneuropsych.com/?p=1089 http://metrowestneuropsych.com/living-alone-with-dementia/feed/ 0 http://metrowestneuropsych.com/competency-evaluations-in-older-adults/ http://metrowestneuropsych.com/competency-evaluations-in-older-adults/#comments Mon, 19 Mar 2012 15:10:20 +0000 Shari http://metrowestneuropsych.com/?p=1087 http://metrowestneuropsych.com/competency-evaluations-in-older-adults/feed/ 0 http://metrowestneuropsych.com/attention-and-productivity/ http://metrowestneuropsych.com/attention-and-productivity/#comments Tue, 06 Mar 2012 19:10:23 +0000 Shari http://metrowestneuropsych.com/?p=1070 http://metrowestneuropsych.com/attention-and-productivity/feed/ 0 http://metrowestneuropsych.com/appointment/ http://metrowestneuropsych.com/appointment/#comments Wed, 03 Aug 2011 23:55:29 +0000 Leslie http://metrowestneuropsych.com/psychological_testing/?p=743 http://metrowestneuropsych.com/appointment/feed/ 0 http://metrowestneuropsych.com/intelligence-testing/ http://metrowestneuropsych.com/intelligence-testing/#comments Wed, 03 Aug 2011 16:42:04 +0000 Leslie http://metrowestneuropsych.com/psychological_testing/?p=730 http://metrowestneuropsych.com/intelligence-testing/feed/ 0 http://metrowestneuropsych.com/mental_health_guide_neuropsychology_report/ http://metrowestneuropsych.com/mental_health_guide_neuropsychology_report/#comments Fri, 17 Jun 2011 18:14:22 +0000 Dr. Jeff Gaines http://metrowestneuropsych.com/psychological_testing/?p=629 http://metrowestneuropsych.com/mental_health_guide_neuropsychology_report/feed/ 0 Family members,Family Resources,Informational Guides Help for clients, family members and teachers. A guide of what to expect from mental health reports. Help for clients, family members and teachers. A guide of what to expect from mental health reports. Metrowest Neuropsychology no 10:56 http://metrowestneuropsych.com/dementia-early-detection-and-treatment/ http://metrowestneuropsych.com/dementia-early-detection-and-treatment/#comments Fri, 11 Feb 2011 21:32:16 +0000 Dr. Jeff Gaines http://metrowestneuropsych.com/psychological_testing/?p=526 http://metrowestneuropsych.com/dementia-early-detection-and-treatment/feed/ 0 Dementia Hi, this is Dr. Jeff Gaines, and welcome to this blog post on dementia. - Dementia is a condition directly affecting about 3 – 4 million Americans today, especially those 70 years and older. - In neuropsychological terms, Hi, this is Dr. Jeff Gaines, and welcome to this blog post on dementia. Dementia is a condition directly affecting about 3 – 4 million Americans today, especially those 70 years and older. In neuropsychological terms, dementia is a condition involving significant difficulty with memory, plus  deficits in at least one other area of mental ability (for example, in expressive language), along with a decline in daily functioning (such as a decline in performance at work). It is important to understand that dementia is a not a singular disease, but a syndrome – a cluster of symptoms that can be caused by any number of disease processes. There are several basic types of dementia, caused by different diseases affecting the brain. One of the goals of a neuropsychological evaluation for dementia is to determine which disease process, if any, is involved - so appropriate treatments can be developed. Importantly, some cases of dementia are essentially preventable – such as certain early cases of Vascular Dementia (when this is caused by an accumulation of small, often “silent” or unnoticed strokes in the brain). Such cases can be prevented, if the individual takes proper long-term vascular health precautions – for example, low-fat diet; regular exercise; consistent use of blood pressure and anti-cholesterol medications; etc. Other forms of dementia are reversible – for example, a dementia caused by severe depression. If the depression is properly treated, dementia can resolve, with one’s memory and other mental faculties returning to a more normal state. Most forms of dementia – including dementia of the Alzheimer’s type, Lewy Body Dementia, Fronto- temporal dementia, Parkinson’s dementia, etc. – are progressive.  The process cannot be reversed, by any current treatments.  However, early detection and treatment planning can certainly help with management of symptoms, and to ensure a higher quality of life for clients and their families.  Neuropsychological testing is a powerful tool for early detection of a dementing process, and for continued guidance in treating dementia. A thorough evaluation by a properly trained neuropsychologist will help to determine the individual client’s pattern of mental strengths and limitations.  It will also help determine whether the client meets criteria for dementia, if so what type of dementia is likely present.  Finally, such an evaluation can help decide which treatments/supports will be most effective in enhancing a client’s quality of life. A neuropsychological evaluation for dementia involves measurement of each key cognitive domain – including an estimate of basic intelligence; orientation to time, place and person; fine motor speed and dexterity; language comprehension and expression; verbal and visual-spatial memory; and measures of executive or frontal lobe function, including sustained and divided attention; rapid task sequencing; plus conceptual reasoning and mental flexibility. In addition, a comprehensive neuropsychological evaluation for dementia should include at least basic measures of mood and personality/behavioral function, through self- and observer-based forms.  These forms are key in assessing for depressive symptoms, anxiety, and other psychiatric concerns (like general agitation, disinhibited or impulsive behavior, etc.) that can accompany dementia. Assessment of mood and especially depressive symptoms is particularly important in dementia.  It is critical to know to whether symptoms such as sadness, lack of interest in daily activities, anxiety, etc. are contributing to cognitive deficits.  In some cases, depressive symptoms are the main contributor to memory problems.  In such cases, as already noted, treatment of the depressive symptoms can improve thinking and memory, to within normal range.  On the other hand, if depression has been ruled out as the main factor in thinking or memory deficits, Metrowest Neuropsychology no 7:21 http://metrowestneuropsych.com/dyslexia_symptoms_solutions/ http://metrowestneuropsych.com/dyslexia_symptoms_solutions/#comments Thu, 27 Jan 2011 23:56:57 +0000 Dr. Jeff Gaines http://metrowestneuropsych.com/wordpress/?p=438 http://metrowestneuropsych.com/dyslexia_symptoms_solutions/feed/ 0 Dyslexia 1.     Dyslexia defined - Dyslexia means difficulty reading, at one or more levels.  It is considered a developmental brain-based disability, but it can be overcome – the brain can re-organize, and learn to read well.  In dyslexia, 1.     Dyslexia defined Dyslexia means difficulty reading, at one or more levels.  It is considered a developmental brain-based disability, but it can be overcome – the brain can re-organize, and learn to read well.  In dyslexia, the individual might have most difficulty with what is called decoding, or determining which written letters or syllables correspond to which sounds.  The individual with dyslexia might instead have most difficulty with reading comprehension (encoding the basic points from a passage read, determining the main ideas or themes in a chapter, making inferences based on what one reads, etc.).  Often, these problems go hand in hand.  If you cannot efficiently decode (recognize and pronounce) written words, you will usually have corresponding difficulty understanding the main points, overall themes, or “big picture” messages in what you are reading.  Dyslexia is often  accompanied by other verbally-based difficulties - with auditory attention, spelling and written expression, etc. 2.     Testing symptoms for dyslexia Neuropsychological testing for dyslexia typically involves IQ measures (to investigate the individual’s basic ability level, for such core skills as vocabulary, verbal reasoning, visual-spatial reasoning, attention, visual scanning and speed of information processing).  It also involves academic measures (to investigate academic achievement to date in basic decoding, reading speed, reading comprehension, spelling, written math skills, etc.).  Further, neuropsychological testing for dyslexia should include measures of working memory (or ability to hold information in mind, while using it); verbal and visual-spatial memory; the ability to perform rapid action sequences; plus concept formation, mental flexibility, ability to use feedback, etc.  Such comprehensive testing allows the neuropsychologist to determine whether dyslexia is the most appropriate diagnosis, and if so which verbal learning difficulties are most prominent in a given individual, so that effective treatments can be developed. 3.     Dyslexia Solutions, and accommodations Treatments for dyslexia include formal reading programs such as Wilson, which helps students systematically develop basic sight reading and reading comprehension skills.  Accommodations for dyslexia in school or at work (for adults with dyslexia) include extra time to complete assignments with a strong reading and/or writing component; test instructions simplified, read aloud and repeated, as necessary; access to lecture notes and/or powerpoints beforehand, and for use in studying; quiet room for tests and other critical tasks; use of visual-spatial materials to support verbal learning, etc.  Metrowest Neuropsychology is preparing its own reading support service for persons with dyslexia, with the help of Dr. Robert Volpe (a specialist in ADHD and Learning Disabilities [including dyslexia] at Northeastern University in Boston, MA).   We will announce this reading support service for dyslexia symptoms and treatment when it becomes available for our clients (children, adolescents and adults) in the Boston-Metrowest area. In the meantime, here are some tips for managing basic reading difficulties (in letter/word identification, or decoding; and in reading comprehension): Read with large type text, when possible To help letters settle on the page, and visually track letters/words: consider use of colored reading rulers, or overlays Read in brief, manageable chunks, with frequent review of key passages Give yourself frequent refresher breaks while reading, to allow for processing of the information presented Read along with a book on tape or CD, to help with letter/word-to-sound correspondence Read books you find enjoyable and inspiring, to increase motivation for reading 4.     In conclusion, reading is truly fundamental, for so many academic subjects (including English, History, Science), for essentially all professions, Metrowest Neuropsychology no 5:55 http://metrowestneuropsych.com/traumatic_brain_injury_treatment/ http://metrowestneuropsych.com/traumatic_brain_injury_treatment/#comments Fri, 29 Oct 2010 00:32:26 +0000 Dr. Jeff Gaines http://metrowestneuropsych.com/wordpress/?p=268 http://metrowestneuropsych.com/traumatic_brain_injury_treatment/feed/ 0 TBI – Recovery and Safety TBI – Recovery and Safety TBI – Recovery and Safety Metrowest Neuropsychology no 10:14 http://metrowestneuropsych.com/adult_adhd_testing/ http://metrowestneuropsych.com/adult_adhd_testing/#comments Mon, 04 Oct 2010 20:40:08 +0000 Dr. Jeff Gaines http://metrowestneuropsych.com/wordpress/?p=224 http://metrowestneuropsych.com/adult_adhd_testing/feed/ 0 ADHD,Adult ADHD Hello All – - This blog post is about Adult ADHD: Testing and Treatment. - We’ll touch on testing and treatment approaches, with some advice at the end on how adults can manage their own ADHD. - Attention-Deficit/Hyperactivity Disorder - ADHD – is f... Hello All – This blog post is about Adult ADHD: Testing and Treatment. We’ll touch on testing and treatment approaches, with some advice at the end on how adults can manage their own ADHD. Attention-Deficit/Hyperactivity Disorder - ADHD – is found not only in children or adolescents, but often continues into adulthood, where it can change form – often times with less hyperactivity, but similar difficulties with inattention, disorganization, and added risks (for example, inattention becoming distracted driving, or impulsivity leading to substance abuse). Experts estimate that as many as 50% of children with ADHD continue to have some form of the diagnosis into adulthood. As we mentioned in our last blog post on ADHD, there are two sets of ADHD symptoms – inattentive, and hyperactive-impulsive.  These symptoms are found in varying degrees within the three basic subtypes of the disorder: ADHD Predominantly Inattentive Type (people having problems mostly with inattention), ADHD Predominantly Hyperactive-Impulsive Type (which is typically found only in young children), and ADHD Combined Type (problems with both inattention and hyperactivity-impulsivity).  This last, “combined” type is very common, including in adults.  These are the adults who often feel restless, even if they don’t outwardly fidget.  They can be impulsive, acting without thinking.  And of course, they typically have marked inattention and other cognitive symptoms – difficulty with focusing, remembering things, organizing and completing tasks, and long-range task planning. Studies have suggested that frontal brain circuits – those involved in focus, and self-control - are disrupted in ADHD.  Studies have also indicated that proper levels of norepinephrine and dopamine – chemicals regulating brain stimulation – are lacking in adults with ADHD.  However, as stated in the previous blog post, adults with ADHD should not be discouraged.  We also know from studies of the brain that it has a remarkable ability to make new connections, improve its circuitries, and actually change its own chemistry, by changing thought and behavior patterns. As with children, in our view, the first approach to managing Adult ADHD should be a formal evaluation. Evaluation should include a careful interview with the adult in question, and with those who know them best (such as family members, etc.). Evaluation should also include forms filled out by all key persons involved – self-report forms, and, when available, observer forms (usually filled out by family members).  These forms – for example the Achenbach behavioral forms, and Conners’ ADHD  forms – help clinicians rule out other major problems affecting attention in adults (such as Anxiety, or Depression).  If the person actually has primary ADHD, these forms also help specify which ADHD symptoms are of greatest concern. It is very important to specify which ADHD symptoms are most troublesome, for a particular adult.  Is there more trouble with simple focus, shifting focus or multi-tasking, planning or organizing tasks, finishing tasks, or restlessness interrupting attention?  Once we’ve answered these questions, we can develop the right recommendations for each adult.  As we’ve said before, careful evaluation gives us insight or knowledge, which in turn provides the best guidance for our adult clients. In our view, it is also helpful to do additional neuropsychological testing for Adult ADHD, wherein we measure a person’s actual attention, memory ability, etc.  Attention and memory patterns are  important.  Some adults focus and remember best when they do hands-on activities, where their eyes, ears and hands are working together.  Some focus and remember best with small chunks of information, frequently repeated.  Some are best able to focus on the first thing they are told, some on the last thing.  Some adults can recall average overall amounts of new information, Metrowest Neuropsychology no 13:54