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When a Neuropsychologist Becomes Part of Movement Disorders Assessment

August 02, 2021

Trouble walking or controlling muscle tremors are familiar signs of movement disorders like Parkinson’s disease, but a host of cognitive reactions to the disease can also require attention. Patients at the Chase Family Movement Disorders Center, part of the Hartford HealthCare Ayer Neuroscience Institute, find support for movement disorders symptoms with the addition of one or two neuropsychologists embedded in the care team at each location. “Neuropsychologists assess cognition and brain function – such as attention, language skills and memory – and also the patient’s mood,” said Dr. Ginger Mills, a Movement Disorders Center neuropsychologist. Patients are referred for a neuropsychological assessment if they or their provider feel cognitive changes need to be addressed, either those due to the movement disorder, normal aging or even a behavioral health concern such as depression or anxiety, she said. The three-hour assessments consist of:

  • A thorough clinical interview to “get a good sense of the patient’s history,” Dr. Mills noted. “That way, whatever data we get, we can put it into context. For example, if the patient reports having attention issues, and tells us they were diagnosed with attention-deficit/hyperactivity disorder as a child, we know it’s not necessarily a change related to the movement disorder. This helps us understand the person as a whole.”
  • Cognitive testing using a variety of mental exercises and standardized measurements that examine the domains of cognition – attention, memory and language. Tests can ask the patient to look at a puzzle with one missing piece and choose the final piece from a list of choices, or recall a list of items given a few minutes earlier. “These tests are designed to see how far the brain can go,” Dr. Mills said. “We then analyze the patient’s performance, and write up a comprehensive report detailing weaknesses and strengths. We include recommendations on how the patient and care team can build on the strengths and use them as a means to facilitate treatment.”
It’s a job that’s part sleuth – the neuropsychologists dig into the patient’s health and lifestyle to uncover causes of things like forgetfulness – and part bridge-builder in that they are often the way patients connect to other members of the care team for behavioral health care or other services. “We pool information from different sources, like an MRI report from the patient’s neurologist, and help provide information on how the brain functions on a day to day basis,” Dr. Mills said. “We’re a nice intersection between behavioral health and neurology, assessing information about the brain but also communicating to other team members what might need to be addressed, like depression.” Because they are tailored to the patient, assessments can also provide key information on the person’s ability to drive or return to work, or help manage medications. Repeat assessments can show if brain function is changing over time. Patients are referred for neuropsychological assessments by their neurologist or other medical provider.