LECTURE 1: INTRODUCTION AND BRAIN DAMAGE
AS A FAMILY AFFAIR
The Profession of a Clinical Neuropsychologist:
1. Clinical NP => a specialty within professional psychology that
applies principles of assessment and intervention based upon the
scientific study of human behavior as it relates to normal and
abnormal functioning of the CNS
- Within healthcare => clinical NPs are professionals who offer
services to benefit patients with cognitive and behavioral
symptoms related to neurological, developmental, and
psychiatric disorders
- Impact of all disorders afflicting the nervous system =>
considerable both globally and in Europe
2. European Brain Council:
- Total European costs of brain disorders (psychiatric and
neurological) in 2010 => 790 billion euros
37% direct healthcare costs
23% direct non-medical costs
40% indirect costs
Cost Effectiveness:
1. Domains to be tested during a clinical NP examination:
- Processing speed, attention, memory and learning, EFs, visuo-
spatial skills, speech and language functions, perceptual skills,
psychomotor speed and coordination of simple motor responses,
emotional and motivational characteristics, social functioning and
social cognition, self-awareness of level of functioning and
judgements regarding psychosocial implications
2. Administration of NP tests, scoring, interpretation, and report of test
results => time consuming
- Brief assessments => take approx. 2hrs
, - Extensive assessments => take approx. 8-10hrs (without
scoring, interpretation and reporting)
- Consequently => NP examinations are expensive
NP examinations => may need justification (in particular in
times of financial crisis)
3. Costs of clinical NP examinations include:
- Costs => direct and indirect costs
- Charges => costs charged for the services
Charges => never reflect actual fees received
- Fees => amount actually paid
Considerably lower than the charges
4. Additional sources of revenue:
- Boost of revenue by medicolegal cases
- Involvement of clinical NPs in research (= support by grants)
Requires additional effort and time by/of clinical NPs:
Obtaining funds, publishing, conference participation
Markers of Value:
1. Refers to money equivalent (e.g., cost saving) of the service
received
2. Comparison between costs of assessment and treatment with
money saved by avoiding other healthcare costs and by returning
an individual to work and social responsibility
3. Objective Markers:
- Reduce costs and liability:
Example:
Young man suffers TBI in accident
Assessment => shows that extent and nature of
impairments reduce man’s capacity to maintain line of
work for which he was trained
Consequently => a lot of dollars lost as result of
brain injury
, NP assessment consequences of accident
documented => capture most of man’s los
income via litigation; reduction of costs for society
by NP medicolegal assessment
Example:
Savings associated with identification of malingerers:
Malingering => intentional production of false or
grossly exaggerated physical or psych symptoms,
motivated by external incentives
Costs due to => unnecessary medical treatment,
trial defense costs, etc.
Example:
Savings associated with differential diagnosis on basis of
NP assessments => e.g., dementia vs depression
Psychiatric treatment available for depression =>
may result in productive lifestyle of patients
If NP findings indicate early dementia => patients
and families can plan for patient’s early significant
decline in cognitive and behavioral functioning
- Improve QoL:
- Assess Effectiveness of Treatment:
Pharmacological treatment, neurosurgery, neurofeedback,
cognitive trainings, etc.
- Guide Treatment Procedures:
E.g., => NP findings contribute significantly to decision
whether patients undergo epilepsy surgery
- Prevent the Use of More Expensive/Additional Diagnostic Tools:
E.g., => NP findings can better predict the diagnosis of AD
than other techniques
- Provide a Continuum of Care for Patients:
Clinical NPs => consult with patients and their families
about the patient’s deficits
, Prepares them to deal with intermediate and long-term
consequences of patient brain dysfunctions
- Improve Physician Education and Decision Making:
E.g., => patients and their families may suffer from pain,
stress, and economic burden when patients return
prematurely to work
3. Subjective Markers:
- Reduce Patient Sense of Psychological Aloneness with Daily
Problems:
E.g., => relief of a patient with brain tumor (“I am not
mad”) when describing an association between deficits and
tumor location
- Reduce Patient Expectations, Confusion and Frustration About
Nature of Their Disturbances:
Patients and families often have unrealistic expectations or
wrong understanding about deficits and their development
- Help Family Members Feel Less Guilty in Making Decisions
Regarding Brain-Dysfunctional Adults and Children:
Many families struggle with the issue of placing a loved-one
in a residential/nursing home
In children => often considerable relief when parents learn
that problems (e.g., ADHD) are not consequence of ‘poor’
parenting or psychodynamic processes
E.g., => feelings of guilt and self-reproach of father who
slapped daughter in face and who got a brain tumor
diagnosed 10 days later
4. Further savings by NP treatment:
- Cost-effectiveness of NP rehabilitation:
Consumption of healthcare => brings benefits that are
both direct (i.e., in the form of freedom from illness,
suffering, and distress) and indirect as a kind of investment
that yields other benefits (e.g., income generations and
occupational opportunities)
AS A FAMILY AFFAIR
The Profession of a Clinical Neuropsychologist:
1. Clinical NP => a specialty within professional psychology that
applies principles of assessment and intervention based upon the
scientific study of human behavior as it relates to normal and
abnormal functioning of the CNS
- Within healthcare => clinical NPs are professionals who offer
services to benefit patients with cognitive and behavioral
symptoms related to neurological, developmental, and
psychiatric disorders
- Impact of all disorders afflicting the nervous system =>
considerable both globally and in Europe
2. European Brain Council:
- Total European costs of brain disorders (psychiatric and
neurological) in 2010 => 790 billion euros
37% direct healthcare costs
23% direct non-medical costs
40% indirect costs
Cost Effectiveness:
1. Domains to be tested during a clinical NP examination:
- Processing speed, attention, memory and learning, EFs, visuo-
spatial skills, speech and language functions, perceptual skills,
psychomotor speed and coordination of simple motor responses,
emotional and motivational characteristics, social functioning and
social cognition, self-awareness of level of functioning and
judgements regarding psychosocial implications
2. Administration of NP tests, scoring, interpretation, and report of test
results => time consuming
- Brief assessments => take approx. 2hrs
, - Extensive assessments => take approx. 8-10hrs (without
scoring, interpretation and reporting)
- Consequently => NP examinations are expensive
NP examinations => may need justification (in particular in
times of financial crisis)
3. Costs of clinical NP examinations include:
- Costs => direct and indirect costs
- Charges => costs charged for the services
Charges => never reflect actual fees received
- Fees => amount actually paid
Considerably lower than the charges
4. Additional sources of revenue:
- Boost of revenue by medicolegal cases
- Involvement of clinical NPs in research (= support by grants)
Requires additional effort and time by/of clinical NPs:
Obtaining funds, publishing, conference participation
Markers of Value:
1. Refers to money equivalent (e.g., cost saving) of the service
received
2. Comparison between costs of assessment and treatment with
money saved by avoiding other healthcare costs and by returning
an individual to work and social responsibility
3. Objective Markers:
- Reduce costs and liability:
Example:
Young man suffers TBI in accident
Assessment => shows that extent and nature of
impairments reduce man’s capacity to maintain line of
work for which he was trained
Consequently => a lot of dollars lost as result of
brain injury
, NP assessment consequences of accident
documented => capture most of man’s los
income via litigation; reduction of costs for society
by NP medicolegal assessment
Example:
Savings associated with identification of malingerers:
Malingering => intentional production of false or
grossly exaggerated physical or psych symptoms,
motivated by external incentives
Costs due to => unnecessary medical treatment,
trial defense costs, etc.
Example:
Savings associated with differential diagnosis on basis of
NP assessments => e.g., dementia vs depression
Psychiatric treatment available for depression =>
may result in productive lifestyle of patients
If NP findings indicate early dementia => patients
and families can plan for patient’s early significant
decline in cognitive and behavioral functioning
- Improve QoL:
- Assess Effectiveness of Treatment:
Pharmacological treatment, neurosurgery, neurofeedback,
cognitive trainings, etc.
- Guide Treatment Procedures:
E.g., => NP findings contribute significantly to decision
whether patients undergo epilepsy surgery
- Prevent the Use of More Expensive/Additional Diagnostic Tools:
E.g., => NP findings can better predict the diagnosis of AD
than other techniques
- Provide a Continuum of Care for Patients:
Clinical NPs => consult with patients and their families
about the patient’s deficits
, Prepares them to deal with intermediate and long-term
consequences of patient brain dysfunctions
- Improve Physician Education and Decision Making:
E.g., => patients and their families may suffer from pain,
stress, and economic burden when patients return
prematurely to work
3. Subjective Markers:
- Reduce Patient Sense of Psychological Aloneness with Daily
Problems:
E.g., => relief of a patient with brain tumor (“I am not
mad”) when describing an association between deficits and
tumor location
- Reduce Patient Expectations, Confusion and Frustration About
Nature of Their Disturbances:
Patients and families often have unrealistic expectations or
wrong understanding about deficits and their development
- Help Family Members Feel Less Guilty in Making Decisions
Regarding Brain-Dysfunctional Adults and Children:
Many families struggle with the issue of placing a loved-one
in a residential/nursing home
In children => often considerable relief when parents learn
that problems (e.g., ADHD) are not consequence of ‘poor’
parenting or psychodynamic processes
E.g., => feelings of guilt and self-reproach of father who
slapped daughter in face and who got a brain tumor
diagnosed 10 days later
4. Further savings by NP treatment:
- Cost-effectiveness of NP rehabilitation:
Consumption of healthcare => brings benefits that are
both direct (i.e., in the form of freedom from illness,
suffering, and distress) and indirect as a kind of investment
that yields other benefits (e.g., income generations and
occupational opportunities)
