Neuropsychological testing for MS related cognitive changes

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People with Multiple Sclerosis (MS) sometimes notice that their thinking is not as clear as it once was. Older people sometimes have similar observations. Psychologists have compared these observations to those of younger people and found that when young people forget, they blame it on stress or distraction or too much going on at once. Older people almost always blame their age. Since MS has a reputation for disturbing brain functioning, it is easy to blame the disease for momentary lapses that more accurately may be attributed to distraction, inattention, or normal forgetfulness.  But many times a person with MS does experience cognitive changes. When there is a question about such cognitive changes, neuropsychological testing may be recommended.

Neuropsychological testing is a subcategory of psychological testing in general. Most people have had some form of psychological testing. Tests like the SATs, tests sometimes described as aptitude tests, tests of personality — all of these originally were prepared by psychologists in order to measure aspects of human behavior and experience. Such tests are very popular and have proliferated. Caricatures of these tests are frequently seen on Facebook and in other social media and are used for entertainment.  But for serious reasons and with serious research a large number of tests were constructed in order to measure cognitive difficulties — trouble with the speed, accuracy, and complexity of thought. These have been called neuropsychological tests.

Unlike some other areas of measurement, there is no single neuropsychological test that measures everything that the brain does. For this reason, psychologists who have studied neurological functioning and measurement, known as neuropsychologists, have collected a variety of tests that sample most aspects of human neurology.

These tests are combined and referred to as a battery of tests. Not all neuropsychologists use the same battery. Some psychologists prefer to use the same battery for every patient, reasoning that this will best describe the patient’s neurological status. Other psychologists prefer to select different measures from a large number, choosing these measures according to the specific question or according to how the patient has done on tests administered earlier in the evaluation.  

Regardless of the way any neuropsychologist approaches test selection, each is trying to do the same thing:  to describe the details of how a patient’s brain is functioning. In addition, the neuropsychologist may be seeking a description of deficits and, perhaps even reasons why these deficits exist.  

Equally important are the conclusions drawn and the recommendations made after understanding how a patient performs on various tests. Sometimes a neuropsychologist can be helpful in suggesting ways to compensate or cope with difficulties. Other times he or she can only describe what is going on and confirm the distressing suspicion that nothing can be done to improve it. Drawing conclusions and making recommendations may be helpful in focusing the efforts of the treatment team in a more uniform direction.

For example, I once referred an elderly woman for neuropsychological testing because she was not responding as fast as anticipated after a fall. The neuropsychologist was able to describe a number of subtle, though important, cognitive difficulties and indicated that she would never be able to achieve the level of independence the rest of the treatment team had expected. She also recommended that we send her out of the nursing home and back to her apartment as soon as possible, but to do so with some assistance at certain times of the day. In this way, she could have a better quality of life without facing pressure to perform better than she was able.

Neuropsychological testing may sound frightening or intimidating. Indeed, testing should be taken seriously. But it should be no scarier then any number of tests each of us has undertaken in high school or college. To prepare for these tests we were told to try to get a full night’s rest, eat a good breakfast with a normal amount of coffee or tea, and try to adhere to our normal routines as much as possible. As with some standardized tests, there is nothing that should be studied or practiced in advance. The tests are designed to reflect regular performance on a normal day, so the day should be as normal as possible.

Not everyone with cognitive difficulties will benefit from neuropsychological testing. The testing can be strenuous and, depending on insurance coverage, can be expensive. If someone is in a stable situation, and shifts in cognitive ability are not likely to make much difference in his or her life, knowing the details of the deficits may not be of great value.  But sometimes knowing the status of one’s mental functioning makes a big difference. When this is the case, neuropsychological testing can be extremely valuable.

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