Neuropsych Exam - What to expect?
 

I saw my doc yesterday. She restarted me on buspar to help with my noise related anxiety but while I was there I mentioned that I've noticed that I'm having concentration difficulties that I don't remember having pre head traumas. I find it incredibly difficult to focus on movies, books, tv shows, you name it. It's getting to the point where I'm avoiding those things because I know I'm never going to finish them (well the tv is usually on but it's just background noise).

Anyway so in talking to her about this she recommended I go through the exam. So now I have to call the place and talk to them about it. I need to call my insurance too, see if it's covered. But I figured I'd ask you fine folks what to expect. I know I've read about them here, I just can't remember what was said. How long did they take? What was involved? Did you get the results right then and there? Were yours covered by insurance? Anything else I might need to know?

Thanks!

Neuro Psych Assessments can vary widely in cost and time. Some NPA's are only a hour or two. Others are 8 to 16 hours over a few days. A minimal NPA will cost about $800 or more. They can cost $4000 or more. The reports are usually completed over the next month. A very abbreviated NPA may have results sooner.

You insurance company will likely baulk at approving such expensive testing. They will likely want a more definitive reason for the referral. Your doctor should be able to perform an MMSE (Mini Mental Status Exam) in her office to get a basic understanding of your functions.

Interesting use of buspar. I have never heard of buspar or other anti-anxiety drugs being used to relieve anxiety caused by sound triggers. For most of us, reducing the sound exposure is the solution.

Regarding your struggles to focus, what have you tried to help with focus ? have you tried reducing background sounds ? Have you tried using headphones to watch TV or computer videos ? I doubt an NPA will be effective at identifying your focus issues. I've had 3 NPA's and discussed focus issues with the psychologist. Most are clueless about PCS caused focus issues. One even commented negatively in his report about my complaints trying to focus because of visual and auditory distractions. He made it sound like it was all made up or 'in my head.'

Your insurance company may be willing to pay for an MMSE. Neuros, psychologists and others can do them. You might benefit from inquiring about doctors who have expertise with PCS and MMSE testing.

A good bit of my noise anxiety is anticipatory, in addition to the acute problems when the noise is right then and there. So the buspar is trying to lower my general anxiety level. I have Ativan for panic attacks that may arise as a result of loud situations.

That's interesting to know about the evaluation. I have not had a chance to make any phone calls today so I don't know what anyone might say. Would I be smart to talk to my therapist? Is that a hoop that insurance may want me to jump through? Or, forgetting the evaluation, would she be able to conduct that MMSE test as well? Or any other tests that may be a good idea? I don't think I'm in horrible shape. I wouldn't anticipate being evaluated and told that I've lost the capability to do 20 different things, or whatever. But I do know that I'm not the same as I was hitting and I'd be interested in knowing how different I don't am and if it's permanent.

Regarding the focusing I haven't tried headphones or anything. I don't know how well they'll work. My problem isn't so much getting distracted by what's happening in the room with me it's being distracted in my own head. I can't stay on topic. Even writing this I started to drift off and had to think about what I was writing again. If I'm reading a book suddenly my mind starts wandering to 10 other things and I find I can no longer focus.

Ok in thinking guess it is a little situational. I'll be watching TV or a movie and then suddenly I just have to check my email. Or get up and do something. I don't know how best to explain it. But my mind is just not there anymore and that's not how I used to be. I just got stuck writing this paragraph. It's frustrating.

In fact I feel almost a little foggy after writing this. Not much, and I'm more ****** and I can feel my heart rate a little elevated. Somethings not right.

Hi Socks. As Mark mentions the tests administered and examination duration will vary depending on the tests performed, which will be based on what symptoms you are presenting.

I've had two, one was an abbreviated (~ 2hours) as inpatient in neuro rehab, and the other was a half day outpatient about three months later. Both were covered by my health insurance.

The exact tests vary depending on how the symptoms present. My deficits included visuospatial and verbal learning and memory, abstract reasoning, mental flexibility, and problem solving. The exam should be conducted by a licensed clinical neuropsychologist.

The evaluation typically starts with an interview to get your self-assessment, and they also observe language, motor skills, and overall affect. They may include a spouse or significant other in the interview (my wife attended this part with me).

They then perform a battery of different tests of cognitive functioning. Again, the exact test may vary based on your areas of difficulty, my tests included:

Subtests of the Wechsler Adult Intelligence Scale (WAIS-IV)
Beck Depression and Anxiety inventories
Reading tests (WRAT-3)
Auditory Learning
Visuospatial memory tests
Trail marking A & B
Wisconsin Card Sorting test
Verbal Fluency

They will compare the results with “normal” scores based on your age, education background and other demographic factors.

Both times I got a verbal summary of the findings from the neuropsychologist at the end of the test session, and had the full written report a couple of days later. The goal should be to assess where you have deficits with a recommendation for treatment. I was fortunate that after my second one I was given a recommendation to resume normal activities. It stated:

“On examination, the patient demonstrated intact cognition in all domains assessed including learning and memory, attention, processing speed, language skills and executive functions. He has shown an excellent recovery from his severe injury only five months ago. From a cognitive standpoint there are no concerns with respect to the patient returning to work full time or returning to driving”

Hoping your recovery goes well also.

Socks,

Lightrail and Mark covered most everything but I will just add a couple things from my experience--

Insurance did cover my testing and mine took about 10 hours over a 2 day period. Originally, I was only scheduled for 1 day but as the testing was proceeding and the neuropsych would gauge the progress he was adding different tests.

Also, we had to go into a second day BC my attention/focus started to wane and I needed rest. The tests need your best effort and so they can be spread out to ensure you are not overly taxed in order to be most accurate.

In addition to the interviews, my eval involved 23 different tests--which I won't bother to list here. It also took my NeuroPsych a lot longer than a couple days to prepare the written report.

Can I also encourage you to go to a store like a Best Buy and try on a pair on noise canceling headphones?

I first joined this forum around Chriatmas and read others recommend them. I--much like you--didn't think it would help much. BUT then I tried them on and I felt tension melt that I had no idea I was even experiencing from all the noise around me!!

I really truly hated to spend that $300 but for 4 months now these have been my best friend! They allow me to get along in situations that I otherwise had significant trouble with before them.

I am hoping to get in to see an audiologist soon and discuss getting these specially made earplugs that musicians use that I have read about which has helped PcS sufferers as well.

If you have any more questions specifically about what I have shared, don't hesitate to message me and I will try to respond prom0tly.

I appreciate the replies. I'm going to call my insurance, the evaluation center and my therapist to ask some questions on Monday. I'll look into noise canceling headphones. Money's tight right now, so not sure I can afford them, but I'll at least look at them.

Thanks guys!