The Assessment of Cognition
As a formally trained neuropsychologist, Dr. Kinsora adheres to findings in neuroscience research to guide his assessment of cognition. Although each assessment is customized to the patient, an assessment of cognition may evaluate any combination of the following domains:
- attentional buffering
- concentration (mental tracking)
- processing speed
- reaction time
- sustained attention
- expressive language
- receptive language
- abstract reasoning
- spatial processing/construction
- memory/new learning
- executive control
- self regulatory skills
- deductive reasoning
- response inhibition
- motor speed/strength/fine motor dexterity
- visual field sensitivity
- tactile perception
- olfactory functioning
- personality functioning
Dr. Kinsora evaluates the resulting data set for validity prior to interpretation in every patient that he sees. This process ensures that the interpretation of neurocognitive measures remains accurate. Once validity of the data set is established, the pattern of performance is compared to known diagnostic groups and well researched cognitive processing pathways. The patterns of performance are then used to formulate a pattern of expected effects of the pattern of performance for the patient in his or her day-to-day life. In many cases, diagnostic groups can be eliminated entirely based on the pattern of performance. Neuroscience research clearly demonstrates that neurocognitive assessment is far more accurate than predictions based on MRI, PET, and other radiological studies in describing the extent of neurocognitive alteration that might be present in various neurological disorders and traumatic brain injuries.
A basic neurocognitive assessment can take between 6 and 8 hours or more to complete, depending on the referral questions, the neurological problems experienced, and the capabilities of the patient. In most cases, we will attempt to complete the assessment in one day. There are exceptions to this long time commitment. For example, our evaluation of the elderly patient may be as short a three hours.
Independent and Medical-legal Evaluations
In cases that are considered independent medical evaluations and those referred as part of litigation, a more comprehensive evaluation is conducted that will be be more sensitive to issues that might be missed by a basic evaluation. These evaluations also include a better appraisal of the complex interrelationship of injury severity, previous strengths, personality variables, and education on neurocognitive functioning. Medical-legal evaluations can sometimes span over two full-day sessions, involving longer interviews and the administration of more cognitive measures. A typical evaluation might be conducted in the following manner:
Day 1: The client arrives at 9:00 am and is interviewed for about two hours. After a brief break the administration of cognitive measures begins. Around Noon a 30 minute lunch break is provided. If the patient appears to be sustaining energy, and is able to continue, much of the assessment can be completed over the remaining 5 to 6 hours. Intermittent breaks are provided as needed to ensure sustained energy and maximum attention to the measures administered. Breaks can prolong the assessment process for the client, but in cases of persistent pain, or fluctuating cognitive efficiency, these additional breaks may be required.
Day 2: (If required) The client is administered the remainder of the neurocognitive assessment.
Center for Applied Neuroscience
"putting neuroscience research into practice"
Thomas F. Kinsora, Ph.D.