Cognitive Impairment/Differential Diagnosis stuff

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Gilly
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Cognitive Impairment/Differential Diagnosis stuff

Post by Gilly » Tue Feb 15, 2011 1:30 pm

Hi Everyone

I work in a memory assessment service - and we've been having a bit of a flux of people coming through with functional mental health problems, as well as those with other organic problems which result in eventual cognitive impairment (such as MS) so its getting more tricky to tease apart impairments - so im going to do a bit of research on potential cognitive profiles - and im going to start my wide net with you guys :)

Does anyone know of any good links/articles about what sort of cognitive impairments you would expect from people with functional diagnoses? - like, a neuropsychological profile?

i know this is ridiculously vague/wide, but i thought i would throw it out alongside my own digging :)

cheers!
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charley
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Post by charley » Tue Feb 15, 2011 1:44 pm

what kind of thing do you mean by a functional diagnosis?

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Post by astra » Tue Feb 15, 2011 3:05 pm

Presumably anxiety and depression rather than organic conditions. i don't really think it's possible to always tease apart, it's a bit of a spurious distinction to make as the functional impacts on the organic and the organic impacts on the functional, IMHO.
From the point of view of mindfulness, as long as you're breathing there's more right with you than wrong with you. Jon Kabat-Zinn

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Post by charley » Tue Feb 15, 2011 4:05 pm

Thanks for clarifying that Astra. Off the top of my head i would say that patients with anxiety/depression tend to have a flat cogntive profile, and bomb on pretty much everything whereas the organic presentations tend to have profiles with focal deficits. Also, effort tests or symptom validity assessments and embedded tests of effort can be good indicators of functional problems impacting on cognition, but again, not always.

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Post by Ruthie » Tue Feb 15, 2011 4:11 pm

I agree that the distinction between "functional" and organic can be extremely blurry.

If someone has an organic impairment, it is quite likely that this will cause them to become depressed and anxious as they cope with the loss of their abilities and adapt to new stresses and difficulties.

If someone has no organic impairment, then the neuropsychological profile would be quite flat. They might be a little bit down on everything due to poor concentration, low motivation or anxiety. If there is an organic impairment you should see a high level of specificity in the profile.

Observations of how someone copes with testing or engages in an interview are absolutely vital in giving you information. For example, do they give up prematurely, do they appear not to attend to the materials, are they visibly anxious or upset etc.

HTH,
Ruthie

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ell
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Post by ell » Tue Feb 15, 2011 4:33 pm

I agree that separating out 'functional' and 'organic' clients is not particularly easy, and possibly not that helpful. Of course, it is useful to know if your client is presenting with dementia or not.

In my/my supervisor's experience, often older people get diagnosed with depression/anxiety when actually they are showing the first signs of dementia such as lack of initiation, apathy, lack of concentration.

In one of my previous OA roles, my supervisor asked me to research what aspects of cognitive testing are affected by depression. I can't remember the exact results, but I seem to remember there being surprisingly little evidence that depression significantly affected test scores, and where it did was mostly on tests of attention. It may be that my lit search was not very comprehensive, or that I am misremembering, so the results of your research will be interesting to see...

L

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Post by katz » Tue Feb 15, 2011 7:20 pm

Hey gilly, not sure what tests you use but in the rbans manual there is a table with cognitive profiles for various diagnosis including parkinsons etc

On the rbans you generally see drops in memory and Lang (to varying degrees in alzheimers (this makes an m shaped profile). Vascular gives you more of a w profile with notable deficits in visuo-spatial and attention while memory can be less affected.

Generally profiles with more specific impairment (e.g just One domain severely below expected) or comorbid and contradictory physical/ functional impairment would prompt further in depth investigations (scans etc) in my service.

The ms society also publish a document called cognition and mnd which may be of interest.

Re depression, it is important to note that depression can be part of the diagnosis for dementia and isn't necessarily a separate entity.

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Post by katz » Tue Feb 15, 2011 7:24 pm

If you want to send me your email address I will forward you that document when I am at work tomorrow.

Hope that helps a little!

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Post by Mexie » Tue Feb 15, 2011 8:02 pm

A bit old, but explains the profiles for various conditions like different types of dementia, MS, Parkinson's, PSP, depression etc.

http://www.amazon.co.uk/Neuropsychologi ... 292&sr=8-2

Shocking price! Quite a bit of it is available on google books though.

Sorry, didn't read the OP properly, a google search for 'chronic fatigue neuropsychology' might be a useful starting point.

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Post by Gilly » Wed Feb 16, 2011 8:20 am

hahaha, i didnt expect this to turn into a functional/organic debate :D

I know they can impact on eachother, and the literature on differentiation of depression is quite large, and pseudodementia is an obvious onsideration in these cases.

What i probably didnt explain properly in my first post, was that with some functional mental health problems, ie schizophrenia, either the disorder itself or long term use of antipsychotic medication can cause cognitive impairment, and was wondering whether or not anyone knew of any literature that has examined this, same with people with MS, who eventually start to experience cognitive problems, whether or not the cognitive problems they experience are particularly unique.

thanks for all answers so far (will write more later, gotta go to work!)
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Post by Kal-El » Fri Feb 18, 2011 5:09 pm

I actually work in a memory clinic service much like yourself and have done a bit of research into the affects of depression on cognition. I think, if i can recall correctly, that the results to date have been quite unclear in terms of which areas are affected. Mainly because most studies tend to use different neuropsychological tests than their counter-parts. So any accurate deductions about what is and what is not affected is difficult. I think some meta-analytical studies suggest that there is a mild correlation between depression and impairments to attention, executive function and memory (which are also, I think, the main areas affected by Schizophrenia??).

I think the research into anxiety on cognition has also produced similar complications but there are some tentative indications that it primarily affects attention.

Hope this is useful for you in your research :D
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