Neuropsychology.

Source: The following is taken from a neuropsychological examination I underwent on 13-Sep-2006.

Behavioral observations: Mr. Clauson arrived promptly for his appointment and was unaccompanied. He was appropriately dressed and groomed and was cooperative throughout the interview and subsequent neuropsychological evaluation. He appeared to put forth a solid effort, despite seeming at least mildly anxious throughout the exam. It is thought that a valid indication of his current level of functioning was obtained and the test results are summarized below.

TESTS ADMINISTERED:

Wechsler Adult Intelligence Scale - III (WAIS-III), Wide Range Achievement Test - 3 (WRAT-3;Reading), Orientation Questionnaire, Mental Control, Conners' Continuous Performance Test (CPT), Trail Making Test (Trails A & B), Stroop Color/Word Test (Stroop), Controlled Oral Word Association Test (COWA), Animal Naming, Wisconsin Card Sorting Test (WCST), Rey Auditory Verbal Learning Test (RAVLT), Rey Complex Figure Test (RCFT), Wechsler Memory Scale-III (WMS-III; Logical Memory), Word Memory Test (WMT), Minnesota Multiphasic Personality Inventory - II (MMPI-II).

FINDINGS:

Intelligence/achievement: Mr. Clauson was given several subtests from the WAIS-III in the present evaluation and scored in the high average range or better on three of the four subtests. Verbally oriented skills were in the superior or very superior range, while there was a significant difference between two visuospatial and perceptual tasks. The patient performed in the high average range on a test of visual construction with a model (Block Design) but was in the low average range on a simpler task involving attention to basic visual details (Picture Completion). This is an unusual relative weakness, especially in light of the patient's very strong performance on other subtests. Mr. Clauson was given the WRAT-3 Reading subtest as a measure of sight reading skill and general academic achievement. His score on this measure was in the high average range (Reading standard score = 115, 84th percentile) and essentially in line with his very strong demonstrated verbal and general intellectual abilities.

Attention/executive function: The patient was alert and fully oriented, answering 14 of 14 orientation questions correctly. Mr. Clauson was able to do a number of simple mental control tasks including counting backwards from 20, reciting the alphabet, and a serial threes task quickly and with little difficulty. Thus, for the purposes of the present evaluation, the patient showed basic attention and concentration abilities that were within an acceptable range.

The patient was given the Conner's Continuous Performance Test as a measure of sustained visual attention. His overall performance was fully within normal limits (CPT index = 0.0) and not indicative of significant problems with attentional focus in the visual realm. His responses tended to be fast overall, though other important indices of inattentiveness were not outside the expected range.

Mr. Clauson was given a number of simple and more complex measures of attention and cognitive speed/efficiency in the present evaluation. Performance on a simple visuomotor tracking task was in the high average range, while performance on a more complex version of the task involving set shifting was in the superior range. Word naming speed was in the high average range, while color naming speed and the ability to inhibit a dominant response were in the superior to very superior range. Associative verbal fluency for broad phonemic and restricted semantic categories were in the high average range. Finally, Mr. Clauson struggled a bit with a traditional executive function measure involving concept formation and subsequent shifting as sorting principles are changed. His performance was within normal limits, but in the low average range and weaker than expected given his very strong general abilities. His performance on this task was not unlike performance often seen in individuals who essentially "overthink" the task. Overall, Mr. Clauson's performance on simple and more complex measures of attention and cognitive efficiency is quite strong and tends to be in the high average to superior range, consistent with demonstrated general ability.

New learning/memory: Mr. Clauson was given a number of measures of new learning and memory in the present evaluation. Performance on a serially presented word list-learning task was in the average range for the initial learning trial, with a very strong subsequent learning curve. Recall of an interference list was essentially the same as initial recall of the target list. Immediate and delayed recalls of the target list were both very strong and well above average. Recognition memory performance for the target words was errorless. The patient produced an adequate copy drawing of a complex visual design, taking a somewhat fragmented approach, but including all details. Immediate and delayed reproductions of the design were in the low average range, while recognition memory for various design elements was in the high average range. Overall, Mr. Clauson showed strong new learning and memory performance on a verbal measure in slightly weaker, but average performance on a complex visuospatial measure.

Symptom validity/effort: Mr. Clauson was given a well-standardized measure of symptom validity and effort that is presented as a difficult memory task. His initial trial performance was within normal limits and suggestive of an adequate effort. This finding, along with the patient's earnest and cooperative attitude suggests that we were able to get a valid indication of his current level of neuropsychological functioning.