Dr Kate Mahony, a Clinical Neuropsychologist in an Older Adult Unit, the King's Wood Centre, North Essex came to speak with us.
Dr Mahony was firstly interested in the functioning of the brain and by stories of injuries to the brain that had affected other parts of people's bodies and behaviour.
Brief History of Neurospsychology:
In the 17th and 18th century, the Renaissance period, there was a great deal if research into looking for the part of the brain that was the seat of the mind
Descartes saw the pineal gland as the seat of the soul
Faculty psychology was one of two main schools of thought. This area divided mental processes into a number of separate, specialised abilities
Gall stressed the role of the cortex based on brain tissue causing bumps in the skull, with bigger bumps indicating greater influence/ability of a certain faculty. This is known as phrenology'.
The development of Electric Brain Mapping showed that phrenology was limited and ultimately caused its downfall
At the end of the 19th century more important landmarks were identified
Modular brain theory was abandoned in favour of mass action'
In the 1930s and 1940s Egan Moniz found that by removing parts of the brains of animals they became more passive, and carried out the prefrontal leucotomy and lobotomy on humans. In the 1940s, over 2000 leucotomies alone were carried out in the US
The Current Role of a Neuropsychologist:
Mainly assessment using Neuropsychological tools and therapy
Many Neuropsychological tools resulted from soldiers returning from war with gun shot wounds to the head. Tools were developed to assess the effects of this.
In the 1980s MRI and CT scans were developed and Neuropsychological tools changed. Neuropsychologists looked more specifically at individual functioning
Tests used include: subtests from the WAIS III, WMS III, the Verbal Fluency Test, Trail making Test, and the Category Fluency Test
Dr Mahony noted that the MMSE (Mini Mental State Examination) was seldom used by psychologists as it is not detailed enough
A common neuropsychological dementia assessment takes around 2 hours-divided into 2 sessions, usually 1 session at the unit and 1 at home
Then assessment results are interpreted and explained to the patient and the family in an understandable manner
Dr Mahony runs Educational groups for clients newly diagnosed with dementia and their carers. These run for 3 weeks, and include explanations of what dementia is, what people are trying to do to improve their quality of life, and strategies to manage difficulties
The most common diagnoses that individuals present with at the King's Wood Centre are Mixed Vascular and Alzheimer's Dementia
Memory problems are not always due to a dementia, they can be caused by depression, stress or big changes in ones life
Dr Mahony finds it easier to assess depression and anxiety during discussion with the client rather than using standardised assessments of this. The BDI, BAI and HADS can be used if felt necessary
Case Assessment:
Mr B, a 62 year old man was referred to MATS (Memory and Assessment Therapy Service) by his GP
He perceived that he had no memory problems, but his ex-wife was concerned about him
MMSE showed scores of 29 and 30/30
He was neatly presented and understood what the assessment was about. However he was also very repetitive during conversation
Memory deterioration was noted following a motor bike accident in 2003, however, his ex-wife noted that it had never been good
Mr B had had hydrocephalus as a baby, and 3 accidents where he had lost consciousness
He had a brilliant autobiographical memory but very poor learning of new information. He could remember facts from the past but had a very poor recall of emotional memories
It was concluded that Mr B had almost amnesic memory impairment for new information and very variable longer term memories depending on emotional significance
This was attributed to aberrant brain development due to hydrocephalus particularly affecting the mesial temporal and limbic structures. This was exacerbated by head injuries, especially the 2003 motor bike accident.
Mr B met the criteria for Asperger's Disorder
He was not found to have Dementia
The feedback to the patient and the family resulted in a good therapeutic outcome.
Questions were asked to Dr Mahony
The therapy for dementia can consist of the following:
Information and Education sessions-Psychoeducational and CBT
Straight Behavioural Therapy
Person Centred Therapy
Cognitive Analytic Therapy, which seems not to work as well with the elderly and memory problems.
What are the features of Parkinsons?
Parkinsons affects a different part of the brain-primarily it is a motor disorder
Primarily affects the basal ganglia, with neurons lost, there is a dopamine shortage
The motor features appear 5-10years before any cognitive problems may appear
Do families get support?
Sometimes they want help, and sometimes they do not-often ask when they need it
Family groups are offered educational groups and talks with professionals
The North Thames Graduate Psychology Group thank Dr Mahony for giving such an interesting talk and Q&A.
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