By Kinsey Kranjcec and Nathan Alam
Neuropsychology connects how the brain and nervous system function with how we think, feel, and act. When illness or injury affects the brain, UAMS neuropsychologists help determine how those changes influence memory, thinking, behavior, and daily life. Through comprehensive evaluations, they build a detailed picture of a person’s cognitive strengths and challenges, helping clarify how a neurological condition may affect everyday functioning. These evaluations can reveal patterns that may not be apparent through brain scans or other medical tests alone and help determine whether cognitive changes are tied to a neurological condition or influenced by other factors, including mood and psychiatric concerns.
In a recent interview, Drs. Jennifer Kleiner and Lee Isaac offered a closer look at neuropsychological care at UAMS. When asked to describe the field simply, Dr. Isaac explained, “Neuropsychologists use cognitive testing to evaluate brain function and connect performance to everyday life, helping patients and providers understand whether there are changes, what’s causing them, and what to do next. We consider all factors contributing to cognitive issues and guide patients, families, and treatment teams toward meaningful next steps.” Their patients range from young adults to those in their 90s and older, and they evaluate a wide variety of conditions and concerns that can affect cognition. These can include dementia, traumatic brain injury, stroke, neurological disorders, and persistent memory problems. Both Dr. Isaac and Dr. Kleiner also regularly evaluate patients before and after deep brain stimulation surgery, which is used to treat movement disorders, including Parkinson’s disease. These evaluations help assess cognitive functioning, identify potential risks before surgery, and track changes afterward.
A typical evaluation begins with an in-depth clinical interview, during which the neuropsychologist learns about the patient’s concerns, medical history, and perspective on how cognitive changes are affecting their daily life. That conversation is followed by standardized testing, typically administered by a technician. In total, the evaluation can take three to six hours. Neuropsychologists often spend another three or more hours on interpretation and report writing. That time allows the team to look closely at each patient’s individual experience, building a fuller picture of their cognitive strengths and challenges than a routine medical appointment allows. Following the evaluation and preparation of the detailed report, the neuropsychologist meets with the patient for feedback to explain the findings and recommendations in an understandable format.
For many patients, a neuropsychological evaluation can be the first step toward understanding what is behind changes in memory, thinking or behavior—and what can be done next. Those changes can be frightening, and uncertainty about a possible diagnosis or the testing process itself may make some people hesitant to seek an evaluation.
One patient described his experience at UAMS as positive, though he acknowledged that the several-hour testing process could be challenging. He arrived without knowing what to expect, but said his doctor made him feel comfortable and well cared for throughout the evaluation. About six months before his appointment, he had begun feeling more disorganized, processing information more slowly and struggling to find the right words in conversation and writing. The changes began not long after a major surgery, and his initial clinical interview raised the possibility that cerebrovascular changes may have played a role. When asked why he chose UAMS, his answer was simple: “UAMS is where the experts practice, so it was an extremely easy decision. I’ve referred several other people who’ve had great experiences.” Knowing he was in experienced hands, he said, helped ease much of his uncertainty about the process. His advice to others experiencing cognitive changes was to not ignore these changes or delay seeking help simply out of fear of what an evaluation might uncover. “I would encourage people not to be scared. Reach out, ask questions, and find the answers. You can’t solve any problems until you know what the problems are.”
Recommendations are also a key component to a neuropsychologist’s work and their value to the patient. They are tailored to each patient and may include cognitive rehabilitation, psychiatric consultation, additional medical evaluation or other treatments and supportive services. Cognitive rehabilitation, sometimes described as “physical therapy for the brain,” can help patients strengthen cognitive skills or develop strategies to work around difficulties with memory, attention or problem-solving. The evaluation also gives neurologists, neurosurgeons, and other providers valuable information to help guide treatment decisions.
That collaboration is built into neuropsychological care at UAMS. Across the medical center, neuropsychologists work closely with specialists in neurology, neurosurgery, geriatrics, physical medicine and rehabilitation, and other fields, contributing to multidisciplinary clinics and treatment planning. In several specialty clinics, neuropsychologists work alongside physicians, social workers, dietitians, and physical, speech and occupational therapists so different aspects of a patient’s health can be considered together.
Research is also woven into the neuropsychologists’ clinical work, with many neuropsychologists balancing patient care with studies aimed at improving how cognitive changes are understood and assessed. Much of the PRI neuropsychologists’ current research includes post-surgical cognitive changes, assessing the impact of rurality on cognitive and neurologic outcomes, and increasing accuracy of commonly used neuropsychological assessments. Ultimately, neuropsychological evaluations offer more than a diagnosis. They can turn uncertainty into a clearer understanding of what is happening, what it means for everyday life, and what steps can come next.