A Handbook of Geriatric Neuropsychology: Practice Essentials (Studies on Neuropsychology, Neurology and Cognition)

__A Handbook of Geriatric Neuropsychology: Practice Essentials__ (Second Edition) brings together experts in the field to integrate the knowledge and skills needed to understand and treat older adults who are experiencing problems with memory and other thinking skills. With three new sections, including coverage of other conditions beyond neuropsychological disorders, special assessment contexts, and more on interventions and ethics, as well as multiple new chapters, and significant updates from the first edition, this book provides a strong foundation for clinicians, educators, and researchers invested in the wellbeing of older adults. The impact and experience of aging, like the practice of neuropsychology, evolves over time. Similarly, through advances in science and professional techniques, neuropsychological practice has continued to evolve. Neuropsychological evaluation remains the most effective method of diagnosing age-related cognitive decline, cognitive difficulties that result from psychological factors, and other related disorders, as well as determining how the various disorders impact functioning and quality of life. This book explores these areas and offers state-of-the-art assessment techniques to assess changes in cognition and behavior and to distinguish normal changes from neuropathology. This book is a go-to resource and key reference for psychologists who serve older adults with known or suspected cognitive problems, as well as those who are invested in promoting brain wellness. It provides much of the information needed to establish and improve foundational and functional competencies in geriatric neuropsychology and establish practices that are personally and professionally rewarding, all aimed at promoting the understanding and wellbeing of older adults. Cover Half Title Series Page Title Page Copyright Page Dedication Contents Series Editor Preface Preface References Acknowledgments About the Editors Contributors Section I: Introduction Introduction Evaluation and Treatment Settings Referral Questions Diagnosis Treatment Consumer Education and Brain Wellness Evolution of Geriatric Neuropsychology Conclusion References Section II: Neurocognitive Disorders 1. Alzheimer's Disease Alzheimer's Disease Neuropathology: A Dual Proteinopathy Neuropathological Staging and Diagnosis The Clinical Syndrome of Alzheimer's Dementia Mild Cognitive Impairment AD Clinicopathological Progression Differential Diagnosis 1. AD does not always present as an amnestic dementia 2. Conditions other than AD can cause amnestic dementia syndromes 3. Multimorbidity in the setting of dementia is the rule, not the exception Early Detection and AD Biomarkers Neuroimaging Cerebral Spinal Fluid Tests AT(N) Biomarker Research Framework Role of Clinical Neuropsychology in AD and Dementia Early Detection and Cognitive Profiling Promoting Cognitive Resilience in AD and Cognitive Aging Managing Neuropsychiatric Disturbance and Caregiver Support Pharmacological Interventions Conclusion Note References 2. Cerebrovascular Disorders and Vascular Dementia Cerebral Vasculature Stroke Risk Factors for Stroke and Vascular Dementia COVID-19 Ischemic Stroke Neurological and neuropsychological effects of ischemic stroke Left middle cerebral artery (MCA) Right middle cerebral artery (MCA) Left anterior cerebral artery (ACA) Right anterior cerebral artery (ACA) Left posterior cerebral artery (PCA) Right posterior cerebral artery (PCA) Acute Ischemic Stroke Interventions Hemorrhagic Stroke Intraparenchymal hemorrhage Prognosis Subarachnoid hemorrhage Prognosis Traumatic Hemorrhagic Strokes Neuroimaging of Strokes Vascular Dementia Types of Vascular Dementia Diagnostic Criteria Prevalence Cognitive Symptoms of Vascular Dementia Conclusion References 3. Parkinson's Disease and Dementia with Lewy Bodies Historical Perspective Neuropathology and Clinical Features of Lewy Body Diseases Hyposmia, Sleep Disorders, and Autonomic Dysfunction Parkinsonism Neuropsychiatric Symptoms Cognitive Impairment Parkinson's Disease Cognitive Impairment in PD Mild Cognitive Impairment Parkinson's Disease Dementia Dementia with Lewy Bodies Clinical Diagnosis of DLB Differentiating DLB from Other Forms of Neurodegenerative Disease Genetics Treatment Roles of and Considerations Related to the Neuropsychological Evaluation Final Considerations References 4. Frontotemporal Dementias Epidemiology Clinical Syndromes Behavioral variant FTD (BvFTD) Neuropsychological Performance Diagnostic Criteria Language Variants of FTD Semantic variant PPA (svPPA) Neuropsychological performance Diagnostic criteria Agrammatic/non-fluent variant PPA (nfvPPA) Neuropsychological performance Diagnostic criteria Motor Variants of FTD Corticobasal Syndrome (CBS) Neuropsychological performance Diagnostic criteria Progressive Supranuclear Palsy Syndrome (PSP) Neuropsychological performance Diagnostic criteria FTD-Motor Neuron Disease (FTD-MND) Neuropsychological performance Diagnostic criteria Neuropathology FTLD-Tau FTLD-TDP FTLD-FUS Genetic and Familial Risk Factors Treatment Pharmacological Treatment Ante-mortem Prediction of Pathology Conclusions References 5. Traumatic Brain Injury in Older Adults Features and Mechanisms of TBI, Dementia, and Mild Cognitive Impairment Diagnosis of TBI Diagnosis of Dementia and Mild Cognitive Impairment TBI In Older Adults: Special Considerations Epidemiology Symptoms and Presentation of TBI in Older Adults Recovery after TBI in Older Adults TBI and Dementia in Older Adults Neuropathological Overlap of TBI and Neurodegenerative Processes Remote TBI and Dementia Recent TBI and Dementia Repetitive Subclinical Brain Trauma (RSBT), Multiple mTBI, and CTE Conclusions Author Note References 6. Delirium in Older Adults Conceptual Issues Clinical Features Subtypes Epidemiology Pathogenesis and Major Theories Risk Factors Assessment Approaches and Diagnostic Instruments Cognitive Assessment of Delirium Diagnosis and Differential Diagnosis Intervention and Prevention Non-pharmacological and Pharmacological Approaches A Note on Delirium and COVID-19 Conclusion References Section III: Other Conditions 7. Psychiatric Disorders in Older Adults Cohort Effects Cultural Considerations Mood Disorders Depression Bipolar Disorder Anxiety Disorders Psychotic Disorders Personality Disorders Conclusion References 8. Sleep, Fatigue, and Pain in Older Adulthood Sleep and Sleep Disorders Age-related Changes in Sleep Sleep Disorders in Older Adults Insomnia Restless Legs Syndrome and Periodic Limb Movements during Sleep Sleep-Disordered Breathing REM Sleep Behavior Disorder (RBD) Advanced Sleep-Wake Phase Disorder Correlates of Sleep Disturbance in Older Adults Physical and Mental Health Cognition and Daily Functioning Sleep Disturbances and Neurodegenerative Disorders Fatigue and Fatigue Disorders Experience of Fatigue in Older Adults Fatigue Disorders in Older Adults Chronic Fatigue Syndrome (CFS) Frailty Syndrome Correlates of Fatigue and Fatigue Disorders in Older Adults Fatigue and Neurodegenerative Disorders Pain and Pain Syndromes Persistent Pain in Older Adults Pain Syndromes in Older Adults Complex Regional Pain Syndrome (CRPS) Fibromyalgia Myofascial Pain Syndrome (MPS) Correlates of Pain in Older Adults Pain and Neurodegenerative Disorders Conclusion References 9. Substance Use Disorders in Older Adults Alcohol Epidemiological and Diagnostic Considerations Chronic Illness and Alcohol Abuse in Older Adults Alcohol, Traumatic Injury, and Disability Neuropathological Changes and Neuropsychological Functioning Psychological Manifestations of Alcohol Abuse Treatment Considerations Drug Abuse Illicit Substance Abuse Cognitive Effects of Illicit Substance Use Prescription and Over the Counter Medications Classes of Medication Cognitive Effects of Medications Physiological Changes in Medication Effects and Risk for Cognitive Decline Increased Incidence of Cognitive Impairment Assessment and Treatment Implications Conclusion References Section IV: Assessment 10. The Clinical Interview Understanding the Referral Question Making the First Contact Beginning the Interview History of the Presenting Problem Other Personal History Wrapping Up Conclusion References 11. Selection and Use of Screening Measures What Is a Screening Measure? Screening Versus Comprehensive Assessment Cognitive Screening Sensory Limitations Montreal Cognitive Assessment Saint Louis University Mental Status Exam Mini-Mental State Exam Rowland Universal Dementia Assessment Scale Blessed Orientation-Memory-Concentration Test Mini-Cog Caregiver Measures of Cognitive Change AD-8 Cognitive Change Index Tele-Screening Tele-MoCA Telephone Interview for Cognitive Status Blessed Orientation-Memory-Concentration (BOMC) Test AD-8 Depression Anxiety Substance Use Short Michigan Alcohol Screening Tool - Geriatric Version CAGE Conclusion References 12. Neuropsychological Batteries for Older Adults Complicating Variables in Older Adults Medication Use Patterns Comorbid Chronic Health Conditions Special Needs of Older Adults During Neuropsychological Assessment Testing Environment Rapport Performance Validity Instrument Selection Standardized Assessment Batteries Neuropsychological Assessment Battery (Stern & White, 2003) Reynolds Intellectual Assessment Scales-2 Repeatable Battery for the Assessment of Neuropsychological Status (Randolph et al., 1998) Dementia Rating Scale-2 Calibrated Neuropsychological Normative System Commonly Used Standardized Instruments for Tailored Batteries Memory Executive Functioning Language Visuospatial Functioning Premorbid Functioning Functional Capacity Conclusions References 13. Teleneuropsychology and Applications of Technology Engagement and Attitudes Regarding Technology Teleneuropsychology Utilization Models of Teleneuropsychology and Associated Considerations Assistant-Proctored Direct-to-Home Empirical Data on Equivalence of TeleNP Services Telephone Measures Computerized Cognitive Test Batteries Conclusions References 14. Symptom and Performance Validity Assessment in Older Adults and Patients with Dementia and Claimed Dementia Symptom Validity Assessment Below-Chance Performance and Cutoff-Based Decision-Making SVA Applied to Geriatric Populations Malingered Dementia Robustness of PVTs in Dementia Profile Analyses as Embedded Consistency and Plausibility Checks Self-Report SVTs Synopsis of Methodological Problems and Their Consequences Conclusions Note References 15. Testing Accommodations in Geriatric Neuropsychology Accommodation Versus Modification The Case for Nonstandard Test Administration Professional Standards Legal Considerations Peer-Reviewed Literature Interview Situations That May Require Nonstandard Administration Motivational Issues Fatigue Lack of Familiarity with Testing Anxiety Pain Limitations due to Health Conditions Hearing Vision Dual Sensory Loss Motor Touch Language Infection Control Teleneuropsychology Future Directions in Assessment Conclusion References 16. Functional Assessment Self-report Informant Report Performance-Based Measures Multi-domain Performance-Based Instruments Domain-Specific and Embedded Instruments Driving Ability Medication Management Financial Management Food Shopping and Preparation Conclusions References 17. Cultural Considerations in Geriatric Neuropsychology Cultural Considerations Vignette Discussion Practice pointer Vignette Discussion Practice pointer Vignette Discussion Practice pointer Vignette Discussion Practice pointer Vignette Discussion Practice pointer Vignette Discussion Practice pointer Vignette A Vignette B Discussion Practice pointer Vignette Discussion Practice pointer Conclusions References 18. Serial Assessment in the Older Patient A Couple Relevant Terms Methods for Assessing Cognitive Change RCIpe Standardized Regression-Based (SRB) Calculation Which Method is Best? A Worked Example Examining Change at the Individual Level Conclusions References Section V: Special Assessment Contexts 19. The Application of Neuroimaging for Normal and Pathological Aging A Primer on Neuroimaging Techniques Structural Imaging Radiography (X-ray) Computerized Tomography (CT) Magnetic Resonance Imaging (MRI) Other (Advanced) MR techniques Diffusion Tensor Imaging (DTI) Functional Neuroimaging Electromagnetophysiological Techniques Positron Emission Tomography (PET) Single-Photon Emission Computed Tomography (SPECT) Functional Magnetic Resonance Imaging (fMRI) What does Neuroimaging Add to Neuropsychology? What Neuroimaging Cannot Tell Clinicians Integrating Neuroimaging and Neuropsychological Findings Conclusions References 20. Assessment of Decision-Making Capacity in Older Adults General Framework for Decisional Capacity Assessment Assessment Process Pre-assessment Considerations Informed Consent Issues Accommodations Values Assessment Diagnosis versus Abilities Healthcare Decision Making Pre-assessment Considerations Legal Standards Questions for Capacity to Consent to Medical Treatment Capacity to Appoint a Health Care Proxy Cognitive Factors Relevant to Healthcare Decision Making Vignette 1 Financial Capacity Pre-assessment Considerations Legal Standards Cognitive Factors Relevant to Financial Capacity Vignette 2 Reporting Opinions about Capacity Common Pitfalls Conclusions References 21. Forensic Assessment in Geriatric Neuropsychology Comorbidities Psychometric Considerations Collateral Sources of Information Technological Considerations Select Psycholegal Examinations of Older Adults Civil Capacity/Guardianship Basics Research Findings Testamentary Capacity Basics Research Findings Competency to Stand Trial (CST) Basics Research Findings Conclusions References Section VI: Intervention 22. The Relay of Neuropsychological Information: Providing Feedback Tasks Before Feedback The Feedback Session Establishing Rapport and Expectations Delivering Results Assessing Comprehension Framing Neuropsychological Results Giving a Diagnosis Managing Emotional Reactions Implications, Recommendations, and Referrals Concluding the Session and Follow Up Future Considerations in Practice Future Research Considerations Conclusion References 23. Neuropsychological Treatment and Wellness Promotion with Older Adults Neuropsychological Treatment Cognitive Intervention Cognitive Stimulation Cognitive Training Cognitive Rehabilitation Psychological Intervention Cognitive Behavior Therapy Problem-Solving Therapy Third-Wave Cognitive Behavior Therapy Life Review Therapy Family Caregiver Intervention Education Skills Training Support Neuropsychological Wellness, Preservation, and Enhancement Physical Health Exercise Pain Blood Pressure and Cholesterol Nutrition Alcohol Oral Health Hormones Sleep Medications Emotional, Social, and Environmental Factors Technological Interventions Psychosocial and Cultural Considerations Conclusion References 24. Working with Families Role of Family in Generating a Referral Role of Family in the Assessment Process Assessment of the Family Family Functioning Cultural Considerations Needs, Openness, and Access to Resources Family in Feedback Ethical Considerations Family Reactions Post-assessment From Family to Caregivers Assessing Family Caregivers Role of Family in Intervention Interventions for Families Family Education and Resource Connection On Being Person-Centered The Dementia Journey, from Diagnosis to Life after Caregiving The Adjustment Process Decision to Institutionalize Death Preparedness Life after Caregiving Conclusion References 25. Medication Effects on Cognition in Older Adults The Chicken or the Egg? Demographics and Risks Anticholinergics Acute Effects Dementia Risk Benzodiazepines and Z Drugs Acute Effects Dementia Risk Proton Pump Inhibitors (PPIs) Acute Effects Dementia Risk Pharmacological Treatments for Dementia Conclusion References 26. Working with Geriatric Healthcare Teams: Opportunities for Neuropsychologists Team Structure and Development Importance of Integrated Geriatric Care Teams Mental Health Integration into Geriatric Care Settings Interprofessional Competencies Competencies for Neuropsychologists working with Teams Competencies for Interprofessional Teams Practical Aspects of Engaging in Health Care Teams Understand Your Role on The Team Be Collaborative and Supportive Acknowledge the Overlap Communicate Competently Appreciate Environmental Design and Influences Clarify Responsibilities and Reimbursement Acknowledge your Team's Needs Conclusions References Section VII: Ethical and Professional Issues 27. Ethical Issues in Geriatric Neuropsychology Salient Issues in Geriatric Neuropsychological Practice Professional Competence Assessment Issues Roles and Relationships Respect for People's Rights and Dignity Managing expectations Ethical Decision-Making in Action Ethical Decision-Making Process Ethical Decision-Making Resources Conclusions Note References 28. Billing and Financial Arrangements for Neuropsychological and Psychological Services for Older Adults Component CPT® Codes for Neuropsychological and Psychological Assessment Neuropsychology Training Programs How to Bill for an Entire Assessment CPT® Code Modifiers Case Example of how to Bill for a Neuropsychological Assessment Case Example of how to Bill for a Psychological Assessment How to Bill for Cognitive Screening Measures, Brief Neuropsychological Assessments, and Comprehensive Neuropsychological Assessments Billing for Telehealth Assessments How to Bill for Geriatric Behavioral Health Treatment Beyond Assessment CMS Billing and Other Insurance Carrier Considerations Financial Arrangements and Ethical Considerations Conclusions References Index