Clinical Neuropsychological Report for Mr. W:
Patient: Mr. W
Brief Background:
The patient being evaluated is 90-year-old, Mr. W. Mr. W is retired, has only 6 years of general education, and is currently residing in A State with his sister and brother-in-law. The reason for Mr. W’s referral is to have him assessed for his decision-making ability. Mr. W was previously seen by a physician in Michigan at the urging of his son, and was diagnosed with “dementia.” Following the diagnosis, the patient’s son reportedly took control of the patient’s finances, has withdraw about $28,000 from the patient’s account, and has also sold off the patient’s coin collection. The patient strongly feels he was misdiagnosed and is endeavoring to gain control back over his financial affairs.
The reason for the initial evaluation that resulted in the patient’s diagnosis was connected to a short series of hallucinations wherefore Mr. W claimed to have seen a silhouette roaming in another room in his house, which he termed the “Boogie Man.” Several days from this first incident, Mr. W claims he had a “black out” episode that resulted in the patient falling and stating that he felt someone pounding his head and pulling him down the stairs…he also felt that this was the “Boogie Man.” Mr. W denied any other experiences and/or auditory or visual hallucinations beyond the aforementioned. As maintained and reported by the patient’s sister and cousin, the patient has had no other episodes, nor is he lacking in memory or thinking processes. Though the patient no longer drives, he is fully capable of independently carrying out daily life activities, such as self-care, taking medications, and doing household chores.
Additional Assessments:
Mr. W has already undergone a number of measures, to include: Wechsler Test of Adult Reading, Wechsler Adult Intelligence Scale-IV, WAIS-IV-Digit Span, Trail Making Test, RBANS Coding, RBANS Semantic Fluency, RBANS Naming Test, RBANS Figure Copy and Line Orientation, Target Cancellation, RBANS Word Test, Story and Figure Recall, and WAIS-IV Similarities. The results from these assessments illustrated mild deficiencies in some areas but were not significant enough to render him incapable of managing his financial, health, and every day life affairs. The patient is fully capable of making his own decisions. However, just to be thorough and ensure nothing was missed, I would like to run a few additional tests.
Due to the comprehensive assessment battery, the only additional measures I feel need to be employed are:
· Direct Clinical Review;
· Assessment Capacity for Everyday Decision-Making (ACED); and
· MacArthur Competence Assessment (MacCAT).
The ACED and MacCAT both utilize standardized questions and scoring systems to ensure objective assessment capacity. The ACED can be administered and scored within 15 minutes, whereas the MacCAT is administered and scored in approximately 30-minutes (Karlawish, 2008).
To maintain ethical and professional standards, clinicians are obligated to address communication barriers, discuss treatment information, and answer patient inquiries BEFORE administering the assessments. The patient must be fully informed and consent to being assessed before any procedures begin. Additionally, the reliability and validity of each of these assessments is largely seen in how when scored and compared in juxtaposition, there are strong correlations in performance in each of the 4 decision-making ability domains.
References
Karlawish, J. (2008). Measuring Decision-Making Capacity in Cognitively Impaired Individuals. Neuro-Signals, 16(1), 91–98. http://doi.org/10.1159/000109763
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