We have two adult positions, and both the first and second year Fellow will participate in inpatient and outpatient evaluations. We recruit one adult Fellow every year, so we always have one first year Fellow and one second year Fellow. The Fellows gain experience working with multidisciplinary teams and medical residents, as well as independently conducting outpatient evaluations.
Epilepsy Monitoring Unit (EMU) – Year 1
The first-year rotation primarily serves the Epilepsy Monitoring Unit, or EMU. On the EMU, the Fellow is responsible for interviewing, testing, and writing the report for patients admitted to the hospital for video EEG monitoring. Patients are admitted for differential diagnosis, as well as pre-surgical workup. There are up to four evaluations per week. The battery is approximately 1.5-2.5 hours of testing, and the report is briefer than an outpatient evaluation. The Fellow presents findings at the weekly Epilepsy Conference. We conduct 8-10 Wada evaluations per year for select epilepsy and tumor patients, and Fellows have the option to participate when possible.
Neurology Memory Assessment Clinic (NEUROMAC) – Year 2
Second year Fellows will staff NEUROMAC at the hospital one half day per week and this typically includes three patients. There are opportunities to participate at 20 S Park NEUROMAC on an ad hoc basis. This clinic is specifically designed for patients with memory problems who also have significant neurological symptoms or are young enough to suggest an early onset degenerative disorder. The team includes neuropsychology, neurology, nursing, and social work. The battery is approximately one hour long, and the report is briefer than a typical outpatient evaluation. The Fellow is responsible for battery creation, test administration, scoring, interview, and report writing. The Fellow also discusses findings with the team and participates in a discussion on differential diagnosis and recommendations. The Fellow also follows at least one patient through the entire clinic appointment—cognitive testing, interview, team conference, neurological examine and feedback.
In addition to general outpatient neuropsychological evaluations, we have many population specific service lines in which Fellows can choose to have extra time and experience. We have conversations with the Fellow throughout training to ensure elective rotations align with each Fellow’s career goals.
Geriatric Memory Assessment Clinic (MAC)
MAC’s are half day clinics that take place off site up to 12 half days per week. There are typically 2-3 patients per half day. The team includes neuropsychology, gerontology, and social work. Patients in these clinics are aged 65 years or older, with concern for memory decline. Evaluations are typically one hour long, accompanied by an abbreviated clinical interview. Reports are briefer than a typical outpatient evaluation. The Fellow interviews, presents findings to the team and discusses relevant diagnoses and recommendations with the team.
Mental Health Clinic
The Mental Health Clinic occurs once per week. It is specifically intended for patients referred from a psychiatrist or Behavioral Health provider. These are patients with primary psychiatric histories referred for targeted assessments. Examples include evaluation of memory decline in a patient with longstanding schizophrenia, or evaluation of rapid loss of independence in activities of daily living for a patient with poorly controlled bipolar affective disorder. This clinic does not accept requests to evaluate for ADHD.
Multiple Sclerosis Multi-Disciplinary Clinic (MS MDC)
The MS MDC occurs one half day per week, and typically includes two patients. The team includes neuropsychology, neurology, and social work. Evaluations are typically one hour long, and accompanied by an abbreviated clinical interview. Reports are briefer than a typical outpatient evaluation. The Fellow presents findings to the team and discusses relevant diagnoses and recommendations with them.
Movement Disorders Outpatient Clinic
The elective includes pre-surgical neuropsychological evaluation in the outpatient setting for patients considering deep brain stimulation. The evaluation includes clinical interview, collateral interview, test administration, and report generation. The Movement Disorder Conference meets monthly, and fellows present possible contraindications or barriers with proposed recommendations to the team.
The elective includes attending rounds on the acute inpatient stroke unit once per week with the Neurology team. The fellow will conduct inpatient evaluation including clinical interview, collateral interview, test administration, and report generation for patients identified by the team. The inpatient rotation volume can be increased if the fellow has an interest in seeing more patients during the patient’s hospitalization. The fellow will also be responsible for presenting preliminary neuropsychological data and recommendations to the team. Further, the fellow will identify patients to be seen in the outpatient neuropsychology clinic 8-12 weeks post discharge. In the outpatient setting, the fellow will conduct the evaluation including clinical interview, collateral interview, test administration (psychometrist support may be available), report generation, and feedback.
Neuropsychological evaluations are performed with patients undergoing hematopoietic stem cell transplant and solid organ transplant (i.e., heart, kidney, liver, and lung). Our evaluations help the transplant team understand whether cognitive and/or psychiatric symptoms will interfere with post-transplant care (e.g., remembering appointments and complex medication regimens). Additionally, etiological factors that may present contraindications for transplant (e.g., neurodegenerative disease) are identified. Occasionally, questions regarding capacity to consent to these procedures are addressed.
Patients include those with mild, moderate, and severe traumatic brain injury, frequently referred by Neurology, Physical Medicine and Rehabilitation, and Family Medicine. The neuropsychological evaluation in those with mild TBIs focuses on differentiating factors that may (or may not) be contributing to cognitive symptoms, assisting with treatment planning, and providing education regarding injury severity and cognitive prognosis. Evaluations of individuals with moderate to severe injuries address ongoing supervision/care needs, accommodations related to level of functioning, and current interventions and the need for additional services.
Sample of a Year 1 Adult Fellow’s week:
|Epilepsy Case Conference
Sample of a Year 2 Adult Fellow’s week:
|Stroke Inpatient Rounds
|Mental Health Outpatient Clinic
|Movement Disorder Outpatient Clinic