Patient Case C – Neuropsychological profile summary
Background info: Biopsychosocial
- Biological info:
o Age 61
o Cognitive functioning: decreased in 2 years (largest decrease in 1 year) –
reported by sister
- Psychological info:
o Functioning: not able to care for self (reported by neighbor/sister)
- Social info:
o Occupation: independent financial advisor
o Education: studied law (assume bachelor degree)
o Financial problems (reported by sister)
o Social network depleting due to strain on relationships
Medical historical background:
- no evidence of particular event/trigger
- no mention of cognitive/physiological issue in last 2 years (no health complaints)
Presentation during session:
- Affect: no presence of distress, mild positive mood, talkative, relatively calm internal
state is he aware of how he feels? (self-awareness)
- Non-verbal behaviour: use of hand gestures, some eye contact, somewhat fidgety
(frequent movement in the chair)
- Verbal behaviour: talkative, jumping from idea to idea (inattention)
- Interaction/connection with reality: able to respond and engage with doctor
- Acknowledgement/recognition of problem: does not have clear insight into why he is
there.
- Self-awareness: unsure if he is self-aware of his reported issues, does not seem
distressed/agitated by being in hospital
- Motor/physical impairments: none observed, speech/movement appear normal
- Attention: unable to focus on the questions asked, unable to complete train of
thought or answer directly to questions
- Communication: speaks and reacts to doctor but does not answer directly, seems to
avoid directly answering questions (denial?),
- Intelligence/language level: uses verbose language but seems to be an act rather
than naturally occurring (overcompensation for cognitive decline – implies level of
insight).
, - Hypothesis of cognitive functioning (e.g. cognitive dysfunctions not diagnosis)
o We suspect there is an issue with his executive functions (e.g. adaptable
thinking, planning, self-monitoring, self-control, working memory, time
management, organization) –
o specifically self-awareness/self-monitoring – including his perception of the
aspects of self (e.g. traits, behaviors, feelings)
- Question to ask patient to test hypothesis
o Are you having any difficulties managing your daily life?
o If yes: then he does not have issues with self-awareness (might be attention
problem or something else)
o If no: then his self-awareness of his situation is impaired and he does not
recognize the changes in his life (might need to further assess memory of
recent events in last 2 years)
Profile Summary:
C is a 61 year-old man who worked as an independent financial advisor and studied law. He
was admitted to hospital because he is unable to care for himself, according to his sister and
neighbors. His sister has observed decreases in his cognitive function for the last two years
with the most rapid decline in the last year. She suspects he has had long-standing financial
problems and his social network is no longer able to support his deterioration. In the initial
interview, C displayed no obvious speech or motor deficits. He was able to communicate
and acknowledge the doctor. However, he attempted to answer her questions but often did
not answer to them directly and veered away from the question at hand. He used verbose
language which did not appear natural or appropriate and seemed forced. His speech
pattern was relatively fast and jumped from idea to idea without completing full coherent
sentences. His non-verbal behaviour displayed some signs of fidgeting/ restlessness by the
use of fast-moving hand gestures and head movements. His affect appeared normal and
relatively mild. He did not present with signs of distress or agitation.
1. What does he suffer from in daily life?
- Does not recognise problems of daily living (focused)
- Admitted due to family concern
- Appears to be financial prolems and ability to work (unclear severity)
2. How big/small is the burden in daily life?
- Appears to be financial/social/work problems (unclear severity)
- From answers on test appears burden would be severe
3. In what way do his/her problems limit her in daily life?
- Unable to work, be finically stable/independent, have meaningful give and take conversations
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