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Cognition Issues in Veterans: A Primer for Providers. Gudrun Lange, PhD Monica Clement, PhD Lawrence Weinberger, PhD. Acknowledgements. We would like to thank the following individuals for their valuable contributions during the development of this presentation: - PowerPoint PPT Presentation
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Cognition Issues in Cognition Issues in Veterans:Veterans:
A Primer for ProvidersA Primer for ProvidersGudrun Lange, PhD
Monica Clement, PhDLawrence Weinberger, PhD
AcknowledgementsAcknowledgements We would like to thank the following
individuals for their valuable contributions during the development of this presentation: Psychology Staff of the Mental Health and
Behavioral Sciences Service at the New Jersey Health Care System
Social Work Staff of the War Related Illness and Injury Study Center in New Jersey
DisclaimerDisclaimer
The views expressed in this presentation are those of the authors and do not reflect the
official policy of the Department of Veterans Affairs or US Government.
Focus of this presentationFocus of this presentation
Presentation’s SignificancePresentation’s Significance
Presentation’s SignificancePresentation’s Significance Influx of a large number of younger
OEF/OIF/OND Veterans with complex health conditions Positive screens for probable history of
PTSD, TBI, Substance use/abuse Need to be sensitive to slowed information
processing and poor attention affecting decision making and multi-tasking
Veteran safety and possible rehabilitation
……the Other Side of the Cointhe Other Side of the Coin
Current State of AffairsCurrent State of Affairs
Current State of AffairsCurrent State of Affairs
Current State of AffairsCurrent State of Affairs
Goals of PresentationGoals of Presentation
Practical Tips for ProvidersPractical Tips for Providers
Behavioral Indicators of Behavioral Indicators of Cognitive DysfunctionCognitive Dysfunction
Veteran is not able to pay attention and concentrate…eyes are wandering around
Veteran seems to be confused Veteran doesn’t seem to get what I am saying Veteran asks me to repeat everything I’m saying Veteran is not compliant with medications Veteran is not able to accurately recall the
meeting with me
Older VetsOlder Vets Repeats stories/questions within
5 – 10 minutes Word-finding difficulty (uses
description or sentence to substitute for single word) Routine tasks becoming challenging Novel activities are perplexing; can not be mastered
with repetition Spouse/family reporting difficulties but vet dismisses
concern in an angry tone Impaired judgment / deterioration in driving skills
Middle-Age / YoungerMiddle-Age / Younger
Middle Age – Mild Middle Age – Mild DysfunctionDysfunction
OEF/OIF VetsOEF/OIF Vets
Practical Tips for ProvidersPractical Tips for Providers
Practical Tips for ProvidersPractical Tips for Providers
Conditions that Affect Conditions that Affect Cognitive FunctionCognitive Function
Make Sure You Think of Make Sure You Think of Rule OutsRule Outs
Case Study: Tom L.Case Study: Tom L. 77 year old, married, white male. Brought to Neuropsychology clinic as wife
complained to his PCP about Tom becoming progressively more forgetful and irritable at home.
College graduate Retired from a sales job x 13 years. Extensive travel in retirement & socially active, but now more reclusive. Interest in gardening maintained Hypertension- labile for years, now well-controlled x 3 years
Wife’s examples of changes in behavior
Tom repeats stories during the course of a visit which irritates guests Prone to speak less precisely, describing objects by function rather than
name
Case Study: Tom L.Case Study: Tom L.
Tom’s CaseTom’s Case
Tom’s CaseTom’s Case
The Referral for The Referral for Neuropsychological Neuropsychological
EvaluationEvaluation Quote from Dr. Rodney Vanderploeg:
“Refer if the evaluation/referral will: Tell you something you don’t already know Make a difference in the patient’s treatment or management”
Referral for neuropsychological evaluation Take rule outs into account Check for prior evaluation by Mental Health, Behavioral
Medicine or Neuropsychology Consider severity of symptom presentation and safety concerns
Assessment of level of Assessment of level of cognitive dysfunctioncognitive dysfunction
What Should a Consult Request for What Should a Consult Request for Neuropsychological Evaluation Neuropsychological Evaluation
Include?Include?
What should a consult request for What should a consult request for neuropsychological evaluation neuropsychological evaluation
include?include?
What should a consult request for What should a consult request for neuropsychological evaluation neuropsychological evaluation
include?include?
The Neuropsychological The Neuropsychological EvaluationEvaluation
Communication is KeyCommunication is Key If you suspect cognitive
problems in a Veteran, make sure to communicate in a variety of modalities Written Verbal Let them try out or repeat what you asked them
to do Keep our Veterans safe!!!
Communication is KeyCommunication is Key Talk to the Veteran about his/her cognitive
problems and possible referral to a Neuropsychologist
Demystify cognitive dysfunction “Am I stupid now?” “Do I have Alzheimer's?” Offer Reassurance
Closing the boxClosing the box
Closing the boxClosing the box
Questions???Questions???