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Cognition Issues in Veterans: A Primer for Providers

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:

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Cognition Issues in Veterans: A Primer for Providers

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  1. Cognition Issues in Veterans:A Primer for Providers Gudrun Lange, PhD Monica Clement, PhD Lawrence Weinberger, PhD

  2. Acknowledgements • 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

  3. Disclaimer 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.

  4. Focus of this presentation

  5. Presentation’s Significance

  6. Presentation’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

  7. …the Other Side of the Coin

  8. Current State of Affairs

  9. Current State of Affairs

  10. Current State of Affairs

  11. Goals of Presentation

  12. Practical Tips for Providers

  13. Behavioral Indicators of Cognitive 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

  14. Older 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

  15. Middle-Age / Younger

  16. Middle Age – Mild Dysfunction

  17. OEF/OIF Vets

  18. Practical Tips for Providers

  19. Practical Tips for Providers

  20. Conditions that Affect Cognitive Function

  21. Make Sure You Think of Rule Outs

  22. 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 

  23. Case Study: Tom L.

  24. Tom’s Case

  25. Tom’s Case

  26. The Referral for Neuropsychological Evaluation • 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

  27. Assessment of level of cognitive dysfunction

  28. What Should a Consult Request for Neuropsychological Evaluation Include?

  29. What should a consult request for neuropsychological evaluation include?

  30. What should a consult request for neuropsychological evaluation include?

  31. The Neuropsychological Evaluation

  32. Communication 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!!!

  33. Communication 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

  34. Closing the box

  35. Closing the box

  36. Questions???

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