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Mercer Psychology and Neuropsychology, located in Lawrenceville, New Jersey, is currently mostly operating via telehealth (i.e., secure internet connection with video and audio) for initial visits, counseling, and feedback for neuropsychological evaluations, as well as limited weekly office hours. As of July, 2024, thirty-three people are on the waiting list for counseling, and the next opening for a neuropsychological evaluation is in October, 2025 (with a standby list for earlier openings).
About Neuropsychology
Neuropsychological evaluation is a way to understand the brain by showing how the brain is functioning. The two primary situations causing people to have a neuropsychological evaluation are:
1) To better understand the effects of an injury or disease you have.
2) To find a disease not apparent from your medical and neurological work-ups.
For you, the neuropsychological evaluation is a key to reveal more about what is going on with your brain and how to function better.
So, you already know you have a condition
affecting the brain, such as:
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Brain injury or confirmed concussion
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Stroke or transient ischemic attack
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Multiple sclerosis
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Parkinson's disease
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Seizures or epilepsy
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Dementia
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Hydrocephalus
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Brain tumor
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Other conditions of the brain
When you already know what's wrong
Or you may have a medical condition that affects the brain, such as diabetes, sleep apnea, high or low blood pressure, or kidney or liver problems, and are also noticing cognitive problems that might result from these conditions. Anxiety, depression, bipolar disorder, and schizophrenia also affect thinking and memory.
For you, the neuropsychological evaluation is about better understanding the effects of what you are dealing with. At the end of the evaluation, you should have a clear sense of your strengths and weaknesses, and of how serious your weaknesses are. I try to figure out how you can use your own strengths to compensate for your weaknesses, as well as what tools you can use to improve your daily functioning. I will also address specific questions about activities, such as returning to work, including potential accommodations for your own position.
When you don't know what's wrong
The other common reason for an evaluation is that you - or your family - sense something is different in your thinking or memory or speech but it is hard to know whether it is normal aging, stress, or the beginnings of a disease like Alzheimer's. Or maybe you were in an accident or had a fall and you are not sure whether the mental changes you notice are from concussion, pain, disrupted sleep, or the stress of being injured. A neuropsychological evaluation can clarify what is going on and how to help you recover. For you, I carefully consider your history and symptoms as I analyze your results and compare them with the patterns we normally see in various diseases affecting the brain, such as:
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Alzheimer's disease
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Concussion (if suggested by your history)
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Dementia with Lewy bodies
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Frontotemporal degeneration
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Primary progressive aphasia
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Vascular dementia
There are many, less common diseases to consider as well.
We can have three outcomes in your case:
(1) Your results appear normal compared to others your age. If your problems worsen in the future, we can use this as a baseline evaluation to compare with future results. (That is, if you are stable or improved in the future, we know you don't have dementia.) I would also talk to you about how to manage the cognitive changes that caused you to see me.
(2) It looks like a specific injury or disease. In this case, we talk about the disease you may have, how you and your loved ones can best manage it, and the importance of having your physicians rule out other conditions.
Like this bird, you may not know what direction you are going, You sense something is wrong, but where do you go next? A neuropsychological evaluation gives you information so you can move forward with your life.
(3) It's unclear - you are not showing widespread or severe enough problems to indicate a disease, or you have conflicting results making it difficult to figure out what is going on, or other conditions - such as sleep apnea or depression or diabetes - may be the source of your symptoms. In this case, we discuss the possibilities and the reasons I am not sure what is going on, and I make recommendations for managing your symptoms and other relevant conditions. If you worsen, we can repeat parts of the evaluation to see what has changed, which helps us zero in on possible causes for the decline you are experiencing.
Of course, there can be other reasons for evaluation, such as (1) clarifying emotional versus medical contributions to your symptoms or (2) addressing legal issues (effects of an injury, competence to make legal or medical decisions).
What should I expect in a neuropsychological evaluation?
Evaluations are non-invasive, painless, and interactive; other than a few breaks, I am with you throughout. Plan on an entire day - or two half days - with a later visit to review the results and recommendations (you will receive a written summary at that time). Very little is computerized or requires your writing; I will act as your secretary, writing down your responses. You will find parts easy, but at other times you will find it difficult. Feeling stuck or challenged or frustrated is entirely normal: I am trying to identify strengths as well as weaknesses, and the only way I know you are especially strong in something is to watch you do things most people cannot do. A completely healthy person will have a few areas of weakness, so I will study your data - compared to healthy people your age - and your history and compare and contrast what we've learned with known patterns of brain functioning and neurological disease to determine whether we should be concerned about your symptoms and cognitive weaknesses.
We typically look at:
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Hand speed/dexterity
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Analysis of visual information
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Language
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Attention
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Processing speed
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Memory
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Problem solving and reasoning
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Emotions
What does a neuropsychological evaluation tell us that a brain scan may not reveal?
A neuropsychological evaluation gives us concrete information about how your brain is functioning. These evaluations can often find the effects of dementia or traumatic changes even when the damage to the structures of the brain is not yet obvious in many brain scans (of course, brain scan technology is improving quickly).
Even the best brain scans may not be specific: that is, they show a problem but it could be emotional or neurological. A neuropsychological evaluation makes the cause clearer, especially when depression, anxiety, or stress is a possible factor.
Do you provide forensic evaluations and Independent Examinations?
Although I have never developed a primarily forensic practice, I have experience in forensic evaluations and Independent Psychological and Neuropsychological Evaluations. I have testified in depositions and given both in-person and video-recorded court testimony.