Neuropsychology Service

As part of the DBS process, all patients will be asked to attend appointments with the Neuropsychology Service.  We work as part of the Multi-Disciplinary team as Clinical Psychologists.

Neuropsychology is a branch of clinical psychology which deals with the brain, nervous system and psychological functioning. Clinical psychologists work towards understanding:

• How illnesses of the brain and nervous system affect memory, mood and the ability to function in daily life.
• How emotions such as anxiety, stress and low mood affect the brain and nervous system.

Clinical psychologists in Neurology have experience in the assessment and psychological treatment of a wide variety of neurological illnesses. They will typically work closely with neurologists and other health care professionals such as psychiatrists, nurses, physiotherapists and family doctors (GPs). Often the neuropsychologist is able to take a broad overview of the patient’s issues and their care pathway and help services to provide the best care.

Neuropsychology has a role in assessing three important areas that can help inform the team if a patient is a suitable candidate for DBS.

Cognition

This is the word given to describe our thinking abilities including memory, language, attention and problem solving.

We know that some neurological conditions like Parkinson’s Disease can lead to changes in our cognition.

We aim to assess someone’s cognition because we know that:

• DBS can make cognitive symptoms worse in some individuals and this can have a negative impact on day to day life.

• If someone has marked cognitive symptoms, it may make it harder to engage fully in all aspects of the DBS process such as remembering to attend appointments, follow medical advice including making adjustment to the DBS system or make the right and informed decisions for themselves.

• Occasionally, cognitive symptoms can be caused by something other than the neurological condition we know someone has. This may influence medical decisions around care and treatment options.

Mental Health

It is important that we assess your mental health and psychological wellbeing for both the past as well as the here and now because:

• This helps the team understand the best ways that we can support you through the DBS process, including after surgery.

• It may be that we need to take time to prioritise supporting your mental health in the first instance, and DBS may not be the right thing at this time.

• DBS can for some individuals worsen existing mental health problems that may have a significant negative impact on day to day life.

Expectations and hopes for DBS

Motivations and hopes for DBS are different for different people.

It is important that we spend some time understanding what these are for each person who would like DBS to ensure that these are realistic.

It can also be helpful to understand what family, friends and carer’s may be expecting from DBS.

Exact outcomes can be hard to predict and we recognise that some people can be very satisfied whilst others may not notice the change they hoped for.  We like to explore how someone may cope with both of these outcomes and what help they may require in the future.

Opt in

You will receive a letter from the Neuropsychology Service inviting you to attend a clinic with one of the clinical psychologists in the Neuropsychology service.  This will happen after you have seen the Neurosurgeon, Neurologist and DBS Clinical Nurse Specialist at the DBS MDT clinic.

If you do not wish to attend your Neuropsychology appointment, you can decline the invitation. You will continue to be reviewed by the DBS team who will discuss next steps at that point.

The Assessment Process

If you do attend, the first appointment would involve a clinical psychologist meeting with you and your family.

Initial assessment takes approximately 2 hours. It is helpful to attend with someone who knows you well as sometimes, other people can notice things that you are not aware of.   You can of course decide to attend on your own if that is what you would prefer.

We will spend time getting to know you and the different ways your condition affects you day to day.

We would aim to speak to you about:

• Day to day living and support you may require
• Roles and responsibilities you hold and how these may be impacted
• Past and current mental health
• Hopes and expectations for DBS
• Worries or concerns about DBS
• Support networks
• Quality of Life
• Goals

We would also use this appointment to complete a Cognitive Assessment. This involves completing paper and pencil tests that look at different parts of our thinking e.g. memory, attention, language, planning etc.   

We encourage people to be as honest as possible when they attend these appointments so we can be confident that the correct decision is being made about whether DBS is suitable or not.

We appreciate that people can be referred for DBS from all over Scotland and therefore, may have to travel some distance to attend appointments.  Making appointments 2 hours long hopefully allows for as much of this assessment process to be completed in one sitting, and reduce travel.  People are encouraged to take as many breaks as necessary for their comfort.

Whilst it is preferable to see people in person, we recognise that this may not always be possible.  We can in certain circumstances complete these assessment using the video call Attend Anywhere platform.

Outcomes

After all assessments are complete, we feedback the outcome to the wider DBS team in person and also via a written report.

A decision around DBS does not sit solely with the Neuropsychology service, but is a team decision based on all assessments that have been completed.  At the end of the assessment process, you will be asked to attend for a review appointment with the DBS team where the outcomes of assessments will be discussed and a recommendation about DBS made.