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Neurosurgery Adds Neuropsychology Component

The UVa Department of Neurosurgery has recently hired a neuropsychologist onto its faculty. Dr. Elana Farace did her training at the University of Virginia Departments of Psychology and Neurology and also comes with a background in traumatic brain injury research. Her current clinical and research interests include improvement in outcomes research in neurosurgical populations and neurocognitive functioning of patients with brain tumors.

Advantages of Assessment
What can a neuropsychologist add to an academic department of neurosurgery and what can a neuropsychologist do for your patients? Clinically, a neuropsychologist can assess neurocognitive changes in memory, attention, language, etc. These assessments can be used to:
  • Distinguish mild or subtle neurocognitive deficits compared to the normal population, which may aid in diagnosis
  • Establish a neurocognitive baseline to use in later treatment decisions
  • Quantify patients' neurocognitive deficits to predict the course of the disease and recovery
  • Assist in decision-making on the patient's return to work or school (or the playing field)
  • Suggest proper management in rehabilitation
  • Aid in litigation concerning the patient's cognitive status (e.g., wills, driving, finances, personal injury)
  • Help patients and families understand the neurocognitive effects of the disease process, including improved coping methods and strategies for coping (e.g., memory aids).

In addition, a neuropsychologist can provide assistance when your patients have concurrent psychological or psychiatric problems. Addressing the psychological component in patients is beneficial because:

  • A concurrent psychiatric disorder frequently complicates the medical picture
  • Sorting out neurological symptoms from psychiatric symptoms can aid in diagnosis
  • Psychological recommendations often help patients stay in compliance with their medical regimen
  • Management strategies for dealing with the difficult patient can be suggested
  • Appropriate treatment or referrals for psychiatric or psychological disorders can be made.
On-Going Studies
In addition to the clinical arena, Dr. Farace has had extensive training in research on behavioral correlates of neurologic events. In association with Dr. Mark Shaffrey, director of the UVa neuro-oncology program, two of her current research projects involve the assessment of and psychological support for the families of malignant brain tumor patients. This research is sponsored by the National Cancer Institute at NIH and the Pediatric Brain Tumor Foundation of the United States.

To briefly describe these studies, families of malignant brain tumor patients sustain all the stress of caring for a loved one with cancer, in addition to the stress of caring for someone with neurocognitive deficits (e.g., memory, attention). Neurocognitive deficits have been shown to add a unique and multiplicative burden to caregivers who deal with the Alzheimer's population. The concern with brain tumor patients is that the caregivers may be undergoing a similar extra burden due to patients' neurocognitive deficits. In this unique population, direct intervention with the family is an excellent avenue to improve patient and the family's quality of life.

Emphasis on Caregivers
We are currently accepting both pediatric and adult patients with malignant brain tumors into a study, along with a primary caregiver (typically the parent or spouse). First, we will test the problem-solving, skills-intervention ability in caregivers of malignant brain tumor patients. We will determine if this problem-solving, skill-intervention ability improves the quality of life in the patient and the family. Caregivers of brain tumor patients will receive either a 10-week (50-minute session once a week) in problem-solving, skills-intervention or will be placed on a waitlist for the same period (the usual control condition for a psychotherapy efficacy study). Second, we will study the correlation between cognitive impairment in pediatric brain tumor patients and caregiver burden and quality of life. An interaction among these variables has been shown in the traumatic brain injury, mental retardation and dementia populations. If this correlation is also found in brain tumor patients, it will help us further target specific family-centered interventions. A significant improvement in brain tumor patient and/or family caregiver quality of life will have important implications for improvement in the medical and psychological care of patients with brain tumors and the quality of life of their families.

Elana Farace, Ph.D., (434) 924-2203; ef6p@virginia.edu

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