The hospital's neuropsychology service, where Harvell was evaluated, does assessments on adults and children. It is focused on the cognitive and behavioral effects of conditions including head injury, cerebrovascular disease, multiple sclerosis, dementia, brain tumor, Parkinson's disease, epilepsy and attention deficit/hyperactivity. Its expertise is essential in the diagnostic process.
Harvell "is vibrant and carries on a lively conversation," Kerchner said, "and it's difficult in the course of a routine medical appointment to see that there's anything the matter."
"When we look at behavior and the brain, we find there's a complex inner relationship," said Stanford neuropsychologist Gayle Deutsch, PhD. "A lot of our behaviors become automatic over our lifetime, but when we break them apart, there is a great deal of complexity." Deutsch began the process of teasing apart the components of cognition to ascertain where Harvell's problems truly began. That territory includes intellectual and executive function, language skills, visual-spatial abilities, attention, memory, motor skills and mood. Deutsch begins with a set of tests that take into account a full range of demographic information used to distinguish those changes that emerge with normal aging and those linked to neurodegenerative conditions.
The tests themselves are designed to evaluate, in the most straightforward way, how the mind is working. Just reading out loud, for example, won't show much. "Pronouncing words is something that is less sensitive to age-related cognitive decline," Deutsch said. A hallmark of Alzheimer's disease, however, is a decline in the brain's ability to retain new information, so the tests Deutsch administers challenge how long someone can remember a list of words or reproduce a set of shapes, or follow directions. As Deutsch moves to test executive function, she will engage a patient's family and friends for their observations. "Our tests are good at measuring conceptual reasoning and problem solving," she said, "but it's also important to look at everyday behavior. Are people showing social skills appropriate for their age? Sometimes people with different kinds of dementia may seem to be less careful about reading social cues. Or they may become apathetic and show no interest in activities. That can't always be measured in a standardized test."