ST DOMINIC-JACKSON MEMORIAL HOSPITAL
DATE OF CONSULTATION: 02/27/97
Jolynne Burns is a 32 year old left handed white female seen at Dr. Fredericks request for neuropsychological exam and consultation. Review of records indicates suggestion of neurodegenerative process and possible cerebellar dysfunction.
On examination, Mrs. Burns is alert and oriented. Her speech is somewhat slurred but intelligible. She does exhibit certain degree of spasticity as regards to motor coordination and has obvious difficulty with some motor coordination tasks on casual exam but interestingly at times, demonstrates limited appreciation for those difficulties. She is a reasonable historian although vague with some historical events.
She maintains that her condition began some time in 1991 or 1992 and she attributes it to a fall in which she hurt her foot while she was walking down a staircase. She is somewhat tangential on presentation at this point. I had a long discourse about living in an apartment vs. a house. She also notes an additional fall presumably around the same time, when she fell in the bathtub and hit her head but there is no indication of loss of consciousness. There is indication of an apparent nervous breakdown in '91 or '92 and she was hospitalized at Mercy Hospital in Oklahoma City for some two to four weeks with an apparent unspecified diagnosis. St. Dominic's Hospital has requested hospital records from that stay. At the time she was managed with Haldol and there may have been some auditory and visual hallucinations at the time. She was also tried on Risperdal and lithium but again, I have no specific records on that.
Mrs. Burns maintains that her sleep is generally good when her husband is home and she maintains that her appetite is good. She does not voice any specific mood complaints and denies any sort of morbid and/or suicidal complaints. She is somewhat concrete and presentation and tangential as was noted above. She maintains that she is independent in all self case.
Her husband's completion of adult neuropsychological history which includes a symptoms survey indicates apparent observation of longstanding (greater than one year) difficulties with problem solving, speech and language, concentration, memory, and particular motor coordination (endorsement of items in the category of motor coordination is by far the most frequent category endorsed). He also indicates some affective complaints in the order of mild anxiety and depression and moderate sensitivity to stress and/or demands.
In review of early history, apparently there were no obvious difficulties with reaching developmental milestones. She apparently had the usual childhood diseases but there is indication of a fall at age 5 in which Mrs. Burns maintains she fell from a truck. There is no indication of loss of consciousness or serious injury to the head, however.
There is no indication of family history of any sort of neurologic or psychiatric disorder. There is no indication of significant alcohol or drug history.
Testing from 02/27/97 is as follows.
Mrs. Burns exhibits moderate to significant difficulty for verbal span of attention and is around the 14th percentile for that task. She, however, is performing within normal limits for visual span of attention task in roughly the 58th percentile for that task.
For measures of receptive language, she performs adequately on a shortened version of the Token Test (35/36 items responded to correctly). Visual confrontation naming is adequate although perhaps slightly below expected level of performance and she does exhibit mild to moderate difficulties for controlled oral word association and verbal fluency task.
Her performance on the Wechsler Adult Intelligence Scale - Revised (WAIS-R) verbal portion reveals borderline level performance (IQ score for verbal is 76). She seems to exhibit relatively greater degree of difficulty for complex verbal expressive tasks and seems to be operating on more of a concrete level for these tasks.
Her performance on the Wisconsin Card Sorting Test is impaired suggestive of significant difficulty with acquisition and significant difficulty with the ability to adapt to changing demands of this task. She is able to complete one correct category sorting 13 trials but seems to persist with that problem solving decision and is not able to generate alternate problem solving rules even with changing demands.
Her performance on the Wechsler Memory Scale - Revised is as follows. She performs in the impaired to borderline range for measures of attention and concentration of which were noted above. Immediate recall for verbal information was the impaired to borderline range, for visual information is in the borderline range with no significant difference between the two measures. Comparison of immediate recall indices vs. delayed recall indices does not suggest significant differences, both are basically in the impaired to borderline range suggesting poor performance as regards to acquisition and/or consolidation of information.
Her performance on the California Verbal Learning Test also suggested difficulty with acquisition and/or consolidation of novel information. On this list of 16 words presented across 5 trials she recalls 5/16 words on trial 1 and improves to 7/16 words at trial 5, both levels of performance being below expected level of performance. She demonstrates proactive and retroactive interference affects and in general her performance on series and delayed recall and recognition level measures indicative of impaired performance.
Her performance on the visual form discrimination task suggests difficulty with visual acuity. Additionally, performance on a series of motor coordination tasks, grooved peg board task, grooved peg board task for the dominant hand, trial making task using the dominant hand, all suggests significant difficulties with complex motor coordination.
Her completion of Personality Assessment Inventory, which involved the assistance of significant other, is considered to be valid. She does not voice any significant nervous or emotional complaints. Her primary focus is on health problems in terms of the initial clinical scales, subscale elevation suggestive of low tolerance to stresses and/or demands and mild to moderate physiological manifestations of anxiety and mild phobic reactions. These are all suggestive of mild to moderate anxious condition. She also demonstrates some irritability but she really does not endorse items reflecting significant depression.
In summary then, this 31year old white female does exhibit moderate to significant difficulties with attention and/or concentration measures and seems to be impaired for measures of reasoning and/or problem solving and memory function along with difficulties with any measures of complex motor coordination.
Personality testing yields results as were noted above that suggests certainly reasonable concern regarding health status but also to a lesser extent the manifestation of some anxious components. Her clinical presentation is somewhat concrete and/or tangential and I think she demonstrates a limited appreciation for cognitive deficits and perhaps her overall emotional or psychological state. I am very curious as to records from previous psychiatric hospitalizations and think that might shed some light on the history of her condition.
Thank you very much for the opportunity to evaluate this patient.