The report is a thorough and accurate presentation of what is observed in the assessment interviews, in order to convey to the recipient's findings, conclusions and suggestions based on data obtained and analysis, according to a theoretical framework. The report has several purposes. In principle, allows the tracking performance and cognitive status of the subject, which serves both for clinical and experimental laos. On the other hand, is a useful tool to guide the systematic, the "return." Finally, the document to be delivered to the patient or, if this has been derived, the attending physician, therefore, must be written in understandable language, with technical terms, if any, accompanied by explanations and theoretical foundations that support them.
structure and content of the report:
The contents of the report varies according to the purpose for which it was requested the evaluation, differential diagnosis, monitoring, research, rehabilitation plan, etc.
is usually preferred to group the results according to the involved areas (memory, attention, language, etc.), Which allows to develop the cognitive profile of patients , planning intervention strategies and monitor changes over time.
There are two trends with respect to the amount of data to be included in the neuropsychological report. On one side are those who think that the key is to describe the cognitive performance, detailing the status of each of the functions assessed, but without mentioning the scores, except where expressly requested. On the other hand, some authors argue that lays the importance of standardization and standardization of the techniques at the time of neuropsychological assessment schedule scores are essential and whether it should be included. However, taking into account both trends, the report includes the following sections as a rule:
1. Heading .- is the first part and usually contains:
patient data: name, age and education.
Reason for assessment and if there were previous assessments.
examiner Name
2. Methods: listing (and description if necessary) of the procedures or techniques used.
3. Results orderly and detailed exposure data collected (according to the logic from the theoretical framework), based on explicit evidence in the previous section. In case of a reassessment, to compare with previous results.
4. Conclusions: part of the report, which summarizes the findings that emerge from the analysis of the data.
We must remember that the neuropsychological assessment works and / or confirms the diagnosis, so the results should be interpreted both in the context of clinical history and neurological examination. In analyzing the results, it is important to study and include the performance baseline (premorbid) of the subject, to compare it with the current. In general to estimate premorbid intelligence capabilities are used more resistant and / or less vulnerable to cognitive dysfunction, such as tests of vocabulary and other verbal skills related: reading test, sub-items of the WAIS verbal, that we will indicate the intellectual level that reached the subject. Is then calculated, based on the score but can and are compared with it all other scores obtained by the patient. The report, therefore, must include an opinion with respect to:
1. current cognitive status represents a decline from a previous level.
2. elements that may help clarify whether this decline corresponds to organic factors, functional or emotional
3. The impact of changes in activities of daily living.
BIBLIOGRAPHY:
From the book "Neuropsychological Assessment" (2008). Debora I., Marina A., Drake and Paula Harris. Buenos Aires: Argentina. Editorial: Paidós.
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