CNA: Meet our Clinic for neuropsychological exams addressed to children, adults and the elderly

CNA: Meet our Clinic for neuropsychological exams addressed to children, adults and the elderly

The CNA evaluates children with learning problems to adults and elderly people with cognitive and memory complaints

The year was 1992, 18 years before the creation of the D’Or Institute for Research and Education (IDOR), when a small clinic in Rio de Janeiro, Brazil, began performing neuropsychological tests aimed at children with learning difficulties. One of the competitive advantages of the clinic was the fact that it was the first service in the country where each patient was analyzed by a multidisciplinary team of physicians, psychologists, and speech therapists. This was the beginning of the Center for Applied Neuropsychology (CNA, in Brazilian Portuguese).

Working until the present day and an integral part of IDOR since the conception of the institution in 2010, the CNA is a pioneering nucleus with relevant international contributions in the field of learning disorders and other problems that affect cognitive functions, not only in children but in adults and the elderly.

When CNA emerged in the early 1990s, diagnoses of learning disabilities, Attention Deficit Hyperactivity Disorder (ADHD) and even autism were very uncommon and far from popular vocabulary in Brazil. Poor school performance was commonly attributed to disciplinary and psychological problems, and children and teenagers with difficulties at school were sent directly to psychotherapy, without proper investigation of possible primary learning problems, such as dyslexia, for example, which is a neurobiological disorder that affects reading and writing performance.

“Of course, the child will not be interested in studying or will have a great chance of living with low self-esteem due to frustration. Everyone understood the test and they didn’t, because they have dyslexia, and will get low grades even though they’ve studied. Before considering that this is a psychological problem and addressing the child to therapy, it is necessary to be sure that they don’t have what we call a learning disorder, such as dyslexia, dyscalculia, and even ADHD – which is not a learning disorder, but often causes school problems due to concentration difficulties”, comments Dr. Paulo Mattos, psychiatrist, researcher at IDOR and founder and clinical director of CNA.

Dr. Paulo Mattos had the idea of putting together a multidisciplinary team to diagnose cognitive difficulties after having contact with the neuropsychological examination during his master’s degree, when his studies evaluated the cognitive functions of people with HIV and AIDS at a time when there were no current antiretroviral therapies. Patients, at the time, brought many complaints about concentration and memory, and there were few resources to evaluate and measure these reports.

“Many complaints in my area are immaterial, that is, they are not objective, clear, or well-defined. Fever, weight loss, and hair loss, are material symptoms that you can measure and quantify, but evaluating an ‘I am very forgetful’ is more difficult. Are you forgetful concerning what? In comparison to others? In comparison to what you were before? You can also be a very anxious person, and you think you are getting forgetful. It is necessary to take these complaints and objectively quantify them, make them material”, explains the psychiatrist, emphasizing the clinical relevance of the tests and questionnaires applied to patients.

Later, during his doctorate, Mattos used neuropsychological assessments in another population, this time elderly people with memory complaints. The challenges were even greater, as it was necessary to distinguish whether forgetfulness was due to age or whether it was a pathological process, like dementia and other neurodegenerative diseases, such as Alzheimer’s. The contact with this new challenge made the CNA incorporate the examination and diagnosis of adults and elderly people with memory problems, thus creating the sector that goes by the name of Memory Clinic, following the same multidisciplinary evaluation pattern applied to other services, in addition to performing additional tests, such as neuroimaging.

Relevance of Early Diagnosis

Early diagnosis is a relevant factor in many cases of cognitive complaints, whether in young or elderly people. In preschool children (under 7 years old), it is possible to map how cognitive development is going. At that age, despite the difficulty in establishing a diagnosis, it is already possible to say whether attention, discrimination of colors and geometric shapes, initial calculation capacity, and motor development are evolving according to what is expected for their age, signaling to parents any area that needs to be more stimulated.

In the case of Autistic Spectrum Disorder (ASD), identifying the problem early enough can be of great benefit to the child. “In most little children, after 6 months there may be one or the other symptom, but isolated symptoms of autism occur in the general population. What professionals call autism is a combination of several symptoms at the same time. And this only becomes clearer around 2 to 3 years old. At the CNA, from the age of 4 it is already possible to carry out an evaluation and, if the hypothesis is confirmed, indicate an early treatment. Because the sooner you intervene, the better the adaptation and the result for the child”, explains the clinical director.

In the elderly, discovering a degenerative process early can have a great impact on the quality of life of the patient, and also of the family, because the medications and therapies currently available on the market only show relevant effects in the early stages of the disease. For this population some biological markers can be identified, complementing the neuropsychological tests. The CNA / Memory Clinic offers patients over 55 years of age two other tests necessary for this diagnosis, which are neuroimaging and the examination of biomarkers in the cerebrospinal fluid (CSF).

Recently, IDOR acquired the most recent and ultrasensitive technology for the evaluation of blood markers, the SiMoA, which should allow the replacement of the CSF test by the blood test in the future, which will be more practical and less invasive for patients. The device is one of the only ones in Brazil, and IDOR is part of the international effort to validate the equivalence between the markers found in the blood exam and those in the CSF exam, creating a reliable database to establish the normality intervals between the markers of the Alzheimer’s disease, among other pathologies.

Dr. Paulo Mattos also points out that all diagnoses that are made in childhood and adolescence can also be made at the CNA by adults and elderly patients. “We even have a line of research on ADHD in the elderly. In the past, it was thought that it was something restricted to childhood, but a few years ago it was discovered that it could persist in adults and even in the elderly. As ADHD causes memory difficulties, it is one more factor to evaluate in elderly people with complaints: is the memory problem due to age, to some pathology, or is it something that already came from ADHD? This distinction is even more challenging”, shares the psychiatrist.

Increase in ADHD and autism diagnoses

In recent years, a large increase in the number of diagnoses of autism and ADHD has been observed worldwide. In the United States, the number of young people diagnosed with ADHD has grown by 50% in the last decade, while the identification of autism in the country has gone from 1 in 150 children, in the 2000s, to 1 in 36 children today. The greater awareness of these conditions may be linked to the increase in diagnoses, however, it is possible that these numbers are exaggerated, resulting from inadequate evaluations, carried out with little methodology. The clinical definition considers a collection of factors, and it is common for many people to present some symptoms of autism or ADHD without characterizing the diagnosis. The prescription of unnecessary drugs with the potential for dependence is the most worrying factor in improper diagnoses, and this underlines the importance of a reliable test based on detailed and updated methodologies.

From tests to multidisciplinary diagnosis

When the patient arrives at the CNA / Memory Clinic, he is initially seen by a doctor, who raises some diagnostic hypotheses based on the complaints presented. From this, specific tests are selected and applied for the suggested condition, with psychologists and speech therapists, according to each case. At the end of these exams – which can last up to 8 hours –, the team meets with all the professionals who participated in the evaluation and each case is discussed until a diagnostic consensus is reached.

In addition to tests, the collection of reports is also an important source for evaluation. Specific questionnaires are applied to all patients from 4 years of age, and other questionnaires about the patient are applied to people close to them, such as children and spouses in the case of adults and elderly people, and parents and teachers in the case of children. and teenagers.

“Another very challenging thing is reconciling the reports. In the parental report, a young mother with one or two children does not have a lot of experience in knowing how a child of that age should be behaving, unlike a teacher who has been working for over 20 years. These professionals have a much more accurate idea that there is something ‘different’ from what is expected for that age group. But the classroom context is completely different from the home context, so some things that the teacher sees, the mother may not see and vice versa, so we collected information from two different environments and the patient himself”, details Mattos.

The test selection at CNA is methodological and in line with scientific literature updates, but Dr. Paulo Mattos points out that the accuracy of the diagnosis and the results of the treatments are merits of the discussion carried out by his qualified team. “I can apply an attention test and get a result lower than expected, but that doesn’t mean the person has ADHD. People may have inattention because they are depressed, because are drug users, or because they had a traumatic brain injury. So the test alone does not say anything. It takes someone with experience to interpret the results. As we apply about twenty, thirty different tests for each patient, it is a very complex analysis ”, he points out.

Since the CNA was invited to be part of IDOR, in 2010, the members of the multidisciplinary team have participated in the Institute’s research projects, which promotes a higher level of scientific updating in the group than is generally observed in attendance clinics. “When Fernanda [Tovar-Moll, co-founder and president of IDOR] invited us to be part of IDOR, the issue of incorporating research into customer service was a great advantage. Since then, all our professionals, in addition to evaluating patients, are also involved in some area of research”, concludes the researcher.

In case of complaints or suspicion of learning, cognitive or memory problems, patients or their families can schedule evaluations through the CNA at +55 21-2295-3796 / 21-2295-0806 / 21-99309-1243. The Clinic is located in Botafogo, in the capital of Rio de Janeiro.

To better understand the schedule, procedures and indications of the service, first check out the website