Section 1: Information About the Patient

Section 1: Information About the Patient

Patient identification

Name: Mr. Bouvier

Age: 45

Sex: Male

Handedness: Right-handed

Marital Status: Married, has two children

Residence: Home, lives together with his partner

Education: Highest degree obtained is a Bachelor’s degree in Accounting

Work status: Senior Accountant at a financial company

Language: Native English speaker

Referrer: Neurologist

Assessor: Psychologist

The patient was in a car accident two years ago, which has led to cognitive, physical, and emotional problems. As a result, he was referred by his neurologist for neuropsychological assessment by a psychologist. Prior to this, he has not received any treatment. The patient was diagnosed with ADHD when he was nine years old and he has been taking adderall ever since. Moreover, he was diagnosed with Generalized Anxiety Disorder during his late twenties. At the time, he received cognitive behavioral therapy for two years, which helped him manage his anxiety without any medication.Subjective information Anamnesis Cognitive: The patient reports difficulties within the domains memory, attention, and executive functioning. Moreover, the patient mentions a decline in his processing speed. He gives several examples, such as losing his train of thought, forgetting important details, needing reminders, and experiencing trouble calculating family finances. Lastly, the patient also has to read information multiple times before he understands it, this was also present before the car accident but it has exacerbated.Apart from that, there were no cognitive issues prior to the accident. The patient experiences no difficulties within the domains language and orientation.Physical: Patient experiences difficulties with falling asleep, these problems were also present prior to the accident, but they have worsened. Moreover, the patient experiences balance issues and tremor.The patient has frequent headaches that are in various locations on his skull. The patient has high blood pressure and is easily fatigued. Activities of daily living are performed independently. Instrumental activities of daily living are partially independent; he can cook and clean, but struggles with more complex tasks such as managing the family finances.Psychological: Patient experiences anxiety and he needs medication (xanax) to manage. The anxiety symptoms are often present before falling asleep. Patient is less social because he does not want to talk about his limitations. Moreover, he feels lonely and isolated. Patient experiences mood swings and is easily agitated, causing a strain in his relationship with his partner. Furthermore, the patient is often frustrated because he experiences difficulties with performing several tasks. This frustration causes him to lash out verbally. The patient experiences worry and stress about his job perspective.Strengths & weaknesses Strengths include language abilities, orientation, independent ADL, and supportive family. Cognitive weaknesses include processing speed, memory, and executive functions. Psychological weakness include mood problems, frustrations, and social withdrawal. 1 / 2

Collateral report The partner of the patient is present during the interview. They mentioned that the patient experiences memory issues. Moreover, he is easily agitated and tends to lash out verbally whenever the children are too loud. The partner also noticed that the patient is more clumsy, he almost fell when he was walking.Furthermore, the patient is easily fatigued and tends to underestimate his symptoms. The patient used to help his children with their homework, but now finds it frustrating, so he no longer helps them.Moreover, whenever the children are too loud the patient gets irritated and he lashes out. All these factors combined have caused parenting issues. The partner has noticed that the patient is drinking more, he drinks at least one drink at night, but not more than 2-3 drinks a day. The aftermath of the accident is experienced as challenging for his family.Onset and course of the current problems Onset of all cognitive, physical and psychological problems began after the car accident two years ago.Some of the experienced difficulties already existed, however, these have exacerbated after the accident.Objective information Neuropsychological assessment has been conducted to assess the extent of the cognitive problems and the possible interplay of other factors on the patient’s functioning. During the assessment the patient was cooperative, polite and motivated. However, he became easily frustrated and anxious when faced with challenging tasks. Moreover, when the tasks became more difficult, he had the tendency to perseverate. The assessment shows no indications of significant impairments within an entire cognitive domain. Average performance was uncovered within the domains orientation, attention, language, visuospatial cognition and memory. Performance on processing speed tasks were generally low average and performance on mental flexibility tasks were weak. These results explain why the patient has to read information multiple times. Moreover, the processing speed difficulties could explain the experienced memory issues. Processing speed affects how quick the brain is able to process information, when new information is not processed adequately, it will most likely lead to problems remembering information later on (Zaremba et al., 2019). Performance on mental flexibility tasks were poor and not within average performance, suggesting deficits within this area. Deficits within mental flexibility could result in problems adapting to new situations and solving problems (Canas et al., 2003). This might explain why the patient experiences trouble with calculating family finances and calculations at work.Lastly, the assessment showed indications of anxiety and depression. These mood disorders also cause cognitive problems. Moreover, these disorders can also cause fatigue, sleep problems, headaches, and mood swings/ increased irritability (Perini et al., 2019; Wei et al., 2016).Based on the available information, post-concussion syndrome seems to be the most plausible diagnosis, as it explains most of the patient’s cognitive, physical, and emotional symptoms.

Section 2: Problems identification

Problem 1: Processing speed issues affecting work performance

The patient experiences slow cognitive processing speed, leading to miscalculations and problems with keeping up with tasks. The low scores on the Symbol Digit Modalities Task and Wechsler Adult Intelligence Scale (WAIS-IV) processing speed index support these findings.

Problem 2: Executive dysfunction affecting flexibility

The patient experiences difficulties with switching between tasks, solving problems, and adapting to new situations. This has resulted in miscalculations at work and mistakes with family finances. This finding is supported by the weak performance on the Trail-Making Test B and the D-KEFS test.

• / 2