Not long after I wrote (here) about the results of my August 2013 neuropsychological examination, I shared those results with my faith community that has been accompanying me on this journey with cognitive impairment. Carol, a friend from the community who is also a neuropsychologist, offered to review the official report I’d received from the National Institutes of Health (NIH).
In her professional capacity, Carol administers and interprets the same tests so I was grateful for her offer. After reviewing the results, she told me she disagreed with the NIH interpretation and that the examination showed clear evidence of cognitive impairment.
On the one hand, her comments shocked me. I’d studied the results of the examination, which comprises multiple separate test items. All but one individual item had been within normal limits. How could the overall examination, then, show impairment? On the other hand, because her conclusion confirmed my own experience of impairment, it left me feeling less crazy and paradoxically relieved.
Just before my recent trip out West, Carol and I sat down and went over her interpretation of the test results item by item. The following is my summary of our conversation.
My IQ was 133, which the narrative described as “superior.” The importance of my IQ, she said, is that it affects the interpretation of some of the individual test in the rest of the evaluation. Considering my overall IQ, the scores of a number of the individual items should also have been considerably higher than the normal range. Many of my scores, however, were only slightly better than average, some of them were below average, and one was so low as to be outside the normal range.
For example, the tester read me a “story” comprising fifteen to twenty discrete “pieces” (for instance, in the sentence “He got up from his chair and left the room” there are two pieces, “getting up” and “leaving.”) I was to re-tell the story, including as many pieces as possible. The normal range for this test is to remember anywhere between 7 and 13 elements. I remembered only 8, still within normal range. Carol said, however, that a person with my IQ should be able to remember at least 13 elements. In other words, taking my IQ into account, my low-normal score indicates impairment in that particular area that measures a certain kind of memory.
Part of the official report is a narrative account in which the interpreter summarizes the implications of the evaluation as a whole. The report, Carol felt, was too brief and did not explore the inconsistencies that Carol had noticed.
Her conclusion was unequivocal: the testing that had previously been interpreted as showing no impairment did in fact show considerable impairment.
Carol’s report has been quite important for me emotionally, which I’ll look into in my next post. I realize that I’m just choosing one expert’s opinion over another’s without having the professional expertise to evaluate one over the other. The NIH version, however, makes me feel crazy, and I’m not crazy. For now, I’ll stick with not feeling crazy.