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Behavioral Neurological Assessment

Report of a Commission of the Swiss Society of Behavioral Neurology

Introduction

The TARMED list contains three items related to Behavioral Neurology and Neuropsychology:

05.0040: Comprehensive specialist behavioral neurological assessment and evaluation of tests performed by other experts (45 min., quantitative value 7).
05.0050: +Assessment by a specialist who performs the assessment (105 Min., quantitative value 7).
05.0060: Mental state examination by a specialist (Value 6)

 

The scale of these assessments, in particular the comprehensive behavioral neurological assessment, is defined only by time and the quantitative value. More specific criteria were not set. In accordance with the managing committee of the Swiss Neurological Society, a commission of the Swiss Society of Behavioral Neurology has addressed this issue and has produced the present report. It contains the following paragraphs:

a)Definition of Behavioral Neurology
b) Content of a comprehensive behavioral neurological assessment
c) Mental state examination by a specialist
d) Elements of a complete behavioral neurological evaluation
e) Training in Behavioral Neurology

a) Definition of Behavioral Neurology

Behavioural Neurology is a subspecialty of Neurology which deals with the evaluation and treatment of mental disorders, i.e. disorders of thinking (cognition), behavior, and emotional experience. Its main purposes are:

  • To provide a clinical assessment of disorders of mental function caused by an injury to the brain;
  • To explore the anatomical and biological basis of mental disorders;
  • To examine the pathogenesis of mental disorders;
  • To indicate aetiological factors;
  • To comment on course and prognosis of mental disorders;
  • To make recommendations regarding therapy and rehabilitative approaches.

b) Content of a Comprehensive Behavioral Neurological Assessment

Behavioral Neurologists use assessment methods that are adapted to the clinical question and situation and that allow for the assessment of the severity and (state of scientific knowledge permitting) the pathophysiology of mental disorders.  The assessment needs to be performed and documented with such precision that it can serve as a baseline for future reevaluation which will document the course of the mental disorder. A comprehensive behavioral neurological examination should assess the following mental functions:

1. Attention and Orientation

  • Vigilance, arousal
  • Sustained attention and divided attention
  • Directed attention
  • Orientation to time, place, situation and personal information
  • Nosognosia (insight into the own state)

2. Executive functions and Behavior

  • Description of behavioral characteristics (social behavior, concentration)
  • Drive
  • Planning
  • Flexibility
  • Inhibition of automatic reactions
  • Abstract thinking
  • Judgement
  • Modulation of social behavior
  • Neuropsychiatric disorders

3. Spoken language

  • Speech production: 
  • Spontaneous speech: fluidity, paraphasias, syntax, articulation
  • Automatic speech
  • Repeating words and sentences
  • Naming stimuli in different modalities
  • Prosody, singing
  • Comprehension

4. Written language

  • Writing words, numbers and sentences
  • Reading (visual and auditory)

5. Language-associated functions

  • Arithmetics verbal and written
  • Body schema

6. Praxis

  • Ideomotor praxis (transitive and intransitive movements; different command modalities)
  • Buccofacial praxis
  • Ideatory praxis

7. Spatial and constructive functions

  • Visuoconstructive functions (constructive praxis)
  • Perception of spatial relations
  • Spatial exploration (perception of body and space)
  • Orientation in space (topographgnosie)

8. Perception and Recognition

  • Visual perception and recognition of objects, colors and faces
  • Tactile perception of objects
  • Auditive recognition of sounds in the environment

9. Memory

  • Immediate memory (short term memory, working memory)
  • Learning (encoding) of verbal and non-verbal material (anterograde amnesia)
  • Recall and recognition of newly learned material (anterograde amnesia)
  • Recall of remote information from episodic and semantic memory (retrograde amnesia)
  • Implicit memory

c) Mental Status Examination Performed by a Specialist

The mental status examination is a limited assessment that has to be adapted to the clinical question and situation.  It can be used to assess and classify relevant mental disorders and provide information about the course of a mental disorder.

d) Elements of a Complete Behavioral Neurological Evaluation

A comprehensive behavioral neurological evaluation fulfils the criteria listed above.  It is based on the history, the outcome of the comprehensive behavioral neurological assessment, the physical examination and possibly additional examinations.  

Please note that the TARMED items 05.0040 und 05.0050 cover only the taking of the history and the comprehensive behavioral neurological assessment and its evaluation, but not the additional examinations (e.g., the neurological examination), and the report.

e) Training in Behavioral Neurology (confirmed by the assembly in 2011)

Neurologists can learn to perform the specialist mental status examination (TARMED 05.0060) during their specialist training or during later additional trainings. 

In contrast, learning to perform the comprehensive behavioral neurological assessment requires a special training. 
The commission recommends the following criteria for the training:

  • The duration of training is at least one year at an institution that is recognised by the Society for Behavioral Neurology. At least 6 months of this time has to take place without interruption. 
  • Place of training: The institution of training needs to have a department of Neuropsychology or Behavioral Neurology that is integrated in a Neurological Clinic A,B,C,D recognised by the FMH.  If the training has been conducted in an institution that is not recognised, then it is the applicant’s responsibility to present the evidence for the recognition to the Society of Behavioral Neurology. The managing committee decides about the recognition of the training.
  • Assessments: At least 150 comprehensive behavioural neurological assessments and a sufficient number of partial assessments have to be performed. 
  • Supervision has to be provided by an experienced Behavioral Neurologist working in a department of Neuropsychology or Behavioral Neurology that is integrated in a Neurological Clinic A,B,C,D recognised by the FMH.

The Swiss Society of Behavioral Neurology, represented by this commission, is prepared to examine the qualification of a Department of Behavioral Neurology to serve as a training centre.

The members of the commission:

  • Dr Jean-Marie ANNONI, Genève
  • Prof. Gil ASSAL, Lausanne
  • Prof. Thierry ETTLIN, Rheinfelden
  • Prof. Marianne REGARD, Zurich
  • Dr Franck RIHS, Berne.
  • Prof. Armin SCHNIDER, Service de rééducation, Genève (Präsident)