Dr. Vivian Clayton is a licensed clinical psychologist specializing in geriatric neuropsychology. Her practice is devoted to three types of assessments: screening and diagnostic evaluations, and legal capacity.
This type of work up takes approximately one hour. It is akin to getting a brain scan, using paper and pencil tests. In addition to assessing the general integrity of cortical functioning, the screening tests will yield a profile on key areas of cognition. This includes short term memory, attention and concentration and frontal/executive functions which include working memory essential for problem solving and decision making.
Frequently, perception of memory loss is correlated to emotional states such as depression. A test will also be administered to gauge emotional well being.
The screening evaluation will not yield a diagnosis of either a mental or cognitive condition. An evaluation whose focus is providing a diagnosis takes two to three hours. Each area of cognitive functioning is examined through the administration of two to three tests per area of cognitive ability (see description, below).
At the conclusion of the screening evaluation, you will know whether your performance falls in the normal range according to the scoring system of each test utilized.
If your scores are not in the normal range, you will be advised to make an appointment with your primary care physician for a medical work up.
Many factors affect memory and cognition. Once identified and treated, the cognitive changes are often reversible. The factors affecting memory and cognition include but are not limited to metabolic and nutritional deficiencies, medication side effects, autoimmune disorders, chronic diseases such as diabetes, prior head injury and depression.
Who Can Make a Referral?
This type of evaluation is usually self-referred.
This one hour evaluation is paid for on a fee for service basis. Insurance, other than Medicare, does not cover this type of screening evaluation.
The goal of a diagnostic work up is to differentiate normal age-related changes in memory from those that suggest either mild cognitive impairment, dementia or depression. Each area of cognition is evaluated using two to three different objective tests. A diagnosis is derived from the integration of clinical interview and scores on the tests which are age graded and statistically normed against the individuals own age group.
Who Can Make a Referral?
Either an individual, a concerned family member and/or a physician can make a referral for a diagnostic evaluation.
Dr. Clayton is a Medicare provider. If the individual has a Medicare HMO such as
Healthnet Seniority Plus or Pacific Care, an authorization must be obtained through the primary care physicians office before an evaluation can take place.
If an individual does not have Medicare, an authorization from the insurance company is recommended so reimbursement rates are identified for the services provided. In all instances where private insurance is the primary source of reimbursement, Dr. Clayton requires the individual pay her directly and she provides a bill, with proper CPT codes and diagnosis, for the individual to submit themselves to their insurance company.
LEGAL CAPACITY EVALUATIONS
The goal of a capacity evaluation is to determine the individuals ability to continue functioning independently in both self care and in managing their financial affairs.
These assessments are also useful in determining if an individual is susceptible to fraud or undue influence.
Typical reasons for a capacity evaluation are:
- Capacity to manage personal and/or financial affairs;
- Capacity to resist fraud and undue influence;
- Capacity to make decisions regarding estate planning, including
amending existing documents and/or creating new ones;
- Capacity to enter into contracts and/or amend existing contracts;
- Capacity to consent to medical treatment;
- Capacity to marry
These types of evaluations are attorney-referred. The context for these evaluations are usually related to issues of possible conservatorship, estate planning, will and/or trust contests and concerns about fraud and undue influence.
Who can make a referral?
Trust and estate planning attorneys, care managers and judges presiding over probate courts are the types of individuals and entities who make a legal capacity evaluation referral.
These evaluations are paid for on a fee for service basis. Medicare does not reimburse for legal capacity evaluations. A Frequently Asked Questions information sheet about procedures and how to set up an appointment is available upon request.