目标:由于交叉的边缘化身份导致的健康不平等和医疗不信任,导致预防性健康检查延迟的发生,包括种族和性取向,有据可查;然而,应用于神经心理学概况的这种复杂的相互作用不太确定。本病例使用神经心理学评估来进一步理解具有重大医学合并症的病例中的脑-行为关系,童年创伤史,潜在的精神疾病,以及历史上被边缘化的社会和文化身份。
方法:患者是一名53岁的右手黑人,有多种脑血管危险因素的男同性恋者,癫痫症,两次远程脑震荡,过去的肾衰竭与随后的移植,以及使用处方抗逆转录病毒药物的HIV,根据过去十年的精神状态下降,由神经病学进行神经心理学评估。
结果:神经心理学测试反映了整体认知缺陷,表现为智力功能困难,运动能力,复杂测序,解决问题,执行功能,口语流利,注意,和记忆。心理功能的自我报告显示与抑郁相关的情绪困难,焦虑,持续的创伤压力,和情绪失调。研究结果与主要的神经退行性疾病最一致,并提示诊断为痴呆并发抑郁症。
结论:这项神经心理学案例研究提供了生物,经济,和其他社会文化因素对认知和情绪功能的影响。这个案例进一步强调了黑人中医疗不信任和延迟预防护理的负面影响,关于神经心理功能和生活质量的同性恋社区。
OBJECTIVE: The occurrence of delayed preventative health screening as a result of health inequities and medical mistrust resulting from intersecting marginalized identities, including race and sexual orientation, is well documented; however, this complex interplay applied to a neuropsychological profile is less established. The present
case uses neuropsychological assessment to further the understanding of the brain-behavior relationship in a
case with significant medical comorbidities, a history of childhood trauma, underlying psychiatric conditions, and social and cultural identities that have been historically marginalized.
METHODS: The patient is a 53-year-old right-handed Black, gay man with multiple cerebrovascular risk factors, a seizure disorder, two remote concussions, past kidney failure with the subsequent transplant, and HIV with prescribed antiretroviral medications who was referred for neuropsychological evaluation by neurology pursuant to a decline in mental status over the past decade.
RESULTS: Neuropsychological testing reflects global cognitive deficits evidenced by difficulties with intellectual functioning, motor abilities, complex sequencing, problem-solving, executive functioning, verbal fluency, attention, and memory. A self-report of psychological functioning revealed emotional difficulties associated with depression, anxiety, ongoing traumatic stress, and emotional dysregulation. Findings are most consistent with major neurodegenerative disorder and suggest a diagnosis of dementia complicated by depression.
CONCLUSIONS: This neuropsychological
case study provides an example of the complex effects of biological, economic, and other sociocultural factors on cognition and emotional functioning. This
case further emphasizes the negative impact of medical mistrust and delayed preventative care in the Black, gay community on neuropsychological functioning and quality of life.