Skip to main content
SpringerLink
Log in

Neuropsychological Assessment and Management of Older Adults with Multiple Somatic Symptoms

  • Chapter
  • First Online:
Handbook on the Neuropsychology of Aging and Dementia

Part of the book series: Clinical Handbooks in Neuropsychology ((CHNEURO))

  • 4613 Accesses

Abstract

Multiple physical complaints are common in older adults and need to be evaluated in a thorough and careful manner. The history and context of the patient’s reported symptoms are particularly important. Patients and clinicians tend to normalize symptoms that might be notable or unusual in young adults as general consequences of the aging process. While this may seem to be clinically expedient, it is important for the neuropsychologist to pay such symptoms special attention. This chapter reviews definitions, clinical presentations, assessment strategies, provision of feedback, consultation with colleagues, and treatment approaches that can be used with older adults that have multiple somatic symptoms. Neuropsychologists are encouraged to familiarize themselves with a widening array of intervention techniques that may benefit their older patients. Finally, several clinical “pearls” are offered to assist those in working with older patients that present with clinically problematic somatic symptoms.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. American Psychiatric Association. Diagnostic & statistical manual of mental disorders. 4th ed, text revision. Washington, DC: American Psychiatric Association; 2000.

    Google Scholar 

  2. Lamberty GJ. Understanding somatization in the practice of clinical neuropsychology. New York: Oxford University Press; 2008.

    Google Scholar 

  3. McCarthy LH, Bigal ME, Katz M, Derby C, Lipton RB. Chronic pain and obesity in the elderly: results from the Einstein aging study. J Am Geriatr Soc. 2009;57:115–9.

    Article  Google Scholar 

  4. Helme RD, Gibson SJ. The epidemiology of pain in elderly people. Clin Geriatr Med. 2001;17:417–31.

    Article  Google Scholar 

  5. Barsky AJ, Orav EJ, Bates DW. Somatization increases medical utilization and costs independent of psychiatric and medical comorbidity. Arch Gen Psychiatry. 2005;62:903–10.

    Article  Google Scholar 

  6. Carson AJ, Ringbauer B, Stone J, McKenzie L, Warlow C, Sharpe M. Do medically unexplained symptoms matter? A prospective cohort study of 300 new referrals to neurology outpatient clinics. J Neurol Neurosurg Psychiatry. 2000;68:207–10.

    Article  Google Scholar 

  7. Escobar JI, Waitzkin H, Silver RC, Gara M, Holman A. Abridged somatization: a study in primary care. Psychosom Med. 1998;60:466–72.

    Article  Google Scholar 

  8. Fink P, Hansen MS, Sondergaard L. Somatoform disorders among first-time referrals to a neurology service. Psychosomatics. 2005;46:540–8.

    Article  Google Scholar 

  9. Drayer RA, Mulsant BH, Lenze EJ, Rollman BL, Dew MA, Kelleher K, Karp JF, Begley A, Schulberg HC, Reynolds CFIII. Somatic symptoms of depression in elderly patients with medical comorbidities. Int J Geriatr Psychiatry. 2005;20:973–82.

    Article  Google Scholar 

  10. Lobo-Escolar A, Saz P, Marcos G, Quintanilla MÁ, Campayo A, Lobo A, ZARADEMP Workgroup. Somatic and psychiatric comorbidity in the general elderly population: results from the ZARADEMP project. J Psychosom Res. 2008;65:347–55.

    Article  Google Scholar 

  11. Sheehan B, Banjeree S. Review: somatization in the elderly. Int J Geriatr Psychiatry. 1999;14:1044–9.

    Article  Google Scholar 

  12. Sarno JE. The divided mind: the epidemic of mindbody disorders. New York: Harper; 2006.

    Google Scholar 

  13. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd ed. Washington, DC: American Psychiatric Association; 1980.

    Google Scholar 

  14. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 2nd ed. Washington, DC: American Psychiatric Association; 1968.

    Google Scholar 

  15. Briquet P. Traite´ clinique et the´rapeutique de l’Hysterie. Paris: Bailliere; 1859.

    Google Scholar 

  16. Escobar JI, Burnam MA, Karno M, Forsythe A, Golding JM. Somatization in the community. Arch Gen Psychiatry. 1987;44:713–8.

    Article  Google Scholar 

  17. Kroenke K, Spitzer RL, deGruy FV III, Hahn SR, Linzer M, Williams JB, et al. Multisomatoform disorder. An alternative to undifferentiated somatoform disorder for the somatizing patient in primary care. Arch Gen Psychiatry. 1997;54:352–8.

    Article  Google Scholar 

  18. Engel CC. Explanatory and pragmatic perspectives regarding idiopathic physical symptoms and related syndromes. CNS Spectr. 2006;11:225–32.

    Article  Google Scholar 

  19. Kirmayer LJ, Groleau D, Looper KJ, Dao MD. Explaining medically unexplained symptoms. Can J Psychiatry. 2004;49:663–72.

    Article  Google Scholar 

  20. Mayou R, Kirmayer LJ, Simon G, Kroenke K, Sharpe M. Somatoform disorders: time for a new approach in DSM-V. Am J Psychiatry. 2005;162:847–55.

    Article  Google Scholar 

  21. Sharpe M, Carson A. “Unexplained” somatic symptoms, functional syndromes, and somatization: do we need a paradigm shift? Ann Intern Med. 2001;134:926–30.

    Article  Google Scholar 

  22. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. 5th ed. Arlington: American Psychiatric Association; 2013.

    Book  Google Scholar 

  23. The Demand for Geriatric Care and the evident Shortage of Geriatrics Healthcare Providers. The American Geriatric Society, 2012. http://www.americangeriatrics.org/files/documents/Adv_Resouces/PayReform_fact5.pdf

  24. Axelrod BN. Neuropsychological report writing. In: Vanderploeg RD, editor. Clinician’s guide to neuropsychological assessment. 2nd ed. Mahwah: Erlbaum; 2000. p. 245–73.

    Google Scholar 

  25. Lezak MD, Howieson DB, Loring DW, Hannay HJ, Fischer JS. Neuropsychological assessment. 4th ed. New York: Oxford University Press; 2004.

    Google Scholar 

  26. Strauss E, Sherman EMS, Spreen O. A compendium of neuropsychological tests: administration, norms, and commentary. 2nd ed. New York: Oxford University Press; 2006.

    Google Scholar 

  27. Delis DC, Wetter SR. Cogniform disorder and cogniform condition: proposed diagnoses for excessive cognitive symptoms. Arch Clin Neuropsychol. 2007;22:589–604.

    Article  Google Scholar 

  28. Boone KB. Fixed belief in cognitive dysfunction despite normal neuropsychological scores: neurocognitive hypochondriasis? Clin Neuropsychol. 2009;23:1016–36.

    Article  Google Scholar 

  29. Butcher JN, Dahlstrom WG, Graham JR, Tellegen AM, Kaemmer B. MMPI-2, Minnesota multiphasic personality inventory—2: manual for administration and scoring. Minneapolis: University of Minnesota Press; 1989.

    Google Scholar 

  30. Beck AT, Steer RA, Brown GK. Beck depression inventory. 2nd ed. San Antonio: The Psychological Corporation; 1996.

    Google Scholar 

  31. Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey MB, Leirer VO. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res. 1983;17:37–49.

    Article  Google Scholar 

  32. Ben-Porath YS, Tellegen A. MMPI-2-RF (Minnesota Multiphasic Personality Inventory-2 Restructured Form): manual for administration, scoring, and interpretation. Minneapolis: University of Minnesota Press; 2008.

    Google Scholar 

  33. Lees-Haley PR, English LT, Glenn WJ. A fake bad scale on the MMPI-2 for personal injury claimants. Psychol Rep. 1991;68:203–10.

    Article  Google Scholar 

  34. Hahn SR, Kroenke K, Spitzer RL, et al. The difficult patient: prevalence, psychopathology, and functional impairment. J Gen Intern Med. 1996;11:1–8.

    Article  Google Scholar 

  35. Rollnick S, Miller WR, Butler CC. Motivational interviewing in health care: helping patients change behavior. New York: The Guilford Press; 2008.

    Google Scholar 

  36. Greenberger D, Padesky CA. Mind over mood: change how you feel by changing the way you think. New York: The Guilford Press; 1995.

    Google Scholar 

  37. Kroenke K. Efficacy of treatment for somatoform disorders: a review of randomized controlled trials. Psychosom Med. 2007;69:881–8.

    Article  Google Scholar 

  38. Sumathipala A. What is the evidence for the efficacy of treatments for somatoform disorders? A critical review of previous intervention studies. Psychosom Med. 2007;69(9):889–900.

    Article  Google Scholar 

  39. van Dessel N, den Boeft M, van der Wouden JC, Kleinstäuber M, Leone SS, Terluin B, Numans ME, van der Horst HE, vanMarwijk H. Non-pharmacological interventions for somatoform disorders and medically unexplained physical symptoms (MUPS) in adults. Cochrane Database Syst Rev. 2014;(11). Art. No.: CD011142. https://doi.org/10.1002/14651858.CD011142.pub2.

  40. Kabat-Zinn J. Full catastrophe living: using the wisdom of your body and mind to face stress, pain, and illness. 15th anniversary edition reissue. New York: Bantam Dell; 2009.

    Google Scholar 

  41. Bonadonna R. Meditation’s impact on chronic illness. Holist Nurs Pract. 2003;17:309–19.

    Article  Google Scholar 

  42. Carlson L, Speca M, Faris P, Patel K. One year pre-post intervention follow-up of psychological, immune, endocrine and blood pressure outcomes of mindfulness-based stress reduction (MBSR) in breast and prostate cancer outpatients. Brain Behav Immun. 2007;21:1038–49.

    Article  Google Scholar 

  43. Sephton S, Salmon P, Weissbecker I, Ulmer C, Floyd A, Hoover K, Studts J. Mindfulness meditation alleviates depressive symptoms in women with fibromyalgia: results of a randomized clinical trial. Arthritis Rheum. 2007;57:77–85.

    Article  Google Scholar 

  44. Nayak NN, Shankar K. Yoga: a therapeutic approach. Phys Med Rehabil Clin N Am. 2004;15:783–98.

    Article  Google Scholar 

  45. Salmon P, Lush E, Jablonski M, Sephton SE. Yoga and mindfulness: clinical aspects of an ancient mind/body practice. Cogn Behav Pract. 2009;16:59–72.

    Article  Google Scholar 

  46. Wang C, Schmid CH, Rones R, Kalish R, Yinh J, Goldenberg DL, Lee Y, McAlindon T. A randomized trial of tai chi for fibromyalgia. N Engl J Med. 2010;363:743–54.

    Article  Google Scholar 

  47. Assefi N, Bogart A, Goldberg J, Buchwald D. Reiki for the treatment of fibromyalgia: a randomized controlled trial. J Altern Complement Med. 2008;14:1115–22.

    Article  Google Scholar 

  48. Peters S, Stanley I, Rose M, Kaney S, Salmon P. A randomized controlled trial of group aerobic exercise in primary care patients with persistent, unexplained physical symptoms. Fam Pract. 2002;19:665–74.

    Article  Google Scholar 

  49. O’Malley PG, Jackson JL, Santoro J, Tomkins G, Balden E, Kroenke K. Antidepressant therapy for unexplained symptoms and symptom syndromes. J Fam Pract. 1999;48:980–90.

    Google Scholar 

  50. Fishbain DA, Cutler RB, Rosomoff HL, Rosomoff RS. Do antidepressants have an analgesic effect in psychogenic pain and somatoform pain disorder? A meta-analysis. Psychosom Med. 1998;60:503–9.

    Article  Google Scholar 

  51. Onghena P, Van Houdenhove B. Antidepressant-induced analgesia in chronic non-malignant pain: a meta-analysis of 39 placebo-controlled studies. Pain. 1992;49:205–19.

    Article  Google Scholar 

  52. Fallon BA. Pharmacotherapy of somatoform disorders. J Psychosom Res. 2004;56:455.

    Article  Google Scholar 

  53. Hoedeman R, Blankenstein AH, Krol B, Koopmans PC, Groothoff JW. The contribution of high levels of somatic symptom severity to sickness absence duration, disability and discharge. J Occup Rehabil. 2010;20:264–73.

    Article  Google Scholar 

  54. Smith GR, Monson RA, Ray DC. Psychiatric consultation in somatization disorder: a randomized controlled study. N Engl J Med. 1986;314:1407–13.

    Article  Google Scholar 

  55. White M, Epston D. Narrative means to therapeutic ends. New York: W.W. Norton; 1990.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Minneapolis VA Health Care System, Minneapolis, MN, USA

    Greg J. Lamberty & Kimberly K. Bares

Authors
  1. Greg J. Lamberty
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kimberly K. Bares
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Greg J. Lamberty .

Editor information

Editors and Affiliations

  1. Department of Neurology, Weill Cornell Medicine, New York, NY, USA

    Lisa D. Ravdin

  2. Department of Neurology, University of Miami, Miami, FL, USA

    Heather L. Katzen

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Lamberty, G.J., Bares, K.K. (2019). Neuropsychological Assessment and Management of Older Adults with Multiple Somatic Symptoms. In: Ravdin, L.D., Katzen, H.L. (eds) Handbook on the Neuropsychology of Aging and Dementia. Clinical Handbooks in Neuropsychology. Springer, Cham. https://doi.org/10.1007/978-3-319-93497-6_21

Download citation

Publish with us

Policies and ethics

Search

Navigation