Articles By Dr Kalinian

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© Dr. Haygoush Kalinian and Coastal Neuropsychology & Concussion Specialists, 2021. Unauthorized use and/or duplication of this material without express and written permission from this site’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Dr. Haygoush Kalinian and Coastal Neuropsychology & Concussion Specialists with appropriate and specific direction to the original content. 


Diseases of the brain commonly produce changes in behavior, including impairment of cognitive, sensory, perceptual, and motor abilities.  These behavioral changes aid in the diagnosis, management, and long-term care of patients with central nervous system diseases. Neuropsychological evaluation can characterize cognitive, behavioral, and emotional disturbances and help the clinician in the course of diagnostic assessment, rehabilitation planning, or development of a management plan.

Central Nervous System disorders of differing etiologies can have markedly different behavioral ramifications. Neuropsychological testing may be obtained by the physician when 1) there is a need to quantify the patient’s deficits, particularly when the information will be useful in predicting or following the course of a disorder (recovery or decline); 2) there is a need to differentiate between organic vs psychiatric disorder; 3) there are only mild or questionable deficits on mental status testing and more precise evaluation is needed to establish the presence of abnormalities or distinguish them from changes that may occur with normal aging; 4) when there is a need to characterize the strengths and weaknesses of a patient, as part of constructing a management or rehabilitation plan or when making recommendations about returning to school or work; 5) when neuropsychological data can provide a more comprehensive profile of function that, when in conjunction with clinical, laboratory, and imaging data, may assist in diagnosis; 6) when the patient is being considered for epilepsy surgery; and 7) when there is litigation that concerns the patient’s cognitive status.

Neuropsychological testing is considered medically appropriate to establish or confirm the diagnosis of brain damage or brain disease when there has been a mental status change, behavior change, memory loss or organic brain injury, under any of the following conditions:

  1. concussion/head injury (open or closed)
  2. cerebrovascular accident
  3. brain tumor
  4. cerebral anoxic or hypoxic episode
  5. CNS infection (e.g., herpes encephalitis, HIV infection)
  6. neurodegenerative disorders (e.g., dementia)
  7. demyelinating disease (e.g., Multiple Sclerosis)
  8. extrapyramidal disease (e.g., Parkinson’s or Huntington’s disease)
  9. metabolic encephalopathy (associated with hepatic or renal disease)
  10. exposure to agents known to be associated with cerebral dysfunction (e.g., lead poisoning, intrathecal methotrexate, cranial irradiation)
  11. to provide a differential diagnosis from a range of neurological psychological disorders that present with similar constellations of symptoms (e.g., differentiation between pseudodementia and depression) when the diagnosis has been unable to be made by a complete psychiatric and/or psychological assessment.

Neuropsychological examinations have the advantage of being objective, safe, portable, and relevant to the functional integrity of the brain.

Results of neuropsychological assessment is considered in the context of the patient’s age, education, socioeconomic status, and cultural background. Neuropsychological test are interpreted by a clinical neuropsychologist, in conjunction with other clinical, imaging, and laboratory information.

A typical neuropsychological assessment includes a clinical interview with the patient, records review, and testing.  Based on the information gathered during the interview and from the documentation and referral questions, the neuropsychologist then decides what cognitive and emotional domains need to be assessed and will select the tests to be in the battery. A typcial neuropsychologial examination includes the followiung functions:

•  Currnet and premorbid intellect

•  Attentionand concentration

•  Lerning and memory

•  Language

•  Visual-spatial  and perception

•  Motor and sensory skills

•  Higher level executive function (e.g., reasoning, problem-solving, sequencing)

•  Mood and personality


Post Concussive Syndrome Following Minor Motor Vehicle Accident or Sports-Related Concussion:

Signs, Symptoms, and Course of Recovery


A blow to the head or sudden jerky motion of the neck, as in a “whiplash” type injury (head does not need to hit something or be hit); can disrupt normal function of the brain.  This type of brain injury is called a Concussion or Mild Traumatic Brain Injury. Concussions are not life threatening and in most cases, there are no lasting effects from injury to the brain.  Eight out of ten patients with a mild head injury show some sings of the syndrome during the first 3 months after the accident. However, 15% of patients with mild head injury continue to experience symptoms of PCS 1 year after the injury.

The brain is made up of millions of long, thin nerve fibers. Some of these fibers can stretch, snap, or break as a consequence of a head injury.  Like any other part of the body, the brain also has blood vessels that can tear and bleed.  This happens soon after the injury, it often stops on its own and heal like any cut will.  Moreover, due to the microscopic size of these nerve fibers, modern technology has yet to visualize them. Therefore, CT/MRI scans of the brain of a patient with PCS are typically normal. Snapped nerves and broken blood vessels are the cause of symptoms after a head injury



I   Early Stage

  • Headaches
  • Nausea and Vomiting
  • Dizziness
  • Drowsiness
  • Blurred or Double Vision

II. Late Stage

  • Continual Headaches
    • Dizziness
    • Irritability and Anger
    • Anxiety,  Depression
    • Insomnia
    • Fatigue
    • Short-term Memory Loss
    • Attention and Concentration Problems
    • Planning and Organizing Difficulties
    • Decision Making and Problem Solving
    • Disorientation
    • Confusion
    • Ringing in Ears
    • Change in Behavior (impulsive)
    • Change in Personality


The recovery process depends on several factors; 1) age  (longer if older than 30),  2) severity of symptoms, 3) the location of the injury (area in the brain injured), 4) mental and physical health before the accident (if you had emotional or medical challenges before the injury,  it may take longer for you to recover),  5) any prior head injuries (the accumulated effects of brain injury influences the course of recovery), and 6) alcohol or drug use (interferes with healing  process).  The most rapid recovery happens the first 6 months after mild head injury, and most patients will be back to normal after 1-3 months.  If symptoms get worse or new symptoms develop after a month, than this is a sign to consult with a doctor specialized in diagnosing and treating brain disorders (i.e., neuropsychologists).


Ani (fictitious name of a patient) was 19-years-old when she was involved in a mild “fender-bender” type of motor vehicle accident.   While driving in a traffic congested California freeway, she was rear ended by a driver talking on the cell phone.  Since the damage to the car was so minor and there was no need for medical services, they decided to just exchange insurance information and   proceed to drive off.  Ani was a student at the local college and she needed to get to school.  The first sign that something was wrong was when she began experiencing difficulty navigating her way around to the school. She had driven this path on numerous occasions, there was no reason for her to get lost and forgetful. She attempted to call her mother, but could not remember her phone number. She became dizzy, confused, began experiencing pain in her neck and head.  She wondered whether the accident could have caused her difficulties….but it was so minor…. What did she have???   As the days went by, Ani’s health deteriorated, to a point, where her mother finally took her to see her family doctor who referred her to a  Neuropsychologist for proper diagnosis and treatment.  Subsequently, Ani was diagnosed with Post Concussive Syndrome (PCS).

If you or a loved one has experienced sport-related concussion and you are looking for concussion specialists in Orange County CA (Dana Point, Laguna Beach, Laguna Niguel, Mission Viejo, San Clemente, San Juan Capistrano CA), please contact our office to schedule consultation with our experts. Call 949-481-8414


Is There Evidence for Mild Traumatic Brain Injury?

 A Case for the Expert Neuropsychologist 




3)      Civil (i.e., causation, damage)

4)     Criminal







The Positive Affects of Aerobic Exercise On The Aging Brain

You know the benefit of exercise on the body, but did you know physical exercise is good for the brain, as well?  The human brain continues to grow and improve with mental and physical exercise.  Physical exercise has a protective effect on the brain and its mental processes, and may even help prevent Alzheimer’s disease. Based on exercise and health data from nearly 5,000 men and women over 65 years of age, those who exercised were less likely to lose their mental abilities or develop dementia, including Alzheimer’s. Inactive individuals were twice as likely to develop Alzheimer’s, compared to those with the highest levels of activity (exercised vigorously at least three times a week). But even light or moderate exercisers cut their risk significantly for Alzheimer’s and mental decline.

 Aerobic fitness has a favorable effect on cognitive functions. For example, physically active seniors are less prone to aging-related cognitive decline than those who lead a sedentary lifestyle. An increase in physical activity raises both aerobic capacity and learning ability in both humans and animals. Seniors who regularly exercise at a moderate to intense level may be less likely to develop the small brain lesions, sometimes referred to as “silent strokes,” that are the first sign of cerebrovascular disease.  These ‘silent strokes’ are more significant than the name implies, because they have been associated with an increased risk of falls and impaired mobility, memory problems and even dementia, as well as stroke, Encouraging seniors to take part in moderate to intense exercise may be an important strategy for keeping their brains healthy.

By improving cardiovascular health, exercise increases the flow of oxygen-rich blood to the brain. Over a lifetime, this makes a big difference to brain function. Increased aer­o­bic fit­ness (fast walking or run­ning) can increase the num­ber of new cells formed in the hip­pocam­pus (cru­cial for learn­ing and consolidation of information from short term to long term memory, known to be affected in Alzheimer’s disease). One of the reasons why the elderly – especially those with coronary artery disease or hypertension – tend to suffer some degree of cognitive decline is in part due to a reduction in blood flow to the brain.

 Exercise also has beneficial effect in specific areas of cognitive function that are rooted in the frontal and prefrontal regions of the brain, located behind the forehead.  This area is involved in planning, organization, and the ability to mentally juggle different tasks at the same time.  Another area is the basal ganglia (deep at the base of he brain), which coordinates commands to move muscles. Research indicates that mental exercise can improve these areas and positively affect memory and physical coordination.  Exercise might be able to offset some of the mental declines that are often associated with the aging brain. 

We are fortunate to live in an area of the country, where the climate is optimum for outdoor activates.  Stay fit; your brain will thank you by providing years of healthy living!


Heart & The Brain


The heart is a muscular organ that is responsible for pumping blood through out your body. Blood then carries oxygen and nutrients to your organs so they can function properly. When the heart stops pumping, as in the case of cardiac arrest (heart attack), oxygen is no longer able to travel to nourish the body, particularly the brain. The human brain constitutes only about 2% of the total body mass, yet utilizes more oxygen than any other organ. It requires oxygen and glucose to produce energy and work efficiently. Brain neurons, or nerve cells, depend on a continuous supply of oxygen, as they are not able to store oxygen and glucose for later use. A slight decrease in oxygen delivery can have serious effects including neuronal death and/or changes in brain function and cognition. This can include anything from problems with remembering to judgment, attention, and mental speed.  Changes in personality, behavior, and mood may also occur.

Brain cells are very sensitive to lack of oxygen.  Some brain cells start dying less than five minutes after their oxygen supply is interrupted or ceased. As a consequence, brain hypoxia (oxygen depravation to tissue) or anoxia (complete lack of oxygen), can severely cause brain damage or death.

What are typical causes of hypoxic/anoxic brain damage?

  • Cardiac arrest (heart attack)
  • Respiratory arrest
  • Anesthesia related complications
  • Hanging
  • Near drowning
  • Sleep apnea
  • Chronic Obstructive Pulmonary Disorder (COPD)
  • Carbon monoxide and other poisonous gas exposure
  • Drug abuse/overdose

What symptoms are associated with hypoxic/anoxic brain damage?

  • Headache
  • Confusion
  • Difficulty paying attention (inattentiveness) and concentration
  • Memory loss
  • Reasoning and judgment
  • Mental flexibility
  • Word finding difficulty- “I know the word, but can’t get it out of my mind”
  • Slowed mental speed and uncoordinated movement
  • Changes in behavior or personality (depression, anxiety, irritability)
  • Emotional lability (uncontrolled emotional expression)

Is there any treatment for hypoxic/anoxic brain damage?
Depending on the cause, extent and severity of brain damage that occurs subsequent to loss of oxygen, there are many treatment options available.  Before seeking any treatment, it is important to undergo a comprehensive Neuropsychological examination or testing of your cognitive and emotional functioning to determine which parts of your brain are damaged and which are still intact.  Hypoxia/anoxia affects different parts of your brain and produces problems in different patients.  Which areas of your brain are damaged and which are still functioning? A profile of your cognitive and emotional strengths and weaknesses will assist the Neuropsychologist in planning a treatment plan to help you and your family improve quality of life. Rehabilitation, psychotherapy, medication, hyperbaric oxygen treatments are some of the treatment options.  The rehabilitation team (i.e., speech therapist, occupational therapist, physical therapist, and Neuropsychologist) can manage your symptoms and improve your quality of life.


Alzheimer Disease


A.  Overview



B.  How to Differentiate Between Dementia or Depression?


C. What is Neuropsychological Evaluation?



  • Stroke Is No Longer a Disease of Old Age

….. It was a day, just like any other day, when Armenouhi (a fictitious name of a patient), a 38-year-old housewife set down to have dinner with her husband and five year old child.  Suddenly, she felt the most excruciating severe headache she had ever experienced. She asked her husband for her high blood pressure pill. Her hand just didn’t feel right. After a few minutes, she tried to get up but had trouble bearing weight on her right lower limb, she turn ed to her spouse and tried to tell him what was happening, but the words couldn’t come out right.  Her husband went to cal 911 and upon his return found Armenouhi on the floor, unconscious…….



B.  How common is it? Every year, about 700,000 people in the United States suffer a stroke. That’s about one person every 45 seconds. And one person dies from stroke every 3 minutes, or nearly 170,000 a year. This means stroke is the nation’s number three killer after heart disease and cancer. It is the major cause of adult disability. The cost of stroke in the US is between $30 and $40 billion per year.

C.  What are the symptoms? Stroke symptoms may not be as dramatic or painful as a heart attack. but the results can be just as life-threatening. Stroke is an emergency. Get medical help immediately and know when the symptoms started. Common symptoms include:

  • Sudden confusion, trouble speaking or understanding speech
  • Sudden difficulty seeing in one or both eyes
  • Sudden trouble walking, dizziness, loss of balance or coordination
  • Sudden severe headache with no known cause

D.  How is it diagnosed?

  • Neurological exam
  • Neuropsychological evaluation, to examine how well the brain is working when it performs certain functions, such as remembering, problem solving, processing information. It is also used to document areas of weaknesses and strengths.
  • Tests that show blood flow and bleeding sites (carotid and transcranial ultrasound and angiography)
  • Blood tests for bleeding or clotting disorders


The good news is, about 50% of all strokes can be prevented through medical attention and simple lifestyle changes.

A   How can I personally prevent it?  Some risk factors, such as age (stroke risk factors doubles with each decade past age 55), sex (males have slightly higher stroke risk, than females), race (African-Americans have double the stroke risk of most other racial groups), and a history of stroke in the family, cannot be changed. However, many others can be controlled. Most controllable factors relate to the health of the heart and blood vessels. Doing these things can help you prevent a stroke:

  • Have regular medical check-ups
  • Control high blood pressure
  • Do not smoke– and stop if you do
  • Treat heart disease, especially an irregular heart beat called “atrial fibrillation”
  • Improve your diet: Avoid excess fat, salt, and alcohol
  • Exercise
  • Manage diabetes
  • Seek immediate medical attention for warning signs

B.  How can medicine prevent it?  Some people are at risk for stroke because of known health factors, such as high blood pressure, diabetes, and heart disease. Also, having had a stroke puts you at greater risk of another attack. Fortunately for people in these situations, there are medical treatments that can help prevent stroke:

1)  Antiplatelets and anticoagulants.  Doctors can prescribe antiplatelet medications (such as aspirin) and anticoagulants (such as warfarin) to reduce the blood’s ability to form clots.

2) Angioplasty and stents   To remove blockages, doctors may thread a balloon angioplasty through a major vessel in the leg or arm to reach the affected vessel. A steel screen called a “stent” is sometimes inserted in a vessel to expand its diameter and improve blood flow.

3)  Carotid endarterectomy   In this surgical procedure, a blockage is removed from the carotid artery in the neck.



  • t-PA (tissue plasminogen activator), a clot-busting drug that is injected within three hours of the start of a non-bleeding stroke
  • Surgery that opens the insides of narrowed neck blood vessels (carotid endarterectomy)

If bleeding causes the stroke, treatment could include:

  • Drugs that maintain normal blood clotting
  • Surgery to fix the broken blood vessels
  • Blocking off bleeding vessels by inserting a coil
  • Drugs that prevent or reverse brain swelling




This rehabilitation period is often a challenge. The patient and family work with a team of physical, occupational, and speech therapists, along with nurses and doctors. Most of the improvement will take place in the first three to six months of the process. But some people can make excellent progress over longer periods.


ADD/ADHD is a complex disorder, WE SPECIALIZE in evaluating complex disorders

Attention-Deficit-Hyperactivity-Disorder (ADHD) or Attention Deficit-Disorder (ADD), as it is called in adulthood, is a neurobehavioral disorder that affects about 2% of the population.  In other words, the disorder is a combination of neurological (brain) dysfunction that causes behavioral problems.  Research studies continually show that individuals who have  ADD/ADHD evidence “brain malfunction’ in different areas that control attention, learning and memory, and executive functions.  While most children with this disorder “grow out” of their symptoms, many children with ADD/ADHD continue to have trouble through adulthood.

Adults’ symptoms may manifest themselves differently from children’s.

Often the most prominent characteristic in ADD adults is inattention, impulsivity, and restlessness as well as frequently accompanying behavioral, learning, and emotional problems.  Other symptoms observed in adults include problems with executive functioning, which is the brain’s ability to oversee the ability to monitor a person’s own behavior by planning, organizing, correcting and learning from mistakes, and reasoning through tasks.

Adults with hyperactive-impulsive symptoms feel restless and constantly “on the go” as they try to do multiple tasks at once. They are often perceived as not thinking before they act or speak.

There are over 100 reasons/conditions that mimic symptoms of ADD/ADHD, such as mood disorder, personality characteristics, bipolar, other psychiatric or medical conditions, illicit drug use, and medications, to name a few.

This is an easily treatable disorder, but without an accurate diagnosis, a person may spend years or even decades struggling and taking medication that are full of side effects, without any relief.  Without accurate diagnosis, there will not be relief from symptoms. By virtue of training and experience, Neuropsychologists are best qualified in evaluating and treating neurobehavioral disorders, such as ADD.  Without a comprehensive Neuropsychological evaluation/testing, you are seeing half the picture, not the whole.

ADD/ADHD is a complex disorder, WE SPECIALIZE in evaluating and treating complex disorders.  Please call us to schedule consultation for adult ADD testing in Dana Point, Ladera Ranch, Laguna Beach, Laguna Niguel, San Clemente, San Juan Capistrano and beyond  

If you are in need of a neuropsychologist Call Us at 949-481-8414

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