Journal of clinical and experimental neuropsychology最新文献

Introduction: Sensory hypersensitivity (SHS) refers to an increased sensitivity to sensory stimuli, often leading to sensory overload and adversely affecting daily functioning and well-being. This study examined the effects of three situational triggers - noise, time pressure, and cognitive load - on task performance, sensory overload, and fatigue. Additionally, we sought to explore the associations between these effects and SHS, while accounting for other influencing factors such as personality, coping mechanisms, and anxiety.

Method: We experimentally tested 105 university students, employing a visuospatial task (the Paper Folding Test, PFT) under eight different conditions, manipulating the three situational triggers. The measured outcomes included task accuracy, average response time, sensory overload, and fatigue. Participants also completed several questionnaires: Highly Sensitive Person Scale (HSPS), Multi-Modal Evaluation of Sensory Sensitivity (MESSY), State and Trait Anxiety Index, Big Five Inventory, and COPE Easy.

Results: Our findings indicated that sensory overload increased as more situational triggers were introduced, with noise having the most significant impact. However, this increase in sensory overload did not correspond to changes in objective performance measures, such as accuracy and average response time on the PFT, which were primarily influenced by cognitive load (i.e. easy versus difficult items). Additionally, individuals with higher levels of SHS (HSPS and MESSY) reported greater overall sensory overload and fatigue. Nonetheless, the impact of the triggers on sensory overload and fatigue was not exclusive to those with high SHS, and neuroticism, conscientiousness, openness, and trait anxiety were significant predictors of SHS, more so than task-related outcomes.

Conclusions: Feelings of sensory overload may not necessarily impair cognitive performance, and the impact of situational triggers can be similar for individuals with and without SHS. This implies that the burden of SHS and overall sensory overload may be influenced by other underlying factors leading to an elevation of baseline sensory overload, warranting further investigation.

Introduction: Diagnostic evaluations for attention-deficit/hyperactivity disorder (ADHD) are becoming increasingly complicated by the number of adults who fabricate or exaggerate symptoms. Novel methods are needed to improve the assessment process required to detect these noncredible symptoms. The present study investigated whether unsupervised machine learning (ML) could serve as one such method, and detect noncredible symptom reporting in adults undergoing ADHD evaluations.

Method: Participants were 623 adults who underwent outpatient ADHD evaluations. Patients' scores from symptom validity tests embedded in two self-report questionnaires were examined in an unsupervised ML model. The model, called "sidClustering," is based on a clustering and random forest algorithm. The model synthesized the raw scores (without cutoffs) from the symptom validity tests into an unspecified number of groups. The groups were then compared to predetermined ratings of credible versus noncredible symptom reporting. The noncredible symptom ratings were defined by either two or three or more symptom validity test elevations.

Results: The model identified two groups that were significantly (p < .001) and meaningfully associated with the predetermined ratings of credible or noncredible symptom reporting, regardless of the number of elevations used to define noncredible reporting. The validity test assessing overreporting of various types of psychiatric symptoms was most influential in determining group membership; but symptom validity tests regarding ADHD-specific symptoms were also contributory.

Conclusion: These findings suggest that unsupervised ML can effectively identify noncredible symptom reporting using scores from multiple symptom validity tests without predetermined cutoffs. The ML-derived groups also support the use of two validity test elevations to identify noncredible symptom reporting. Collectively, these findings serve as a proof of concept that unsupervised ML can improve the process of detecting noncredible symptoms during ADHD evaluations. With additional research, unsupervised ML may become a useful supplementary tool for quickly and accurately detecting noncredible symptoms during these evaluations.

There has been both a national and global emphasis within the past 3 years to promote diversity, equity, inclusion (DEI), and cultural respect in healthcare and academia. One discipline and healthcare arena where this has been evident is the psychology field. Indeed, there has been rampant and widespread adoption and advancement of DEI and cultural respect across most of psychology. Unfortunately, not all psychology specialties have fully embraced DEI or focused on provider factors, one of which is clinical neuropsychology. Regarding DEI efforts and emphasis in clinical neuropsychology, the majority of research and education has primarily focused on patient demographic and neuropsychological test factors. While such patient demographic and test factors are important and merit significant attention, so too does the focus on the clinical neuropsychological provider. Unfortunately, the clinical neuropsychology specialty has provided little to no focus on the provider's role in DEI and cultural respect. The purpose of this critical review is to focus on the role of the clinical neuropsychologist and how it impacts DEI and cultural respect. Specifically, the review will inform the factors that impact the practice of clinical neuropsychology on the part of the provider including unconscious/implicit bias, diagnostic threat, and microaggressions. Also, the review will inform strategies to create a DEI responsive and culturally respectful clinical neuropsychological practice with the overarching goal to uncover the clinical neuropsychological role to advance and evolve the specialty through a DEI and culturally respectful lens. With considerable work completed in other aspects of DEI and cultural respect, the clinical neuropsychology specialty is well poised to now focus on the role of the provider. This focus can provide a constructive path forward to create new knowledge to advance the role of the provider to optimize overall clinical, research, and training practices.

Introduction: This study cross-validates and expands upon previous research by examining the optimal number of PVT failures necessary to determine invalid performance when 10 PVTs are administered during a neuropsychological evaluation. Additionally, the study assessed the degree of skewness of individual PVTs and PVT intercorrelations for the overall sample and by validity group.

Method: Participants were 283 adult neuropsychology outpatients evaluated at an academic medical center. Participants were initially classified as having valid (≤1 PVT failure; n = 225) or invalid (≥2 PVT failures; n = 58; base rate of 20% performance invalidity) performance based on four independent criterion PVTs. Failure rates of 10 additional PVTs were then compared, and sensitivity and specificity were calculated at different thresholds (e.g. ≥1, ≥2, ≥3, ≥4 PVT failures) to determine the optimal threshold for detecting invalid performance while maintaining ≥ 90% specificity.

Results: Findings indicate that failing ≥ 2 PVTs yielded 86% sensitivity/76% specificity, failing ≥ 3 PVTs yielded 69% sensitivity/92% specificity, failing ≥ 4 PVTs yielded 57% sensitivity/96% specificity, failing ≥ 5 PVTs yielded 29% sensitivity/99% specificity, and failing ≥ 6 PVTs yielded 22% sensitivity/100% specificity. PVT intercorrelations were generally small for the overall sample and by validity group. As expected, data were more highly skewed for patients with valid performance.

Conclusions: Findings were consistent with previous research and demonstrate that the three-failure threshold optimally detects invalid performance when 10 PVTs are administered. These findings inform the use of multiple PVTs in clinical settings and aid in the interpretation of PVT results.

Introduction: Self-monitoring abilities, both in the moment (online) and general self-knowledge (offline) of one's errors, are crucial to implementing modification to tasks to support healthy, independent aging. Cognitive strategies (CS) aid in functional, physical, and cognitive abilities, but without recognition of their need, individuals may struggle to complete daily tasks. The current study examined whether higher levels of self-monitoring would predict higher use and quality of real-world cognitive strategies in older adults.

Methods: Participants included 80 community-dwelling midlife and older adults. Participants completed a remote battery of neuropsychological tasks, including a computerized go-no-go task that evaluated online self-monitoring, and a self-reported questionnaire to measure offline self-monitoring (Cognitive Self-Efficacy Questionnaire). To assess CS, a count score (CS Quantity) and utility score (CS Quality) were computed based on strategies utilized in completion of real-world prospective memory tasks.

Results: Online self-monitoring was not significantly related to offline self-monitoring (r(77) = -.07, p = .52). A hierarchical regression revealed that while offline self-monitoring significantly predicted 7% of the variance in CS Quality, above and beyond age, global cognition, and premorbid functioning (ΔR² = .07, ΔF = 6.23, p = .02), the addition of online self-monitoring did not contribute significant incremental validity (ΔR² = .001, ΔF = 0.12, p = .73). The second hierarchical regression revealed that neither online nor offline self-monitoring significantly predicted CS Quantity, after controlling for sex (ΔR² = .004, ΔF = 0.29, p = .60).

Conclusion: The results support the distinction between online and offline self-monitoring concepts and their assessment. For community-dwelling midlife and older adults without dementia, clinicians may consider an individual's perceptions of their ability to self-monitor when working to facilitate the use of cognitive strategies.

Objective: To examine neuropsychological characteristic differences between typical and atypical language dominance in adult persons with epilepsy (PWE) and mesial temporal sclerosis (MTS), including exploring the impact of selected clinical variables on detection of atypical language and neuropsychological performance.

Methods: Adults with intractable epilepsy and MTS (n = 39) underwent comprehensive, pre-surgical evaluation including fMRI and neuropsychological assessment. Participants with concordant lateralization of MTS and seizure onset were included. Participants were grouped by dichotomized typical or atypical language lateralization based on fMRI results. Neuropsychological performance and other relevant clinical variables of the aforementioned groups were then compared.

Results: Those with atypical language demonstrated poorer performance across neuropsychological tasks as compared to those with typical language lateralization. Although, typical neuropsychological measures used to evaluate language lateralization were not among those significantly different between the groups. Differences in neuropsychological performance were particularly pronounced on TMT A, TMT B, Stroop (Color), GPB (Dominant), and GPB (Non-Dominant). ROC Curve was provided to evaluate reproducibility at different thresholds.

Conclusion: This pilot study revealed those with atypical language lateralization demonstrated greater cognitive dysfunction across neuropsychological tasks than those with typical language lateralization. Neuropsychological measures outside of the domain of language tests detected subtle changes of functional neuroanatomical reorganization while language domain tasks revealed no significant differences between aforementioned groups in pre-surgical evaluation of PWE. While these preliminary results require further replication, these are important implications for diagnostic and prognostic evaluation.

Individuals with memory impairments may need to rely often on the external world (i.e. offloading). By memorizing only a fraction of the items at hand, and repeatedly looking back to the remainder of items (i.e. inspecting), they can avoid frailty or effortful memory use. However, individuals with subjective concerns may also prefer to rely on the external world even though their capacity is intact. Crucially, capacity assessment fails to recognize offloading strategies, while inspection assessment may reveal how people choose to deploy memory in everyday life. To disentangle the relative contributions of memory capacity and memory self-efficacy to offloading behavior, we recruited 29 individuals who were referred to a memory clinic and 38 age-matched individuals. We assessed memory capacity using neuropsychological measures, and memory self-efficacy using questionnaires. Inspection behavior was assessed in a copy task that allowed participants to store information to their preferred load or to rely on the external world. Referred individuals had lower capacity scores and lower memory self-efficacy. They inspected as often as controls, but used longer inspections and performed worse. Across all subjects, memory capacity - but not memory self-efficacy - explained inspection frequency and duration, with higher capacity associated with fewer and shorter inspections. Capacity measures thus translate to how people choose to deploy their memory in tasks that do not force full capacity use. However, people generally avoided remembering more than two items per inspection, and thus avoided using their full capacity. Inspection behavior was not further explained by memory self-efficacy, suggesting that inspections are not a sensitive measure of constraints experienced in everyday life. Although we provide support for the predictive value of capacity tasks in tasks with more degrees of freedom, capacity tasks overlook offloading behavior that individuals may employ to avoid using their full memory capacity in everyday life.

Background: Acquired brain injury (ABI) is associated with social cognitive impairments, yet these impairments are often overlooked during clinical assessments. There are few validated and clinically appropriate measures of social cognition in ABI. The current study examined the validity of the Brief Assessment of Social Skills (BASS) in measuring social cognition following ABI.

Method: Twenty-eight people with ABI were recruited from local brain injury rehabilitation and support services and completed measures of social cognition, general intellectual ability, and social functioning. Twenty-eight controls demographically matched for age, gender, and years of education also performed these measures.

Results: A diagnosis of ABI was significantly associated with poorer performance on five subtests of the BASS. The BASS had moderate correlations with established measures of social cognition and measures characteristics that are distinguishable from general cognition. There was minimal evidence of a relationship between performance on the BASS and social functioning, with a significant relationship between a BASS subscale and informant-reported living skills and total social functioning. Using a series of case studies, the clinical utility of the BASS was emphasized by the development of unique social cognitive profiles across ABI individuals, including impairments in areas not significant at a group level.

Discussion: The BASS is a brief and comprehensive measure that is able to detect social cognition impairments in ABI patients. Given the prevalence of impairment in social cognition following ABI and the implications of these abilities on social functioning, this measure can be used in comprehensive neuropsychological assessment to guide and monitor progress toward rehabilitation goals.

Background: Children diagnosed with brain tumors are at risk to develop neurocognitive problems. Post-traumatic stress and sleep have been associated with poorer neurocognitive outcomes in the general population, and could be potential targets for intervention in brain tumor patients. Therefore, this study examined neurocognitive functioning in children newly diagnosed with a brain tumor and the associations between posttraumatic stress and sleep with neurocognitive outcomes.

Methods: Children 6-16 years old who were newly diagnosed with a brain tumor completed questionnaires on post-traumatic stress and sleep, actigraphy for sleep, and tests for neurocognitive outcomes. One-sample t-tests and chi-square tests were used to compare neurocognitive scores with age norms. Multivariable regression examined associations between post-traumatic stress, sleep, demographics, and medical factors associated with neurocognitive functioning.

Results: Of all eligible children, 60 patients with newly diagnosed brain tumors were included, at an average of 51 days after diagnosis (67% male, mean = 11.5 years at diagnosis). Compared to age norms, patients with brain tumors scored lower on measures of attention, inhibition, and verbal memory (meanZ = -0.40 to -0.98, p < .05). History of obstructive hydrocephalus was associated with poorer attention (p < .05) and processing speed (p < .05), posterior fossa tumor location was associated with poorer working memory (p < .01), and starting chemotherapy or radiotherapy treatment before the assessment was associated with poorer verbal memory (p < .05). Post-traumatic stress and sleep were not associated with neurocognitive outcomes at this phase (p > .20).

Conclusion: A subgroup of children with newly diagnosed brain tumors shows deficits in neurocognitive functioning, which highlights the importance of early monitoring to identify children at-risk for problems. Hydrocephalus, posterior fossa tumor location, and starting treatment, but not post-traumatic stress and sleep, are associated with poorer neurocognitive performance at this phase. Longitudinal research will be important for identifying biopsychosocial factors that may be associated with cognition over time.

Objective: Prior work indicates that discrete emotions are linked to performance across multiple domains of cognitive function and thus have the potential to impact cognitive profiles in neuropsychological assessment. However, reported presence and magnitude of the relationships between emotion and cognitive test performance are inconsistent. Variable findings in this regard could be due to failure to consider motivations associated with expressed emotion. To better understand the potential impact of expressed emotion on neuropsychological test performance, it may be beneficial to consider approach and avoidance motivation during assessment.

Method: The current cross-sectional study examined associations between cognitive performance and digitally phenotyped facial expressions of discrete emotions on dimensions of approach (i.e. joy, sadness, anger) and avoidance (i.e. fear, disgust) in the context of virtual neuropsychological assessment in 104 adults (ages 55-90).

Results: Initial facial expressions categorized as anger and joy predicted later reduced cognitive performance in aspects of memory and executive function within the virtual session, respectively. Test performance was associated neither with sadness nor with avoidance emotions (i.e. disgust or fear).

Conclusions: Results of the current study did not strongly align with approach/avoidance explanations for links between emotion and cognitive performance; however, results might support an arousal-based explanation, as joy and anger are both high arousal emotions. Additional investigation is needed to understand the intersection of emotion motivation and physiological arousal in the context of neuropsychological assessment.