Journal of clinical and experimental neuropsychology最新文献

Introduction: Use of embedded performance validity tests (PVTs) helps efficiently monitor performance within neuropsychological batteries, particularly when embedded within instruments such as the Wechsler Memory Scale (WMS) Logical Memory (LM) subtest. Killgore and DellaPietra's 2000 commonly referenced WMS-III Rarely Missed Index (RMI) was developed through simulated design and not updated using WMS-IV items. This study investigated the utility of the WMS-III RMI in our clinical sample, while also seeking to validate a WMS-IV RMI update utilizing an archival Pearson non-stimulus sample (NSS) and our clinical archive.

Method: Fifty cases from the Pearson NSS archive and clinic archive PVT Pass (N = 195) and Fail (N = 95) cases were included. Determination of PVT Pass-Fail was based on passing ≥2 stand-alone and/or embedded PVTs. The original RMI was updated using WMS-IV questions adapted from WMS-III. The novel WMS-IV RMI was developed by identifying LM recognition items answered with ≥ 70% accuracy in the Pearson NSS or ≥ 90% accuracy in the Pass-PVT group. Items entered into exploratory discriminant function analysis revealed a structure matrix with group correlation of ≥ 0.30, and standardized canonical discriminant function coefficients of 0.59, 0.46, 0.41, 0.33, and 0.23 for WMS-IV LM recognition items 14, 16, 22, 28, and 29, respectively. Items were weighted based on these coefficients, aggregating to an index ranging from 0 to 202.

Results: Unexpectedly, no original RMI items overlapped with the novel RMI. The novel RMI cutoff of ≤140 resulted in 90.3% specificity with 25.3% sensitivity. Novel RMI AUC was 0.66, with an optimal cutoff of ≤190 to maximize sensitivity (64.2%) and specificity (65.4%).

Conclusions: Results caution clinicians and researchers against using dated PVTs, while PVTs determined by simulated designs should not be assumed to stand up to clinical samples.

Introduction: Optimizing cognitive outcomes of pediatric epilepsy surgery requires understanding of risk for change in function, typically based on hemispheric lateralization of language skills. Identification of cognitive lateralization in children is complicated by disease in the setting of ongoing functional development. A quantitative method for assessing lateralization, the Cognitive Lateralization Rating Index (CLRI), was used as a systematic way to assess lateralized cognitive dysfunction in a sample of pediatric epilepsy surgery candidates.

Method: The current study examined demographic and clinical variables in relation to the CLRI in 179 patients evaluated prior to epilepsy surgery from a national multi-site cohort.

Results: The sample was comprised of 179 patients (43.3% female; 76.3% White, 83.6% not Hispanic/Latino; age of seizure onset M 6.58 years; seizure type: 84.7% focal; side of seizure onset: 51.3% left hemisphere, 38.1% right hemisphere). Results demonstrated that lateralization of cognitive dysfunction in a pediatric sample, as well as characterization of presumed atypical functional organization, is possible with the CLRI. There was no significant association of demographic variables on lateralization. Age of seizure onset was not significantly related to the CLRI. Children with focal epilepsy were more likely to have lateralized cognitive profiles than children with generalized seizures, though this relationship was not significant. Additionally, analyses demonstrated those with left hemisphere seizures were significantly more likely to have dominant hemisphere dysfunction or presumed atypical organization on the CLRI.

Conclusions: Results establish the CLRI as a potentially useful tool for both research and clinical care to quantitively stratify cognitive risk profiles for pediatric epilepsy surgery evaluations.

Introduction: Rumination, a predisposing and perpetuating feature of depression, has been linked to personality and cognition. However, little is known about their comparative influence on rumination. This study examined personality and cognitive variables as predictors of rumination in early-onset, later life depression (LLD) relative to healthy controls (HC).

Methods: Participants were 98 adults aged 55-79 divided into an HC group and LLD group (including active and remitted depression). Secondary analysis considered the subset of LLD with a current depressive episode to investigate effects in state-level depression. Personality predictors included the five domains assessed by the NEO-PI-R. Cognitive domains were executive functioning, attention, and global cognitive ability. Hierarchical linear regressions included predictors of rumination, with variable blocks composed of 1) demographic characteristics, 2) group (LLD vs HC), 3) cognitive/personality variables, and 4) interaction terms for variables with significant main effects. Secondary state depression analysis considered MADRS score in the second block and select predictors in the third block.

Results: Group (LLD vs HC) significantly predicted rumination in the primary analysis and remained significant following inclusion of all cognitive and personality variables. Neuroticism, and less significantly perseveration on the WCST, also predicted rumination; while there was some indication that cognitive variables were associated with increased rumination in LLD, results overall did not reach significance. MADRS score significantly predicted rumination in the secondary analysis, though predictor variables did not moderate this association.

Conclusion: Results demonstrate that personality, namely neuroticism, is more predictive of rumination than cognition in older adults. Depression history, neuroticism, and to a lesser extent cognitive flexibility were associated with higher levels of rumination in LLD, while only depression symptom severity was predictive of rumination in state depression. Findings suggest personality is more related to rumination than cognition in LLD, though the relationship may be distinct for state and trait depression.

The field of neuropsychology has been slow to adapt the use of new technologies, relative to other healthcare fields, accounted for by multiple factors, including a lack of sufficient normative data, reliability, and validity for novel measures; low motivation by testing companies to develop measures that utilize modern psychometrics; and comfort in continuing to use measures and processes that have been used for decades in clinical practice. While these are all reasonable rationales for continuing to practice what we know, we find ourselves in a zeitgeist with rapidly developing technologies that can change and improve the way that we practice. At the same time, there is a growing recognition of cognitive health as a critical vital sign that needs to be well-managed throughout the lifespan to contribute to general good health and well-being, requiring large-scale screening efforts at the population level. Neuropsychologists are specialty care practitioners with limited bandwidth to provide comprehensive evaluations. Stepped-care models in neuropsychology that deploy novel technological innovations provide a solution to both challenges heretofore described. This manuscript, an adaptation of this author's 2024 Society for Clinical Neuropsychology's Presidential Address, illustrates models of stepped-care in neuropsychology and describes how novel tools, currently employed primarily in research settings, can eventually be integrated into the clinical practice of stepped-care neuropsychology. It also describes steps that our field is taking now to enter the new age of digital healthcare provision.

Introduction: Concussions present a significant public health concern, with an estimated 1.6 to 3 million sport-related cases reported annually in the United States alone. Athletes are particularly vulnerable due to repeated exposure to high-risk situations. We wish to validate a novel assessment tool designed to evaluate cognitive functioning through a sport-specific, decision-based task.

Method: This study introduces SENIC (ENgaging and Immersive Cognitive Simulation), a dynamic, context-sensitive cognition task developed collaboratively with athletes and stakeholders. SENIC integrates ecological validity by contextualizing cognitive tasks within the athlete's sport. This approach offers an integrated view of cognition, as opposed to traditional methods that assess cognitive functions independently. Reaction time, a behaviorally linked indicator, serves in this study as a measure of information processing efficiency. Ninety-six athletes without current or recent concussion completed SENIC and the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) battery. Construct validity was examined using a multitrait-multimethod matrix (MTMM) approach.

Results: The MTMM revealed correlations between SENIC's detection time and ImPACT's reaction time, ImPACT's visuomotor speed, and ImPACT's visual memory, providing preliminary evidence for convergent validity.

Conclusion: Our study proposes an innovative neurocognitive assessment approach that combines external validity with dynamic cognition. SENIC seems promising in providing a contextually relevant evaluation of cognitive functioning in athletes at risk of concussion.

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.

This introduction outlines the Society for Clinical Neuropsychology's (SCN) programming at the 2024 APA Convention, highlighting advances in DEI, technology integration, and intervention in neuropsychology. This special issue of JCEN captures key themes and presentations.

Background: Metamemory is the awareness of and ability to evaluate one's own cognitive abilities. This study examined impaired metamemory as a possible mechanism contributing to persistent cognitive symptoms after COVID-19.

Methods: Individuals with previous COVID-19 illness were recruited. Participants completed questionnaires regarding physical health, mental health, and their COVID-19 illness. To assess memory and metamemory performance, participants were presented with 50 words and then completed a two-alternative forced choice recognition memory task with a confidence rating after each trial. This was repeated for 3 blocks of 50 trials each. A signal detection theory framework was applied to derive metrics of memory performance (d'), metamemory performance (meta-d'), and metamemory efficiency (M-ratio). We compared participants who self-reported persistent cognitive symptoms at the time of their metamemory assessment (n = 47) to participants who denied persistent cognitive symptoms (n = 87). We used a general linear model to compare groups, covarying for age and days between COVID-19 and metamemory assessment.

Results: Participants with and without self-reported persistent cognitive symptoms did not differ on memory performance (d': p = .24, $\beta$ = 0.22 95% CI [-0.1, 0.6]), metamemory performance (meta-d': p = .28, $\beta$ = 0.20 95% CI [-0.2, 0.6]), or metamemory efficiency (M-ratio: p = .85, $\beta$ = -0.04 95% CI [-0.4, 0.3]). Those with persistent cognitive symptoms reported a higher degree of depression (p < 0.001, $\beta$ = 0.83 95% CI [0.5, 1.2]), anxiety (p = 0.016, $\beta$ = 0.50 95% CI [0.2, 0.9]), and somatic symptom scores (p < 0.001, $\beta$ = 0.92 95% CI [0.5, 1.3]).

Conclusions: Patients with and without self-reported persistent cognitive symptoms had similar memory accuracy and both demonstrated good (synchronous) awareness of their memory test performance. While both cognitive and metacognitive impairment appear unlikely to drive cognitive symptoms after COVID-19, psychological distress (particularly anxiety) remains a compelling candidate perpetuating factor. Future mechanistic research is necessary to understand if and how psychological distress contributes to cognitive symptoms, and vice versa.

End-stage organ failure (e.g. kidney, liver, heart, lung) is a critical medical illness and can result in death without solid organ transplantation. However, many patients present with cognitive deficits and challenges with adherence, which can limit access to life-saving transplant. In this session, we provided an overview of the medical and biopsychosocial factors impacting cognition among patients with end-stage organ disease. Dr. Kyle Jennette discussed the pathophysiology of organ dysfunction and relationships with the central nervous system (CNS) among those with liver, kidney, heart, and lung failure. Dr. Sarah Szymkowicz described neuropsychological profiles associated with those conditions, focusing on biopsychosocial factors and comorbid medical disease states that may impact cognition. Mrs. Amanda Messerlie explained the risks and benefits of solid organ transplant as a potential treatment for organ failure and associated cognitive difficulties. Finally, Dr. Jenessa Price integrated this information in a discussion of the specialty practice of Transplant Neuropsychology, including interpreting cognition in the context of the full biopsychosocial picture, framing transplant readiness based on the comprehensive evaluation, and delivering meaningful feedback within the multidisciplinary treatment team setting. Attendees increased clinical understanding of this medically complex population and gained insight on the specialty practice of Transplant Neuropsychology, toward the goal of increasing comprehensive neuropsychological care and access to transplant among those at-risk for cognitive difficulty.