Journal of clinical and experimental neuropsychology最新文献

Objective: Almost 10% of Veterans have experienced homelessness, which is associated with complex healthcare needs and high levels of physical and mental health comorbidities. Measures of autonomic nervous system dysregulation, including higher resting heart rate (HR) and lower time domain and higher frequency domain measures of heart rate variability (HRV), are associated with worse physical and mental health in Veteran and civilian populations. However, these associations have not been explored in unstably housed Veterans with mental health conditions.

Method: 43 male Veterans who were homeless/at-risk and receiving residential mental health treatment completed measures of HRV, neuropsychological performance, neuropsychiatric symptoms, and functioning. Time-domain and frequency-domain measures of HRV were calculated. Correlations between neuropsychological performance, symptoms, and HRV measures were computed. Multiple regression was used to examine predictors of variance in HRV variables.

Results: Higher HR and worse HRV metrics were significantly (p < .05) associated with worse physical health (r = 0.37-0.39), neuropsychological performance (r = 0.35-0.40), neuropsychiatric symptoms (r = 0.33-0.38), and functioning/disability (r = 0.39-0.50). Multiple linear regression revealed that symptom and neuropsychological variables explained 22-50% of the variance in HR and HRV.

Conclusions: HRV in Veterans may serve as a noninvasive biomarker correlate of healthcare needs in unstably housed Veterans.

Introduction: Late-life depression (LLD) is associated with cognitive deficits, particularly in memory and executive functions. Rumination, namely brooding, may also negatively impact cognition. Few studies have investigated multivariate relationships between depressive symptoms and different types of rumination on cognition in LLD, which was the focus of the current study. We also explored whether relationships differed by gender and depression age of onset.

Method: Cognition was measured via five cognitive composites (Attention/Working Memory, Processing Speed, Language, Episodic Recall, and Executive Functions). LLD who completed both the Montgomery Asberg Depression Rating Scale (MADRS) and Ruminative Responses Scale (RRS) was used in analyses (n = 91). RRS subscales included Brooding and Reflection rumination. Two separate bootstrapped multivariate multiple regressions examined whether MADRS, Brooding, or Reflection, and their respective interactions predicted cognitive performance after covariate adjustments and Bonferroni correction. Exploratory analyses using similar models but stratified by gender and depression age of onset were also conducted.

Results: Only Brooding significantly predicted cognitive performance in the multivariate omnibus models (F(7,78) = 3.52, p = 0.006). Follow-up univariate analyses showed significant relationships for Language (p = 0.005, BCa 95% CI [-0.09 to -0.02]) and Episodic Recall (p < 0.001, BCa 95% CI [-0.012 to -0.04]) domains, with higher Brooding associated with lower cognitive performances. Exploratory analyses demonstrated a significant multivariate effect of Brooding in both men and women; however, the only significant univariate effect was for Episodic Recall in women (p = 0.025, BCa 95% CI [-0.11 to 0.01]). Age of depression onset was not significant for any of the multivariate models.

Conclusion: Elevated Brooding (and not depressive symptoms, Reflection rumination, or their interactions) was associated with lower language and memory functions in LLD. This effect may be greater in women, particularly for memory. Interventions aimed at improving brooding rumination in LLD may also benefit cognitive performance.

Introduction: Cognitive impairment is a commonly observed characteristic of people living with schizophrenia (PLWS). Adequate monitoring of intellectual decline and status in this population requires reliable estimates of premorbid IQ because objective IQ data predating schizophrenia onset are often unavailable. However, premorbid IQ estimation in PLWS is frequently complicated by confounding factors. The primary objective of this systematic review is to explore and compare extant approaches for estimating premorbid IQ in PLWS and, in doing so, identify factors that might inform the selection of the most reliable method for this clinical population.

Method: A systematic literature search was conducted across PubMed, Web of Science Core Collection, EBSCOhost, SCOPUS, and The Cochrane Library electronic bibliographic databases. After deduplication, study selection was conducted in line with predefined inclusion and exclusion criteria. The quality assessment of studies was conducted using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool.

Results: 43 articles involving 8,012 participants with schizophrenia spectrum disorders were included. Premorbid IQ estimation methods such as the National Adult Reading Test (NART), Wide Range Achievement Test (WRAT), Test of Premorbid Functioning (ToPF), Wechsler Test of Adult Reading (WTAR), Oklahoma Premorbid Intelligence Estimate (OPIE), demographic regression algorithms, and "hold" test approaches based on subtests from the Wechsler Adult Intelligence Scale (WAIS) were employed. Studies comparing these methods report inconsistent levels of agreement, with differences associated with factors such as schizophrenia chronicity, age of onset, and years of education.

Conclusions: A range of measures are available for estimating premorbid IQ in people living with schizophrenia. However, their precision is limited by several factors identified in this review. We urge researchers and clinicians to recognize these limitations. We have created an evidence-based guide to support the selection of the most optimal estimation method for premorbid IQ in PLWS.

Background: A class action lawsuit filed by two ex-players that claimed the use of race-norms within the 2014 National Football League concussion settlement agreement violated the 14th amendment focused national attention on how the field of clinical neuropsychology assesses racially/ethnically diverse adults.

Objective: Review the reasoning behind the introduction of race-norms into clinical neuropsychological practice with the goal of providing concrete assessment and research steps for their replacement.

Results: The need for race-norms stemmed from: (a) research that consistently showed that African Americans as a grouping had lower mean scores than European Americans on a wide range of neuropsychological tests, and (b) estimation of preexisting skill level at the 50th percentile of non-racially stratified norms. They successfully reduced false-positive misclassifications among African Americans. Historically, this was preceded by debate over the causation of African versus European mean score differences on intelligence tests. Advances in genetic research have shown that commonly used racial categories are genetically heterogeneous and lack clearly defined genetic boundaries. U.S. racial (and ethnic) categories define populations that differ in their average levels of social and economic advantage/disadvantage and are better viewed as heterogeneous, nonscientific sociopolitical units.

Conclusion: Replacing race-norms involves using performance-based estimates of preexisting skill level that are individualized and not subject to racial profiling. In research, racial/ethnic group comparisons give way to the study of measurable sociocultural dimensions on which these groupings differ that potentially impact neuropsychological test scores. To date, few such dimensions have demonstrated incremental contributions beyond that of years of education except for qualitative aspects of education and bilingualism.

Objective: Inconsistent results have been reported in studies examining how the prefrontal cortex influences decision-making abilities. Moreover, earlier studies have mainly documented the role of executive functions as the primary cognitive mechanism underlying deficits in decision making. However, the involvement of other cognitive domains, particularly those related to logical reasoning - such as cognitive estimation processes - has never been explored in the context of decision-making impairments. The objective of this study is to examine both the association between lesions to different regions of the prefrontal cortex and cognitive estimation with decision making, and whether their implications may vary based on the degree of uncertainty inherent in the decision task.

Method: Thirty patients with prefrontal cortex damage were compared with thirty control subjects matched by gender, age, and education on their performance on the cognitive estimation task and the Iowa Gambling Task assessing decision-making.

Results: Patients with prefrontal cortex damage were significantly impaired compared to control subjects in both these domains. Further analyses, including correlations and regression, indicated that performance on the cognitive estimation task predicts decision-making performance on the Iowa Gambling Task, especially under condition of risk. Finally, voxel-based lesion analysis identified a partially overlapping bilateral prefrontal network, centered within the ventral and dorsomedial areas and extending into the dorsolateral prefrontal cortex, associated with deficits in both cognitive estimation and decision-making.

Conclusions: This study emphasizes the importance of considering diverse cognitive domains in understanding decision-making impairments, offering new insights that could inform clinical interventions and enhance patient care.

This study investigates visual working memory (WM) performance in children aged 7-12 years with Autism Spectrum Disorder (ASD) compared to typically developing (TD) peers, focusing on face stimuli to evaluate social-relevant memory processing. The research aims to identify differences in visual WM functioning and determine whether errors in recall stem from reduced precision or increased random guessing. Participants completed a visual WM task requiring them to memorize and reproduce the orientations of faces presented on a screen. Results demonstrated that children with ASD exhibited significantly poorer overall visual WM accuracy than TD children. A fine-grained analysis of error patterns revealed that the ASD group showed markedly lower precision in recalling spatial details of the stimuli, indicating less stable or detailed memory representations. However, rates of random guessing-a measure of attentional lapses or task disengagement-did not differ significantly between groups. These findings underscore that visual WM deficits in ASD are primarily driven by reduced precision rather than fluctuations in attention or motivation. The study highlights the importance of precision-based mechanisms in understanding atypical cognitive profiles in ASD, offering insights into potential interventions targeting memory consolidation or perceptual encoding strategies to enhance functional outcomes. By isolating precision as a key deficit, this work advances theoretical models of visual WM and informs tailored approaches to support memory-related challenges in ASD.

Objective: Neuropsychological baseline evaluations in youth are critical in the context of sport concussion management. Youth athletes typically undergo annual baseline evaluations to account for the rapid cognitive development that occurs throughout childhood. However, the reliability of measures used in baseline evaluations at an interval greater than one year is relatively unknown. This study examined the test-retest reliability of non-computerized neuropsychological assessments administered at different time points and aimed to provide neuropsychologists with data to inform their decisions in test selection and clinical interpretation.

Method: Healthy youth male athletes (n = 28, M_age = 11.24 years) completed two comprehensive baseline evaluations on average 22.67 months apart. The intraclass correlation coefficient measured test-retest reliability, and a mixed effects model examined the degree of improvement in test scores and within-subject variability across administrations using both raw and normative scores.

Results: Measures of visuoconstruction, cognitive switching, working memory, contextualized verbal memory, inhibition, and simple attention produced good reliability (>.75), while a measure of visual memory demonstrated poor reliability (<.50) for both normed and raw scores. The authors observed significant interactions between age and time elapsed between baseline administrations for measures of visuoconstruction, visual processing speed, and cognitive switching. Normed scores for measures of working memory, simple attention, and inhibition showed more within-subject variability than raw scores.

Conclusions: All measures, except NEPSY-II Memory for Designs, demonstrated moderate to good test-retest reliability for both absolute and normed scores over an average 22-month interval between baseline administrations. However, clinicians should not overlook potential practice effects when interpreting a youth athlete's second baseline performance. The authors also underscore the value of examining raw data in understanding of cognitive maturation across cognitive domains. Future research should examine the reliability of baseline evaluations incorporating both non-computerized and computerized measures, and replicate findings in a larger sample of youth athletes.

Introduction: Despite the recognized importance of social cognition in predicting functional outcomes in schizophrenia, there is a lack of widely accepted measures that assess this broad domain while possessing psychometric validity and predictive utility. This study aimed to address this gap by providing incremental validity data for a promising social cognitive measure assessing facial affect recognition in patients presenting with treatment-resistant psychosis.

Method: Using a clinical archival dataset comprising 59 consecutive admissions to an inpatient treatment-resistant psychosis unit, this study examined facial affect naming performance from the Advanced Clinical Solutions-Social Perception (ACS-SP) affect naming subtest, and the association with neuropsychological functioning and symptom severity. Hierarchical regression models were used to assess whether facial affect recognition predicted daily functioning, including measures of functional capacity and functional performance.

Results: The ACS-SP affect naming measure showed limited sensitivity for impairment relative to other cognitive domains. Affect naming showed weak to moderate correlations with a broad range of non-memory cognitive functions, and no association with symptom severity. After controlling for cognitive functioning and symptoms, the ACS-SP affect naming task predicted poorer functioning with regard to functional performance but not functional capacity.

Conclusions: The ACS-SP affect naming task associates weakly to moderately with other measures of cognition, but also likely taps into social cognitive skills not measured by typical neuropsychological tests. This measure was predictive of some aspects of functional outcomes in patients with treatment-resistant psychosis, and therefore may be a useful tool to incorporate into routine neuropsychological assessments in such treatment settings.

Background: Inflammation, chronic pain, and hypertension have been identified as risk factors for cognitive decline; few studies have examined the interplay between multiple risk factors and even fewer have considered these factors in underserved rural populations.

Objective: This study analyzed the relationships between inflammation, chronic pain, and hypertension with cognitive functioning in an underserved, primarily Hispanic, rural population from Project FRONTIER (Facing Rural Obstacles to Healthcare Now Through Intervention, Education, & Research).

Methods: This epidemiological study enrolled 1,864 participants (M_age = 59.68 years, SD_age = 12.21) living in five rural counties in West Texas. Consented participants disclosed medical diagnoses (e.g. chronic pain), completed five cognitive evaluations (i.e. the Repeatable Battery for the Assessment of Neuropsychological Status, the Trails Making Test A and B, and Clock Drawing 1 and 2), and attended a medical examination during which a physician confirmed existing medical conditions (e.g. hypertension) and collected a blood sample for further analysis (e.g. inflammation markers).

Results: Analysis via MANOVA revealed a multivariate effect of inflammation (V = .02, F(4, 969) = 3.72, p = .006) and a multivariate effect of hypertension (V = .03, F(4, 969) = 6.69, p < .001). There was no multivariate effect for chronic pain (V = .01, F(4,969) = 2.18, p = .07) and no significant two way or three way interaction. Post-hoc ANOVAs further illustrated the relationships between specific cognitive functioning domains and inflammation or hypertension.

Conclusions: The current study findings suggest that underserved rural populations have unique epidemiological experiences that are distinct from prior findings in urban populations. Inflammation and hypertension are important clinical considerations as risk factors for cognitive decline. Future research should explore interventions that support rural-dwelling individuals impacted by provider shortages.

Objective: The study aims to update normative data for three of the tests which are most widely used in the Italian clinical services for dementia screening: the Rey-Osterrieth Complex Figure test, the Coloured Progressive Matrices test and the Controlled Oral Word Association test. In fact, the obsolescence of normative data is a crucial problem for cognitive tests, and their periodical updating is recommended because of the Flynn Effect: the longer the time which has passed since standardization, the greater the likelihood is that scores will overestimate real abilities.

Methods: A total of 364 neurologically healthy individuals (130 males/234 females; age ≥ 40, mean = 65.67 ± 10.29 years, education = 12.98 ± 3.88 years; MMSE score = 29.32 ± 1.11) were recruited from Rome and the surrounding area and divided into 8 groups by five-year age intervals (range 40-85 years). Linear models with modulating effects for age, education, and gender were applied to obtain the correction scores. Percentiles and Equivalent Scores were calculated as well.

Results: Normative data corrected for age, gender and education were obtained for the three tests. Decremental effects of age and incremental effects of education were confirmed, while mixed results were found for gender. When compared with previous Italian normative studies, a global increase in the mean scores was recorded.

Conclusions: The study provides updated scores for the Italian population for three tests widely used in clinical and experimental settings. The effects of aging, education, and gender on cognitive performance are confirmed, as well as the Flynn effect and the necessity for periodical updating of normative data for neuropsychological tests.