Journal of clinical and experimental neuropsychology最新文献

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.

This commentary explores the rapidly evolving role of Artificial Intelligence (AI) in clinical neuropsychology, offering a critical framework for its responsible integration. Drawing on recent work that used AI to automate a neuropsychological screening tool; the article discusses key fears about AI and its more tangible risks, across safety, privacy, diagnostic bias, "erosion" of clinical judgment, and a lack of transparency. Rather than a disruptive or displacing force, this commentary argues that it represents a natural evolution of the historical shared commitment within neuropsychology and AI research to understand learning and adaptation. Key ideas are explored that highlight the value of AI as a powerful augmentative tool that automates discrete tasks, freeing neuropsychologists to focus on higher-level clinical and ethical duties. It concludes that whilst AI will not replace neuropsychologists, it is already permanently reshaping clinical workflows, decision-making and the broader contours of practice, as other key technological advances have historically achieved. Therefore, cultivating AI literacy is a fundamental step in effectively responding as opposed to reacting to these global changes. It dually challenges and positions our professional community to actively define sound ethical parameters, uphold scientific rigor, and ultimately leverage automation to enhance equitable access to high quality care.

Introduction: Social functioning is affected in various ways in behavioral variant frontotemporal dementia (bvFTD), and having tests available to assess aspects of social functioning increases the accuracy of diagnostic evaluation. One such aspect is having an accurate semantic representation of socio-emotional concepts. We designed a clinical test, the social interaction vocabulary task (SIVT), to capture this aspect. It requires participants to select a photo from a set of distractor photos that depicts a social interaction term most accurately, for example, the term "consoling." We showed in an earlier study that bvFTD patients perform below threshold on the SIVT, and that brain regions associated with poor test performance overlapped with regions typically affected in bvFTD patients. The objective of the current study is to examine the psychometric properties of a Dutch translation of the SIVT.

Methods: We translated the SIVT into Dutch using a forward and back-translation model and examined the psychometric properties of this translation. We also generated Dutch norms using a sample of 14 patients with bvFTD, 47 presymptomatic mutation carriers, and 53 healthy controls and compared performance with other nonsocial function tests.

Results: We found that the Dutch translation discriminates well between bvFTD patients and healthy controls but does not discriminate between non-symptomatic individuals. Additionally, moderate to high correlation with emotion recognition and semantic language tests was found, and weak correlation with executive functioning tests.

Conclusion: These results indicate that the Dutch translation of the SIVT discriminates well between bvFTD patients and non-symptomatic individuals. In combination with tools that are already available, this test can help clinical practitioners in the Netherlands to create a comprehensive picture of a patient's overall social functioning.

Objective: Approximately half of out-of-hospital cardiac arrest (OHCA) survivors have enduring cognitive impairment. This study investigated the effectiveness of a combined cognitive rehabilitation approach, combining metacognitive strategy training with direct computerized-training, to improve cognitive functioning in daily life after OHCA.

Method: A single-case experimental design with a non-concurrent multiple baseline was used including five participants. The intervention (6-10 weeks) entailed therapist-guided metacognitive and direct training, with a randomized starting date.  Participants completed daily visual analog scales on personal problems and subjective cognition (memory, attention, executive functioning). Cognitive tests and questionnaires on cognition, memory failures, societal participation, and quality of life were administered pre- and post-intervention. Statistical analysis included visual analysis, (weighted) TAU-U tests, and multilevel regression.

Results: Visual analysis showed improvements in personal daily problems for all adherent participants (n=4). Weighted TAU-U scores were small but significant for the personal problems (TAU-U=.19, p<.01) and attention (TAU-U=.18, p=.02). Three participants showed a significant decrease in personal problem severity during and after treatment. Descriptive cognitive test scores suggested an improvement. Participants reportedfewer memory failures and greater societal participation, but no statistical analyses were conducted. Subjective cognitive changes were mixed, life satisfaction remained stable.

Conclusions: The combined treatment improved daily cognitive functioning after OHCA.

Background: The Telephone Interview for Cognitive Status-Modified (TICS-M) is a widely utilized tool for remotely assessing cognitive function, particularly among community-dwelling older adults who are unable to attend in-person evaluations. In healthcare, AI has the potential to enhance service delivery by increasing efficiency, expanding accessibility, and reducing the cost per service. Using a conversational AI chatbot, we automated administration of TICS-M (traditionally administered by psychologists), referring to this chatbot-administered version as TICS-M-AI. The aim was to investigate proof-of-concept for chatbot automation of cognitive assessment. We report three studies evaluating psychometric properties of TICS-M-AI and an additional study on safety.

Method: Study1: Concurrent validity of the TICS-M-AI was assessed by administration of the TICS-M (by Psychologist) and the TICS-M-AI to the same participants (n = 100), one week apart. Study 2: Test-retest reliability was assessed by administering the TICS-M-AI twice to each participant, one week apart (n = 82) and comparing results. Study 3: Construct validity was assessed by attempted replication, using TICS-M-AI data (n = 264), of a previously published study by Lindgren et al. (2019) of item response patterns observed using data obtained by traditional clinician administered TICS-M. Study 4: Safety was assessed by comparing rates of reported assessment-related distress between TICS-M (n = 100) and TICS-M-AI (n = 264) administrations.

Results: TICS-M-AI concurrent validity (r = 0.81, 88% classification agreement, κ = 0.73) with the TICS-M and good test-retest reliability (r = 0.76, ICC = 0.72, 83% agreement, κ = 0.65). Using the TICS-M-AI we replicated Lindgren et al. (2019) result which used the TICS-M.

Conclusions: TICS-M-AI administered by an AI chatbot performed well compared to traditional TICS-M administration by a psychologist. TICS-M-AI is reliable, valid, and equally safe with added advantages of lower cost, scalability, and broader accessibility. Future research should address generalizability across diverse populations and refine AI adaptability.

Introduction: Neuropsychological perspectives on aging suggest that episodic memory and executive control are highly vulnerable. Previous studies have used composite indexes representing young and older adults' relative performance in each of these two domains. However, the episodic memory measures that have made up that composite are often common clinical ones (e.g., Logical Memory from Wechsler Memory Scale) and may therefore be susceptible to practice and/or ceiling effects.

Method: In the present study, we replaced the previous episodic memory measures with new ones that are novel, reliable, valid, and easy to administer online, and asked how they fit together and with the existing executive control composite. We also examined the relations between the updated composite scores and participant age, sex, and several health characteristics (i.e., depressive and anxiety symptoms, sleep, medications, vascular health, and COVID-19 infection). We administered our updated battery to healthy young (YA; n = 97) and older adults (OA; n = 96) over videoconference.

Results: Using confirmatory factor analysis with age invariance testing, we successfully replicated the two-factor structure in OAs but not in YAs. YAs had higher episodic memory composite scores than OAs, whereas the inverse was true for executive control. In both age groups, males had higher executive control composite scores than females. Although many of the health-related variables differed between age groups in the expected direction, none were significantly associated with either composite after adjusting for multiple analyses.

Conclusions: Our findings suggest that this updated battery may be suitable for remote use with healthy older adults and is related to participant sex. Additional studies replicating our factor structures in larger samples will be beneficial.

Introduction: An important frontier for neuropsychology involves developing additional technologies that could complement current behavioral approaches. Concurrent electroencephalographic (EEG) markers are especially promising for informing the neural processes underlying cognitive performance during neuropsychological assessments. The EEG aperiodic exponent shows sensitivity to both age and task-related effects, with prior studies relating smaller exponents to poorer performance in older adults, and larger exponents to greater task engagement in general. This study aimed to extend these previous experimental findings on the aperiodic exponent to a standardized assessment context and begin clarifying its relations to clinically meaningful aspects of cognition and aging.

Method: EEG was recorded during resting conditions and administration of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) from 21 younger adults and 24 older adults. Two-level mixed-effects regression models were run to assess the effects of age, general cognitive task engagement (vs. rest), and cognitive domain (Index) on the exponent.

Results: Consistent with prior studies, exponents were generally larger during cognitive tasks compared to rest (F(2,81.76) = 61.54, p < .001) and in younger versus older adults (F(1,42.37) = 26.80, p < .001). Moreover, compared to younger adults, older adults' exponents exhibited greater sensitivity to cognitive domain (Age ×Index interaction: F(5,206.93) = 9.51, p < .001).

Conclusions: Results suggest that key effects of the exponent (i.e. age and task) can be reproduced during realistic assessment scenarios, and suggest the exponent is more sensitive to between-person and age group differences than task effects. Additional investigations are needed to clarify the potential of the concurrent exponent to capture clinically meaningful cognitive processes.

Objective: Specific cognitive functioning is described among people with prelingual deafness who use sign language. This would be linked to sensorial deprivation from a premature age and associated with early exposure to sign language leading to a different organization of visuo-attentional and linguistic processes in deaf people, and thus to specific functioning of the nonverbal memory system. Due to a lack of validation, psychometric tests cannot be used to assess cognitive and memory disorders in deaf people who communicate in French Sign Language.

Methods: We previously transposed the validated a screening test for cognitive impairment into a version adapted for sign language users: Mini-Mental-State - Langue des Signes (MMS-LS). It takes into account the cultural and linguistic characteristics of this population, providing a useful clinical tool for practitioners. The present study was designed to improve assessment of neurocognitive disorders of deaf individuals by establishing normative values for visual memory tests. Thus, the Rey-Osterrieth Complex Figure and the Doors test from the Doors and People tests were administered to a cohort of 110 deaf signers.

Results: Psychometrics analyses showed excellent inter-rater reliability for copy and reproduction in memory tasks. Both tests exhibited excellent internal validity and were found to be sensitive to the presence of neurocognitive disorders as demonstrated in a group of participants with Major Neurocognitive Disorders and a low MMS-LS score.

Conclusion: Normative values, expressed in percentiles, established from these tests must be interpreted with precaution due to the small number of participants. However, these tools could be made available to neuropsychologists to facilitate clinical use, with further advice on how to better take into account the specificity of this population.