Journal of Neuropsychology最新文献

The neuropsychological assessment of executive functions is an important part of the diagnostic process for many neurological diseases and for predicting the ability of neurological patients to function independently. Unfortunately, for the majority of commonly used executive function tests there is a paucity of updated normative data, particularly for older adults. This complicates the process of a clinically meaningful assessment. To help address this, we provide normative data for three well-validated tests of executive functions, the Stroop Colour/Word Test, the Controlled Oral Word Association Test and the Hayling Sentence Completion Test, alongside scores from an estimate of general intellectual ability. These tests are sensitive to frontal lobe damage and provide clinicians with information about possible focal damage to the left and right frontal lobes. Percentiles are presented for five age cohorts across the adult lifespan (18-92 years). A regression equation with age and predicted full-scale IQ also allows for the categorisation of normal and defective performance on the Stroop and Hayling tests. Given the increasing proportion of older adults requiring neuropsychological assessment, we investigated separately two groups in the older adult range: 65-79 years and 80-92 years. We found a decline in performance for older adults on all three tests. This decline was more marked amongst lower scoring older adults. We did not find a significant relationship between sex and performance on any of the three tests. The findings are discussed in the light of the cognitive reserve theory of ageing.

Dementia constitutes one of the most widespread neurological disorders, representing an important health concern due to its increasing prevalence. Among the various types of dementia, Alzheimer's disease (AD) is the most common in the elderly, characterized by episodic memory impairment and also a decline in executive functions. Mild cognitive impairment (MCI) is considered a transitional stage between normal ageing and dementia, often described as a pre-dementia state. Distinguishing between these states is of paramount importance for the detection and appropriate care of patients. Functional Assessment Battery (FAB) is a screening tool for assessing executive function. In this study, 36 healthy individuals (HC), 31 single-domain amnestic mild cognitive impairment (aMCI) patients, and 29 Alzheimer's disease (AD) patients were assessed using FAB to determine its reliability, validity, and discriminative validity in a Spanish sample. Results indicated a good internal consistency of FAB in the AD sample (α = .71), but not in the aMCI group (α = .49). Significant differences between HC and both aMCI and AD groups were observed in the total scores of FAB. The FAB also showed good accuracy in distinguishing between HC and patients (AUC = 0.85), with an estimated optimal cut-off point of 16.5. However, its ability to distinguish between aMCI and AD individuals was lower (AUC = 0.68). More studies are necessary to corroborate our results using larger samples.

Objective: Immersive virtual reality (VR) enhances ecological validity and facilitates intuitive and ergonomic hand interactions for performing neuropsychological assessments. However, its comparability to traditional computerized methods remains unclear. This study investigates the convergent validity, user experience and usability of VR-based versus PC-based assessments of short-term and working memory, as well as psychomotor skills, while also examining how demographic and IT-related skills influence performance in both modalities.

Methods: Sixty-six participants performed the Digit Span Task (DST), Corsi Block Task (CBT) and Deary-Liewald Reaction Time Task (DLRTT) in both VR- and PC-based formats. Participants' experience in using computers and smartphones, and playing videogames, was considered. User experience and system usability of the formats were also evaluated.

Results: While performance on DST was similar across modalities, PC assessments enabled better performance on CBT and faster reaction times in DLRTT. Significant correlations between VR and PC versions supported convergent validity. Regression analyses revealed that performance on PC versions was influenced by computing and gaming experience, whereas performance on VR versions was largely independent of these factors, except for gaming experience predicting performance on CBT backward recall. Moreover, VR assessments received higher ratings for user experience and usability than PC-based assessments.

Conclusion: Immersive VR assessments provide an engaging alternative to traditional computerized methods, with minimal reliance on prior IT experience and demographic factors. This resilience to individual differences suggests that VR may offer a more equitable and accessible platform for automated cognitive assessment. Future research should explore the long-term reliability of VR-based assessments.

Following an increased need for remote cognitive screening solutions, we aimed to investigate the construct validity and determine initial sensitivity/specificity estimates of the Tele-OCS, a stroke-specific remotely administered cognitive screening tool. To this end, a secondary data analysis is presented from 98 stroke survivors from the OX-CHRONIC longitudinal study (average 4.5 years. post-stroke). Convergent validity was examined for overall Tele-OCS performance against MoCA total score, and separately for each of the subtasks against matched neuropsychological tasks. Divergent validity was examined against different neuropsychological tests and presumed to be unrelated self-reported anxiety, as measured with HADS-A. Overall, we found that the Tele-OCS subtasks had good convergent/divergent validity. All subtasks also showed excellent specificity (min 80%), and whilst the cancellation task also showed good sensitivity (80%), all other subtasks came at a cost of lower sensitivity, compared to a more sensitive neuropsychological assessment. The Tele-OCS provides a brief, remote, first-line cognitive screening tool that reliably detects cognitive changes where these are clearly present, specifically and validly measuring distinct cognitive domains, which contrasts with a domain-general cognitive screening approach.

We investigated the course of recovery of emotion recognition impairments during the first year after mild stroke. Furthermore, we studied whether long-term emotion recognition impairments are related to behavioural problems and mood problems. Patient recruitment took place at the stroke unit of a general hospital. Fifty-eight mild ischaemic stroke patients underwent neuropsychological assessments of emotion recognition and overall cognition at 6-8 weeks and 1-year post-stroke. At follow-up, questionnaires were administered to identify behavioural problems and mood problems. Emotion recognition scores of patients were compared to scores of 109 healthy controls that were matched according to age, sex and educational level to identify impairments. Baseline patient emotion recognition scores were compared to the patient scores at follow-up to investigate recovery. In this group of mild stroke patients, emotion recognition was impaired compared with healthy controls, with no recovery over time. One year after stroke emotion recognition was impaired in 31% of the mild stroke participants. At 1-year post-stroke, impaired emotion recognition was associated with overall cognitive impairment and self-reported behavioural problems, but not with mood. Even in mild stroke, emotion recognition is on average impaired in the long term and related to behavioural problems. A substantial portion of mild stroke patients have impairments in emotion recognition both in the subacute phase as well as in the long term. Early assessment of emotion recognition is important to identify patients at risk of developing behavioural problems. Appropriate and early treatment might be necessary to prevent persisting problems.

Reports of patients with impaired verbal short-term memory are central to the debate of whether there are independent short-term stores or whether immediate repetition is supported by activated long-term memory. Patients with selective impairments of verbal short-term memory support models with independent buffers. However, it has been argued that these patients were too rare to provide reliable data. Second, it has been suggested that these patients might suffer from subtle impairments of word perception, comprehension or production which previous studies had failed to notice. Ten neurological patients were assessed. Nine participants had impaired immediate spans for digits, letters and words whilst having unimpaired word perception, comprehension and production. Another patient exhibited better preserved immediate repetition despite severely impaired word perception, comprehension and production. This double dissociation provides unequivocal evidence for the functional independence of short- and long-term memory. The size of the present group of STM participants, the largest to date, makes it impossible to ignore data from neuropsychological patients.

Creative cognition involves linking weakly or unrelated concepts, enabled by semantic control (inhibiting dominant associations to retrieve weaker ones) or through spreading activation within the semantic system. Semantic aphasia (SA) patients have impaired semantic control despite relatively preserved semantic representations. To date, no studies have examined creativity in SA. It remains unclear how impaired control affects patients' creative potential, and whether spreading activation alone supports this. Creative potential was assessed across three experiments. Experiments 1 and 2 involved 11 SA patients and 25 controls; Experiment 3 included 13 SA patients and 14 controls. In Experiment 1 (category judgement), participants selected five targets from distractors across 24 categories with differing coherence levels (shared features among members). Experiment 2 (constrained category fluency) involved generating five exemplars per category. Creative potential was measured via uniqueness, flexibility, semantic distance and creativity ratings. Experiment 3 (unconstrained fluency) asked participants to name as many Animals as possible in 1 minute, with additional measures of clustering and switching. Although SA cases were unable to shape retrieval to pre-defined associations (in the category judgement task), they showed creative potential in the constrained fluency task. In the unconstrained fluency task, patients were less able to use strategies. However, with fluency controlled, no group differences in creative potential existed. These findings provide the first neuropsychological evidence that spreading activation, even with impaired semantic control, can support creative responses. Creative potential in SA depends on task demands, aligning with broader findings of patients' sensitivity to context.

Post-stroke fatigue (PSF) is a prevalent symptom associated with attention deficits. However, it is currently unclear what drives these. Here we applied Load Theory of Attention to investigate the role of perceptual load in the relationship between attention, distraction and fatigue levels in PSF. Thirty-two chronic stroke survivors performed a selective attention task of either low, medium or high perceptual load (varied through the number of relevant target features and their combinations). Neural responses to targets and distractor checkerboard flicker (vs. no flicker) were measured with frequency-tagged EEG responses. The results showed that fatigue severity scores were predictive of response slowing, and that this slowing was increased with higher levels of perceptual load. Fatigue severity was also associated with increased neural responsiveness to distractors, specifically: EEG 10 Hz (distractor flickering frequency) power was greater in the presence (vs. absence) of distractor flicker for participants with high (vs. low) fatigue-symptoms scores, across all levels of perceptual load in the later time period of each task trial. Overall, these results clarify the exacerbating effects of perceptual load on fatigue-related slowing, stressing the importance of cognitive, as opposed to purely motoric, deficits. Importantly, they demonstrate that increased fatigue severity involves reduced ability to suppress neural responses to irrelevant distractors, irrespective of perceptual load on attention. An account for attention in PSF based on a specific deficit in distractor suppression that is found irrespective of task demands can explain a myriad of PSF symptoms (e.g. sensory perceptual overload, difficulties to concentrate).

Artificial intelligence (AI) and machine learning (ML) algorithms are revolutionising the world, and they have the potential to revolutionise neuropsychology as well. A particularly fruitful field for this revolution is the cognitive assessment of neurodegenerative disorders, such as Alzheimer's disease, Parkinson's disease, Mild Cognitive Impairment and Primary Progressive Aphasia. This narrative review explores the impact of ML and AI in classifying these patients by using biomarkers or neuropsychological tests, using vast amounts of data and providing previously unattainable insights. Additionally, the article will evaluate the accuracies of several ML algorithms, such as support vector machines, random forest or convolutional neural networks. The article will also discuss the challenges related to ML like the risk of overfitting and the need for ML algorithms to execute a differential analysis among several pathologies-a capability that current research has yet to achieve fully. Furthermore, it proposes new directions to improve the clinical utility and accuracy of ML classification algorithms in neuropsychology, underlining the possibility for theoretical advancements based on the results of these classifications.

Neuropsychological assessment in mild cognitive impairment (MCI) increasingly includes executive functions evaluation to improve diagnostic accuracy. Handwriting analysis, though common in dementia studies, is less explored in MCI. This single-centre study aimed to compare neuropsychological tests and handwriting parameters, assessing their individual diagnostic value. The study included two groups: MCI (n = 46, female/male ratio 41/5, mean age 76.87 ± 5.08) and controls without cognitive impairment (n = 46, ratio 42/4, mean age 75.70 ± 5.97). The assessment included MoCA, MMSE, Comprehensive Trail Making Test (CTMT), verbal fluency test and handwriting analysis using Livescribe Echo Smartpen. Logistic Regression (LR), K-Nearest Neighbours (KNN) and Linear Discriminant Analysis (LDA) models were used to identify patients with MCI. Patients with MCI performed worse on neuropsychological tests, generating fewer words in verbal fluency (p < .01) and taking longer on CTMT (p < .01). Neuropsychological tests outperformed handwriting measures in MCI classification (AUC: CTMT = .81, semantic fluency = .76, phonemic fluency = .72). Among the handwriting measures, text height (AUC = .68) showed the best performance, while other kinematic features ranged from .63 to .64. After combining all neuropsychological tests, KNN achieved the best classification of MCI (AUC = .84, ACC = .82, MCC = .63), while handwriting-based models performed worse, with LR reaching the highest AUC (.64), ACC (.62) and MCC (.23). CTMT and verbal fluency tests are useful in diagnosing MCI, while handwriting measures showed limited classification value.