Journal of Neuropsychology最新文献

This study investigated Theory of Mind (ToM) deficits in patients with suspected idiopathic normal pressure hydrocephalus (iNPH), a condition affecting motor, cognitive and autonomic functions. Given the overlap between ToM-related neural networks and those affected in iNPH, we examined whether ToM impairments are a feature of the disease. Thirty-eight patients with possible/probable iNPH and 25 healthy controls completed the Reading the Mind in the Eyes Test (RMET) along with typically administered neuropsychological tests in this population. Group differences were analysed while controlling for age and education. Pre- and post-lumbar puncture (LP) cognitive changes were also examined, and regression analyses explored cognitive and disease-specific predictors of ToM performance. Compared to the controls, patients performed significantly worse on all cognitive tests (p > .005), including the RMET [F(1, 59) = 7.209, p < .012, partial η² = .102, 95% CI [0.009, 0.278])]. Evans Index and education were significant predictors of ToM performance (p =.005). Post-LP, while a subset of patients improved in gait and verbal fluency, their ToM scores remained unchanged. ToM deficits are part of the cognitive profile of iNPH. The association between ventricular enlargement and ToM impairment necessitates further research into the neural mechanisms underlying social cognitive dysfunction in iNPH. Incorporating ToM measures in neuropsychological evaluations may aid early identification of patients with social cognitive deficits and facilitate targeted interventions.

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.

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).

We aimed at validating the Mini Social Cognition and Emotional Assessment (Mini-SEA) in a German cohort of mildly impaired behavioural-variant frontotemporal dementia (bvFTD) patients and healthy controls. The Mini-SEA comprises the Facial Emotion Recognition Test (FERT) and the Faux Pas Test (FPT) measuring Theory of Mind (ToM) abilities in social norm-related real-life stories. We examined the diagnostic performance of the Mini-SEA alongside other neuropsychological assessments and investigated its structural neural correlates. We included 32 bvFTD patients and 54 controls in logistic regression models with forward-stepwise selection containing demographics, standard neuropsychological battery (CERAD-NAB+) and the Mini-SEA scores to identify the most relevant variables. Demographic, neuropsychological and daily-life activity associations were explored. Voxel-based morphometry analysis was conducted in a subsample (14 bvFTD and 14 controls) on regions previously linked to emotion processing and ToM functions. The Mini-SEA yielded a very good performance, being in the best-fitting model with a high odds ratio alongside the executive-language and memory measures. Specifically, the FERT indicated the strongest effect in the group differentiation. Mini-SEA showed significant associations with executive-language tests and daily-life activities. In canonical emotion processing brain regions, we found associations of the Mini-SEA composite and the FERT with grey matter volumes in the left insula and lentiform nucleus of putamen. Within ToM regions, associations were found for the Mini-SEA composite and the FPT in cerebellar regions. The German Mini-SEA discriminates well between mildly impaired bvFTD patients and controls. We also demonstrated its significant value for neuropsychological assessment and neuro-behavioural associations in regions underlying emotion processing and ToM.

Harmonized neuropsychological assessment for neurocognitive disorders (NCDs) is an urgent priority in clinics. Neuropsychology assessments in NCDs seldom include tests exploring social cognitive skills. In 2022, we launched the SIGNATURE initiative to optimize socio-cognitive assessment in NCDs. Here, we report findings from the first initiative phase, including consortium creation and evaluation of the state of the art in socio-cognitive assessment in memory clinics. We developed an ad hoc online survey to explore practices and measures, relevance, and obstacles preventing the use of socio-cognitive testing in clinics. The survey was distributed within the SIGNATURE network. National coordinators were identified to disseminate the survey to local collaborators and scientific societies active in the field of dementia and/or neuropsychology. Data were analysed in aggregate form and stratified by geographical area and variables of interest. Four hundred and thirteen (413) responses from 10 European and Latin American geographical regions were recorded. Responders were balanced between physicians and psychologists. Seventy-eight (78) % of respondents reported no/limited experience with socio-cognitive measures; more than 85% agreed on their relevance in clinics. Ekman-60 faces was the most well-known and/or used task, followed by the Faux-Pas and Reading-the-Mind-in-the-Eyes tests. Lack of clinical measures, assessment time, guidelines, and education/training were reported as main obstacles. Real-life barriers prevent the adoption of socio-cognitive testing in clinics. Bidirectional collaboration between clinicians and researchers is required to address clinical needs and constraints and facilitate consistent socio-cognitive assessment.

Faced with increasing diversity in Europe, a large body of research in neuropsychology has emerged to develop tools for the reliable detection of cognitive disorders in diverse older adults. Following this perspective, few tools have been validated, particularly for assessing episodic memory, such as the Nine Images Test (TNI-93). The aim of the present study was to test the interest of adding a delayed recall to the classic TNI-93 procedure for the detection of clinical Alzheimer's disease (AD) in diverse populations. A French retrospective analysis was conducted based on the clinical and neuropsychological data of 281 patients (111 who received a clinical diagnosis of AD; 101 with a cognitive profile not suggestive of AD and 70 patients with a subjective cognitive decline). The sample was mostly composed of people with a low level of education and non-French speakers. The TNI-93 data from the neuropsychological assessment, including a free and a cued recall after a 20 min delay, were analysed. First, AD patients performed more poorly than both other groups on all scores. However, performance decreased more significantly after a 20 min delay in AD patients than in the other groups. Second, the Receiver-Operating-Characteristic analysis showed that the higher diagnostic accuracy for the detection of AD patients was obtained for the 20 min free recall. These results confirm the relevance of the TNI-93 for the clinical detection of AD in diverse populations. The added delayed recall condition seems relevant to highlight the accelerated forgetting of AD patients in a 20 min time window following learning.

The ‘KeyStrokes’ test (KS) was created as an online and computerized neuropsychological assessment to assess simple attention, processing speed, and executive function. This pilot study aims to show proof of concept of the KS test as a computerized assessment. Building on a previous feasibility study, we assessed the KS test's internal consistency and correlations to other neurocognitive assessments. Participants were recruited from a clinical sample of patients referred for standard neuropsychological evaluation and were asked to perform several standard neurocognitive tests and six subtests of the KS: two response time trials (arrows, words), three inhibition trials (arrows, words, arrows/words) and one inhibition/switching trial (arrows/words). We assessed internal consistency; conducted correlation analyses between each KS subtest, standard neuropsychological tests, and demographic characteristics (age, education, ethnicity, and gender); and conducted multiple regression analyses to assess the relationship between test performance and age and education. We assessed 87 individuals with a mean age of 54.09 years. Correlations between KS subtests were positive and strong (all above ρ > .72, p < .001). Subtests were generally positively correlated with select WAIS-IV and Reynolds Interference Task subtests, and negatively correlated with trail making tests, the grooved pegboard test, and age. Age significantly predicted performance (p < .001), whereas education did not. Ethnicity appeared to correlate with certain subtests, whereas gender did not. Analysis of correlations between the KS subtests and multiple well-established neuropsychological tests showed the possible viability of the KS as a new neurocognitive measure assessing areas of attention, processing speed, and executive function. Additional study of the KS can provide more evidence for its use as a new computerized, and possible online neuropsychological assessment.

Patients with dural arteriovenous fistulas (DAVF) suffer from cognitive impairments that go often unrecognized. This study aimed to explore the severity of cognitive impairment as well as specific cognitive domains affected in DAVF patients and to track its evolution over long-term follow-up after embolization. Consecutive DAVF patients (and an equal number of healthy controls) were prospectively enrolled and underwent a comprehensive baseline neuropsychological (NP) assessment. These patients were re-evaluated postembolization at a short-term follow-up of 1 month and long-term follow-up of 8–12 months. Thirty-one patients were included, with a male-to-female ratio of 5.2:1 and an average age of 45.1 years. NP assessments revealed significantly impaired cognitive scores across all domains (Addenbrooke's Cognitive Examination [m-ACE], the Rey Auditory Verbal Learning Test [RAVLT], the Wechsler Memory Scale, digit span forward and backward tests, and the Trail Making Test Parts A and B) in the DAVF group compared to healthy controls (p < .001). Post embolization, the m-ACE (p < .001), RAVLT (p = .04), WMS-verbal delay (p = .002) and Trail making test B (p = .019) scores showed statistically significant improvement compared to healthy controls at 1 month. However, the cognitive scores did not fully recover to the level of healthy controls at long-term follow-up. Though treatment leads to significant cognitive recovery, lasting residual cognitive deficits are persistent in DAVF patients compared to healthy controls. Inclusion of comprehensive NP evaluation in work up can unmask subtle cognitive deficits that may guide in therapeutic decision making especially in ‘benign’ DAVFs.

Transient global amnesia (TGA), a transient memory disorder in clinical neurology, is a unique clinical model for the study of hippocampal dysfunction and its implications for memory processes. While data are rather unequivocal concerning the relevance of the hippocampus for episodic memory, there is considerable dispute about its role for semantic memory. This study aimed at exploring how hippocampal impairment, which underlies the clinical presentation of TGA, affects semantic memory retrieval, particularly with regard to different retrieval strategies. Data from the acute and post-acute phase of 17 TGA patients and 17 healthy controls matched on socio-demographic factors were collected. Categorical word fluency tasks were differentiated into three retrieval strategies: first, with activation of episodic-spatial memory content; second, with novel and flexible linking of semantic memory content and third, with activation of overlearned semantic memory content. We find that hippocampal impairment during TGA significantly restricts semantic word fluency performance, with the degree of impairment depending on the retrieval strategy used and most pronounced when flexible relinking of semantic content is required. Our results suggest an important hippocampal contribution to semantic retrieval, especially in connection with novel and flexible linking of semantic content. They may furthermore be practically relevant for the early differential diagnosis and therapy of memory disorders.

Updated criteria pertaining to the diagnosis of Alzheimer's disease (AD) have sparked debate over the reliance on biomarkers—particularly amyloid-β and phosphorylated tau. While biomarkers promise earlier detection and standardized criteria, the potential extension and interpretation of their use in asymptomatic individuals remains controversial. Many individuals with abnormal biomarker profiles never experience cognitive decline, raising concerns about overdiagnosis, unintended negative psychosocial consequences and the blurring line between risk and definitive diagnosis. We, and others, argue that biomarker positivity should be reframed not as a definitive diagnosis but rather as an indicator of elevated risk, particularly in the absence of cognitive symptoms. Doing so better aligns with current evidence, preserves clarity in diagnosis, and avoids unintended psychosocial consequences. Crucially, the role of cognitive reserve—influenced by education, other life experiences and structural inequities—must be considered, particularly among racially and ethnically diverse populations historically underrepresented in AD research. Biomarker thresholds (as well as neuropsychological tools) derived from predominantly non-Hispanic white cohorts may not generalize across groups, risking misclassification and inequity. As the field moves towards precision medicine and AI-driven risk models, inclusive data and culturally valid frameworks are essential. Ultimately, embracing a risk-based, multifactorial approach respects the complexity of AD and promotes equitable care. This perspective calls for interdisciplinary collaboration to refine diagnostic strategies that are scientifically grounded, socially conscious and responsive to the lived realities of diverse populations. Only then can we responsibly integrate biomarkers into practice without sacrificing nuance.