Journal of the International Neuropsychological Society最新文献

Objective: Increasing survival probabilities among children and young adults with acute lymphoblastic leukemia (ALL) have led to a growing population at risk for long-term neurocognitive sequelae. This study investigated cognitive functioning among individuals treated for ALL under the Nordic Society of Paediatric Haematology and Oncology ALL2008 protocol in Eastern Denmark, including performance across multiple domains and associations with age at diagnosis, sex, time since end of treatment, hematopoietic stem cell transplantation (HSCT), and neurotoxic events during treatment.

Method: Eighty-three survivors of ALL diagnosed before age 25 underwent neurocognitive testing at a median of 7.24 years post-treatment (interquartile range: 4.20-8.78). Performance was measured as age-standardized Z scores derived from normative data. Impairment was defined as Z ≤ -1.3 and severe impairment as Z ≤ -2.0. Multiple linear regression was used to investigate associations between cognitive outcomes and clinical risk factors.

Results: Average performance was generally comparable to norms, but at least 38.6% of participants showed severe impairment in one or more domains, and at least 12% in two or more. Younger age at diagnosis was associated with poorer processing speed, executive functions, and non-verbal reasoning, while HSCT was associated with poorer processing speed and non-verbal reasoning.

Conclusions: Although average performance of the participants was generally comparable to norms, a notable proportion exhibited multi-domain, severe cognitive impairment. Associations with age at diagnosis and HSCT indicate potential for risk-stratified cognitive monitoring and targeted interventions.

Objective: Switching is one of three primary executive functions alongside inhibitory control and updating but remains relatively understudied in childhood attention-deficit/hyperactivity disorder (ADHD) compared to investigations into working memory and inhibitory control deficits. Where extant literature in adults suggests that switch costs are due to a combination of task set inertia and task set reconfiguration costs, it is not clear which of these is most relevant to explaining ADHD-related atypicalities in performance.

Methods: Children with (N = 34) and without ADHD (N = 28) aged 8-12 (average age = 9.45) completed a 192-trial computerized cued switching paradigm. Diffusion model decomposition of the data was performed to identify cognitive subprocesses responsible for the switch.

Results: Consistent with the switching literature in adults, switch costs for children were due to a combination of both task set inertia (reduced drift rate) as well as slower task set reconfiguration (Ter) on switch versus repeat trials. Children with ADHD were less accurate than non-ADHD controls, but the ADHD × Switch interactions were not significant for any variable, indicating that the deficit was general and not switch-specific. Lower accuracy was in turn attributed to slower general drift rate among children with ADHD.

Conclusions: This study contributes to a growing literature finding that the performance deficits in children with ADHD across executive and non-executive function tasks are related to lower-level perceptual decision-making weaknesses that have downstream effects on higher-order processing.

Objective: Within resource-limited health care, it is important to demonstrate the value and impact of neuropsychological assessment (NPA) services. However, the most suitable methods for capturing these outcomes are yet to be established. We aimed to identify key potential outcomes of NPA, existing measures of these outcomes, and issues and challenges associated with outcome measurement.

Method: Focus groups of experienced Australian neuropsychologists discussed possible NPA outcomes, existing measures, and challenges of outcome measurement, analyzed using thematic analysis. The Delphi method of expert consensus was then used to identify the most important set of NPA outcomes, using iterative survey rounds with expert panelists. Panelists also rated the top three outcomes most likely to demonstrate the impact of NPA in trials.

Results: There were 50 potential NPA outcomes generated by the focus groups, spanning proximal and distal patient, caregiver, health service, and societal domains. Numerous issues and challenges were identified associated with meaningfully measuring NPA outcomes. After three Delphi survey rounds (n = 46), a total of 16 outcomes achieved consensus agreement. Few existing validated measures were identified. The top three rated outcomes were 1) better patient and/or caregiver understanding of presenting problems, 2) better patient and/or caregiver understanding of how to manage and cope with cognitive symptoms, and 3) diagnostic clarification.

Conclusions: Psychoeducational benefits of NPA were considered by Australian experts as key outcomes relevant across contexts; however, there are no existing measures of these outcomes. Future research should develop valid outcome measures to be used in clinical trials evaluating NPA impacts.

Objective: This study investigated functional connectivity in the default mode, central executive, dorsal attention, and salience networks (SN) and its relation to executive function in youth with traumatic brain injury.

Methods: Twenty-three youth with traumatic brain injury (11 with moderate-to-severe injury (6 male, m_age = 11.78 ± 2.68 years, m_{timesinceinjury} = 3.71 ± 2.43 years) and 12 with complicated-mild injury (9 male, m_age = 12.59 ± 1.99 years, m_{timesinceinjury} = 4.55 ± 1.59 years) and 17 youth with orthopedic injury (11 male, m_age = 11.75 ± 2.12 years, m_{timesinceinjury} = 3.95 ± 1.79 years)) completed resting-state functional magnetic resonance imaging and a parent rated their child's executive function.

Results: We found group differences in the strength of connectivity among four regions in the default mode network (DMN) and two regions of the SN, ps < .05, Eta² = .151-.229. The orthopedic injury group demonstrated significant negative between-network connectivity, while brain injury groups had negligible negative or, in some cases, positive between-network associations. Groups did not differ on parent ratings of executive function, as all groups fell above the normative mean, reflecting poorer than expected everyday executive behavior. Attenuation of typical negative between-network association between the posterior cingulate in the DMN and two regions of the salience network was associated with worse parent-rated executive behavior (rs = .291-.317, ps < .05).

Conclusions: Findings illustrate the implications of disrupted downregulation of the default mode network by the SN following pediatric brain injury. They also demonstrate how disruption in functional connectivity may underlie poor executive function after childhood traumatic brain injury.

Objectives: Mild cognitive impairment (MCI) involves measurable cognitive decline that does not yet significantly disrupt daily functioning but may signal increased risk of dementia. Reliable prediction of dementia conversion in MCI is essential for early intervention and optimized clinical trial design. This study aimed to evaluate the predictive performance of various machine learning (ML) classification algorithms using clinical and neuropsychological data.

Methods: Data were drawn from the Gothenburg MCI Study and included 347 patients from a memory clinic, of whom 84 (24%) converted to dementia within two to six years. We applied 11 ML classification algorithms (logistic regression, linear discriminant analysis, naïve Bayes, k-nearest neighbors, LASSO, ridge regression, elastic net, decision tree, random forest, gradient boosting, and support vector machine (SVM)) to predict dementia conversion based on 54 clinical predictors (e.g., cerebrospinal fluid biomarkers, neuropsychological test scores, comorbidities, and demographics). In a second step, we included delta scores reflecting change in neuropsychological test performance from baseline to follow-up.

Results: Without delta scores, LASSO, ridge, elastic net, random forest, and SVM performed best, achieving accuracy ≥0.87, kappa = 0.64, and AUC-ROC ≥0.90. These models demonstrated high specificity (0.94) but moderate sensitivity (0.68). Including delta scores improved performance, with ridge and elastic net achieving accuracy = 0.90, kappa = 0.73 and 0.72, AUC-ROC = 0.94, specificity = 0.96, and sensitivity = 0.73. The elastic net model yielded a positive predictive value of 0.85 and a negative predictive value of 0.92.

Conclusions: ML models incorporating clinical and cognitive change data can accurately predict dementia conversion in MCI, supporting their utility in clinical decision-making.

Objective: Sensory burden, a momentary experience of being bothered by sensory stimuli, is a frequent challenge following acquired brain injury (ABI). This study quantitatively tested a theoretical model conceptualizing sensory burden as a dynamic interaction between situational triggers and an individual's biopsychosocial resources using an experience sampling method.

Method: 41 individuals with ABI (median age = 59 years, median time since injury = 6.3 years) provided real-time data at seven semi-random intervals per day over seven consecutive days. Multilevel regression modeling assessed the influence of situational triggers (setting, company, effort, activity dissatisfaction, and negative affect) and individual resources (processing speed, fatigue, and sleep quality) on sensory burden.

Results: Momentary fluctuations in sensory burden varied in severity and variability across individuals. Sensory burden was associated with higher levels of negative affect (β = .58, p < .01), activity dissatisfaction (β = .07, p < .01), effort (β = .09, p < .01), and being in company (β = .39, p < .01). Moreover, sensory burden was related to slower processing speed (β = -0.04, p = .02) and higher fatigue (β = .19, p < .01). However, no interaction effects were found. Effort was the only positive, significant between-person predictor (β = .56, p < .01).

Conclusions: These findings underscore the dynamic and individualized nature of sensory burden after ABI, emphasizing the need for personalized interventions targeting sensory hypersensitivity. Future research should explore additional triggers, resources, and causal pathways to further elucidate the proposed mechanisms and inform treatment development.

Objective: This study aimed to explore the correlates of zero, one, and multiple performance validity test (PVT) failures on cognitive test performance in patients with various degrees of severity of traumatic brain injury.

Method: 306 participants completed the Trail Making Test as part of a neuropsychological evaluation within 1-36 months post-injury. They were assigned to zero, one, or ≥ two fail groups on the basis of at least two independent PVTs. Group differences in Trail Making Test performance were analyzed with analysis of variance, with post hoc contrasts with the Bonferroni correction for multiple comparisons. Groups were also compared on various background characteristics.

Results: Participants who passed all PVTs had statistically significantly better performance on both parts of the Trail Making Test as compared to those who failed either one or multiple PVTs, with the latter two groups not differing statistically significantly from each other. PVT failure was relatively more common in participants who were female, had an uncomplicated mild TBI, were involved in financial compensation-seeking, and were seen at a longer time point since injury.

Conclusion: Failure of even only one PVT is associated with lower neuropsychological test performance in patients with traumatic brain injury, especially when empirically validated criteria are used that are stratified by injury severity. Such failure does not always reflect malingering but must be interpreted and addressed in the context of patient background characteristics.

Objective: While early-life adverse experiences have been linked to late-life cognitive decline, few studies have explored war exposure. Paradoxically, one study even indicated a late-life cognitive advantage of early-childhood war exposure. In the present study, we explored these associations.

Methods: We examined older adults exposed to World War II (1940-1944; n = 1179) and the subsequent Civil war (1946-1949; n = 962) in Greece during early and middle childhood with a comprehensive neuropsychological assessment and for ApoE-ε allele status, including demographic information and medical history.

Results: Higher cognitive performance in language tasks predicted middle childhood, relative to early childhood, WWII-exposure group membership (B = .316, p = .038, OR:1.372, 95%CI:1.018-1.849), primarily for men, while higher attention/speed (B = .818, p = .002, OR:2.265, 95%CI:1.337-3.838) and total cognitive score (B = .536, p = .040, OR:1.709, 95%CI:1.026-2.849) were predictors of belonging to the middle-childhood group, only in men. Individuals who did not meet criteria for Mild Cognitive Impairment (MCI)/dementia were more likely to belong to the middle-childhood war-exposure group. Similarly, for the Civil war, higher cognitive scores and reduced likelihood to meet criteria for MCI/dementia were predictors of middle, relative to early childhood war exposure group membership (visuospatial score: B = .544, p = .001, OR:1.723, 95%CI:1.246-2.381, MMSE: B = .134, p = .020, OR:1.143, 95%CI:1.021-1.297), primarily for women. Results remained consistent when adjusting for multimorbidity, sex, education, current age, depression, and anxiety.

Conclusion: The present findings suggest that better cognitive performance and lower likelihood of MCI or dementia were associated with being exposed to significant hardships, such as war, during middle childhood, regardless of potentially confounding factors. Further studies are needed to shed light on this relationship.

Objective: Thai researchers developed a new self-report measure of executive functions for adolescents based on Diamond's framework (the Behavioral Inventory Measure of Executive Functions [BIMEFs]). How it was developed, its psychometric properties, and norms by sex and age are reported here.

Method: An independent panel of experts evaluated the content validity of BIMEFs. Reliability was checked using Cronbach's alpha with a sample of 45 secondary students. 1,865 students, ages 12 - 18 years (65% female) from across Thailand participated in the normative study.

Results: The BIMEFs consists of 42 items that assess inhibitory control (IC), working memory (WM), and cognitive flexibility (CF), including eight subcomponents. For all items, the index of item-objective congruence was >0.5 and Cronbach's alpha was >0.7. Confirmatory factor analysis (CFA) showed the adjusted goodness of fit index to be 0.9. The strongest sex difference was for IC. Students of 13 years scored lower on EFs overall, IC, WM, CF, and all subcomponents than older students. Self-control, verbal working memory, and being able to change perspectives showed the most pronounced differences by age.

Conclusion: The BIMEFs, which is designed to be culturally-appropriate for Thailand and cross-culturally generally, is the first EF questionnaire based on Diamond's framework. It shows good psychometric properties and sensitivity to age and sex differences. It indicates that IC development, at least in Thailand, plateaus earlier than WM and CF and that CF shows a more protracted development during adolescence than IC or WM.