Journal of the International Neuropsychological Society最新文献

Objective: Evaluating pauses in natural speech is a promising strategy for improving reliability, validity, and efficiency in assessing cognitive functions in people with mild cognitive impairment (MCI) and Alzheimer's dementia (AD).

Method: We conducted a quantitative meta-analysis of studies employing automated pause analysis. We included measures of speaking rate for comparison.

Results: We identified 13 studies evaluating pause measures and 8 studies of speaking rate in people with MCI (n's = 276 & 109, respectively) and AD (n's = 170 & 81, respectively) and healthy aged controls (n's = 492 & 231, respectively). Studies evaluated speech across various tasks, including standard neuropsychological, reading, and free/conversational tasks. People with AD and MCI showed longer pauses than controls at approximately 1.20 and 0.62 standard deviations, respectively, though there was substantial heterogeneity across studies. A more modest effect, of 0.66 and 0.27 SDs, was observed between these groups in speech rate. The largest effects were observed for standardized memory tasks.

Conclusions: Of the many ways that speech can be objectified, pauses appear particularly important for understanding cognition in AD. Pause analysis has the benefit of being face valid, interpretable in ratio format as a reaction time, tied to known socio-cognitive functions, and relatively easy to measure, compute, and interpret. Automation of speech analysis can greatly expand the assessment of AD and potentially improve early identification of one of the most devastating and costly diseases affecting humans.

Background: Language deficits are frequently described by patients with multiple sclerosis (MS); however, objective characterization remains somewhat limited due to its omission from standard MS cognitive evaluation and the inconsistent findings that arise from current language measures.

Objective: To establish alternative approaches to characterizing single-word level language in MS, this study (i) validates the Sydney Language Battery (SYDBAT) visual confrontation naming subtest and (ii) examines the insights provided by examining naming errors and latencies.

Methods: 40 MS patients from Royal Melbourne Hospital's Cognitive Neuroimmunology Clinic and 40 matched controls completed a series of neuropsychological tests, including the SYDBAT and 'gold standard' confrontation naming task, the Boston Naming Test (BNT). Error types and latencies on the SYDBAT were extracted from assessment audio recordings.

Results: SYDBAT and BNT scores were highly correlated (r = 0.81, p < .001) and these tasks reported comparable receiver operating characteristic curves (p = .091). Latency analysis captured lexical retrieval difficulties, with patients displaying significantly longer mean latencies than controls on the SYDBAT (p = .012, β = 0.54).

Conclusions: These findings support the validity of the SYDBAT and value of the latency analysis in characterizing language impairment in MS. Use of the SYDBAT and latency considerations contribute to a broader assessment with a briefer administration time compared to gold-standard evaluation. The study thereby offers clinicians an enhanced toolkit to more effectively and appropriately evaluate language functioning and supplement standard cognitive evaluation in this population.

Objective: Spatial neglect is a heterogeneous post-stroke disorder with subtypes differing in reference frames, processing stages, and spatial domains. While egocentric peri-personal neglect recovery has been studied, recovery trajectories of allocentric peri-personal visuospatial and personal neglect remain unclear. This study investigated recovery time courses of egocentric and allocentric peri-personal visuospatial and personal neglect during the first 12 weeks post-stroke; whether initial severity predicts recovery and defines distinct patient clusters; and how subtypes interrelate over time.

Method: Forty-one first-ever stroke patients were evaluated at weeks 3, 5, 8, and 12 post-stroke using the Broken Hearts Test, Line Bisection Test, Visuospatial Search Time Test, and Fluff Test. Recovery was analyzed using linear mixed models, clustering with Gaussian finite mixture models, and interrelationships using Spearman correlations.

Results: Significant improvements occurred in egocentric and allocentric peri-personal visuospatial and personal neglect, primarily between weeks 3 and 5, followed by a plateau. The Line Bisection Test detected no changes. Higher initial severity predicted greater residual impairment. Cluster analysis identified near-normal, mild, and moderate-to-severe baseline subgroups with distinct recovery trajectories. Moderate-to-good correlations (ρ = 0.33 - 0.55) emerged between egocentric and allocentric neglect at week 3 and when timepoints were pooled.

Conclusion: Neglect improved mainly between weeks 3 and 5 after which recovery plateaued, mirroring motor and language recovery and suggesting a shared time-limited window. Initial severity was a determinant of recovery, highlighting the value of early severity stratification to monitor and support recovery potential after stroke. As subtypes are distinctive, assessment should include multiple neglect tests.

Objective: Neurocognitive assessment is an essential research instrument for autism spectrum disorder (ASD), as the clinical manifestations are rooted in diverse neurocognitive processes that cause variation in clinical presentation. Few instruments comprehensively capture relevant neurocognitive domains, and most require professional assessors. The Penn Computerized Neurocognitive Battery (CNB) is widely used in child and adolescent psychiatry research across cultures. This study adapted and validated the CNB for a clinical ASD cohort in Hong Kong.

Method: In this Hong Kong version of the CNB (CNB-HK), thirteen cognitive tasks were translated and adapted, with one task for sensorimotor speed and twelve belonging to four specific domains (episodic memory, social cognition, complex cognition, and executive function). The CNB-HK was administered to 636 normal-IQ children with ASD (mean age: 8.4 years, 87.1% male) and 412 children without ASD (mean age: 8.6 years, 55.1% male). Factor structure was examined using factor analyses.

Results: The CNB-HK had high feasibility for children with ASD, with <7% invalid data across all tasks. The original four-factor and bi-factor structures were replicated with good model fit, and partial scalar invariance was achieved between children with and without ASD. The factor scores correlated positively with estimated IQ in the ASD group. The ASD group had worse performance across all four cognitive domains and the g factor compared to the group without ASD.

Conclusions: The CNB-HK is a valid, multi-domain cognitive assessment tool for children with ASD in Hong Kong, offering a feasible and reliable approach for research and clinical settings.

Objective: This study aimed to update normative data and establish cut-off scores for a fruit-based semantic verbal fluency (SVF) task among older Taiwanese adults as a method for detecting mild cognitive impairment (MCI). The task was chosen due to its familiarity and cultural neutrality for Mandarin-speaking populations.

Method: SVF performance was evaluated in 245 healthy control participants and 360 individuals diagnosed with MCI. The influence of demographic variables was examined, and regression-based correction formulas were developed. Receiver operating characteristic (ROC) analyses determined optimal cut-off values according to established clinical classifications of MCI.

Results: Age, education, and sex significantly influenced SVF performance. A demographically corrected 15th percentile threshold of 10 words was proposed for community screening. An optimal ROC-derived cut-off of 11.5 words yielded an AUC of .716 (95% CI: .68-.76), with sensitivity of 57.8% and specificity of 73.9%. SVF scores were significantly correlated with global cognition, memory, and processing speed.

Conclusions: The fruit-based SVF task is a quick, culturally relevant tool for detecting early cognitive impairment. Revised norms and cut-off scores can improve MCI identification in Mandarin-speaking seniors.

Objectives: To extend the current understanding of executive function (EF) deficits in youth with neurofibromatosis type 1 by investigating the impact of cognitive load on performance compared to typically developing children.

Methods: In this prospective multicenter study, 42 children with neurofibromatosis type 1 (NF1) (ages 7-18) completed neuropsychological assessments of intellect and executive functioning. Age- and sex-matched controls (n = 42) were drawn from the normative database for the tasks of executive control (TEC). Multivariate and supplementary univariate analyses examined group differences and task effects (inhibitory control and working memory demand). Associations between TEC performance and parent-reported executive dysfunction (BRIEF) were also explored.

Results: Both groups showed reduced accuracy and speed with increased inhibitory demand and made fewer errors with increased working memory demand. However, children with NF1 were significantly less accurate and consistent across tasks, particularly under higher cognitive load, while controls improved or maintained performance. Significant group × cognitive load interactions were observed, and laboratory-based deficits in NF1 were associated with parent-reported executive dysfunction.

Conclusions: Children with NF1 experience unique and multidimensional decrements in EF performance in response to increased cognitive load, unlike typically developing peers. These deficits appear to be clinically relevant. Targeting working memory and inhibitory control may reduce susceptibility to cognitive overload and improve outcomes for children with NF1.

Objective: Neuropsychological assessments commonly include word list learning tasks to assess verbal memory and learning. The California Verbal Learning Test (CVLT) provides multiple outcome measures and information regarding strategies used to enhance the coding and retrieval of information. Despite its popularity, the CVLT has not yet been formally translated into Hebrew and adapted to the Israeli population.

Methods: The CVLT-III was adapted to Hebrew (CVLT-III_Hebrew), and normative data of healthy Hebrew-speaking adults living in Israel (age range: 20 - 65, education range: 9 - 20) were collected (N = 235).

Results: CVLT-III_Hebrew core scores were influenced by age, education level, and, to a lesser extent, sex. Normative data for the Hebrew-speaking Israeli population were generated using an overlapping interval strategy, and regression models were used to evaluate the necessity of adjusting core scale scores for sociodemographic variables. Internal reliability was very high. Clinicians can employ an easy-to-use calculator for adjusting CVLT-III_Hebrew core scores.

Conclusions: The adapted CVLT-III_Hebrew provides a valuable tool for evaluating the verbal memory of Hebrew speakers. Caution, however, is warranted when assessing individuals with lower education levels, as the normative sample was relatively highly educated. This highlights the importance of expanding the normative sample to include a broader spectrum of educational levels and ages. Moreover, the inclusion of Israeli minority groups, currently unrepresented in this normative sample, is of importance.

Objectives: Body-focused repetitive behaviors (BFRBs) include activities like hair pulling and skin-picking that can lead to functional impairment. The neurocognitive underpinnings of BFRBs remain unclear, with inconsistent findings across domains.

Methods: This online study aimed to investigate the neuropsychological capacities of individuals with self-reported BFRBs. We administered the Go/No-Go test to assess inhibitory control and attention and the Verbal Learning and Memory Test to evaluate learning, recall, and memory confidence. From the 2,129 participants who entered the survey, 412 individuals with self-reported BFRBs and 412 matched controls from the general population were included. Drop-out was high.

Results: Individuals with BFRBs showed no inhibitory deficits on the Go/No-Go test but made fewer hits on the Go trials compared to controls, indicating attentional lapses. Regarding memory, only immediate recall was worse in the BFRB sample. Controls were biased toward being more confident. When we divided the sample by impairment (>1 SD below the mean of controls), a minority of the BFRB group showed deficits in attention and immediate recall.

Conclusions: Our findings suggest that neurocognitive deficits are not prevalent in BFRB, affecting less than 20% of our sample. Yet, attentional problems in a subgroup of individuals with BFRB highlights the need to study heterogeneity within BFRBs. Potential moderators such as motivation, stress, and self-stigma remain to be explored. Our findings must be interpreted with caution given the study's limited generalizability due to its online format, high drop-out rate, and absence of independent diagnostic confirmation.

Objective: For patients with primary malignant brain tumors, cognitive decline is incredibly common and contributes to reduced independence in daily functioning. These patients often rely on informal caregivers (e.g., family, friends) for functional support, shown to increase caregiver distress in other neurologic populations. However, few studies have investigated this relationship in neuro-oncology; thus, we explored whether neuro-oncology patients' neurocognitive function was associated with caregiver burden.

Method: Neuro-oncology patients completed neuropsychological tests assessing commonly affected cognitive domains, and caregivers completed a validated measure of caregiver burden including impact on daily schedule, self-esteem, and availability of family support. Dyads were selected from a previous randomized-controlled trial (SmartCare) for distressed neuro-oncology caregivers. Independent samples t-tests and hierarchical regressions were used to evaluate the relationship between patients' neurocognitive performance and caregiver burden.

Results: Seventy-eight neuro-oncology dyads were included for analyses (Patients: M^age = 53.4, 65.4% male, Caregivers: M_age = 52.5, 71.8% female, 84.6% spouse). Caregiver schedule burden, but not self-esteem or family support, was significantly higher for caregivers of patients with deficits in verbal memory and divided attention (p < .05). After controlling for disease-specific characteristics and motor dexterity, only patient verbal memory performance remained a significant predictor of caregiver burden (p < .05). Inhibition and verbal fluency were not related to caregiver burden domains (ps > .05).

Conclusions: Patients' verbal memory performance appears to be indicative of cognitive changes that contribute to increased caregiver demands on their daily schedule and time burden. Maximizing patients' functioning through leveraging their continued cognitive strengths and implementing individualized cognitive rehabilitation programs may improve caregiver burden.

Objectives: Instrumental activities of daily living (iADLs) are critical in aging and neurodegenerative research, both diagnostically (e.g., distinguishing dementia from mild cognitive impairment) and as endpoints for trials maintaining or improving functioning. However, measurement has not consistently kept pace with a changed world wherein the ability to navigate technology is pertinent to maintaining independent functioning. The current study used harmonization approaches to link traditional and technological iADLs measures using two samples.

Methods: 262 individuals (53.4% women, 91.7% non-Hispanic White, M_age = 76.2, M_education = 15.6) completed both measures: (1), the Functional Activities Questionnaire (FAQ), and (2), the new Expanded FAQ. Item response theory (IRT) analyses extracted item parameters to characterize measure psychometrics and accurately determine individual functional ability. Harmonization was done using both nonequivalent groups anchor test (NEAT) and equipercentile linking methods with supplementary traditional iADL parameter estimates from the National Alzheimer Coordinating Center (n = 48,605).

Results: Correlations verified the measures were sufficiently related (r_s = .79), and confirmatory factor analyses and reliability determined all items assessed a single construct. Items from both measures complemented each other to provide more information about milder and more severe functional change. NEAT models converged to provide IRT linking equations and equipercentile conversation tables.

Conclusion: This study provides critical information for harmonizing evolving technological iADLs with traditional iADLs that are assessed in longstanding cohorts. It further provides support for use of an expanded FAQ.