Journal of the International Neuropsychological Society最新文献

Objective: The present study sought to determine the associations between executive functioning and Big Five personality traits in an undergraduate sample.

Method: Participants included 200 undergraduates (73% women), with a mean age of approximately 21 years. Participants completed the Big Five Inventory-44 and a psychological assessment battery, which included the Trail Making Test and the Semantic Fluency Test.

Results: Results from multiple regression analyses suggested agreeableness was negatively associated with Semantic Fluency - Animals (β = -0.310, p < 0.001). Moreover, conscientiousness was positively associated with Trail Making Test B-A (β = 0.197, p = 0.016), but negatively associated with Trail Making Test A (β = -0.193, p = 0.017).

Conclusions: Overall results identified that executive function association with personality varies by construct. Given conscientiousness' differential associations within the executive function task performances, future research should examine the conscientious threshold that would result in psychological symptomatology associated with extreme lows and highs in conscientiousness.

Objective: Accurate appraisal of one's own abilities (i.e., insight) is necessary for appropriate compensatory behaviors and sustained independence during aging. Although insight is often purported to be related to executive functioning (EF), nuanced understanding of the cognitive correlates of insight for functional abilities among nondemented older adults is lacking. Because insight shares neuroanatomic underpinnings with time-based prospective memory (PM), the present study examined the contributions of time-based PM, beyond event-based PM and other potential cognitive confounds (i.e., episodic memory, time estimation, and EF), in predicting insight into one's own performance on instrumental activities of daily living (IADLs) among community-dwelling older adults.

Method: A group of 88 nondemented, community-dwelling older adults completed performance-based measures of time- and event-based PM, episodic memory, time estimation, and EF, as well as IADL tasks followed by self-appraisals of their own IADL performance as indices of insight.

Results: Time-based PM was moderately-to-strongly associated with insight, beyond event-based PM, time estimation, and episodic memory [F(1,83) = 11.58, p = .001, η_p² = .122], as well as beyond EF and demographic covariates [F(1,79) = 10.72, p = .002, η_p² = .119].Specifically, older adults who performed more poorly on a time-based PM task overestimated the efficiency of their own IADL performance to a greater extent.

Conclusions: Findings suggest that nondemented older adults with poorer time-based PM may be more prone to inaccurately appraising their functional abilities and that this vulnerability may not be adequately captured by traditional EF measures.

Objective: To establish quick-reference criteria regarding the frequency of statistically rare changes in seven neuropsychological measures administered to older adults.

Method: Data from 935 older adults examined over a two-year interval were obtained from the Alzheimer's Disease Neuroimaging Initiative. The sample included 401 cognitively normal older adults whose scores were used to determine the natural distribution of change scores for seven cognitive measures and to set change score thresholds corresponding to the 5^th percentile. The number of test scores that exceeded these thresholds were counted for the cognitively normal group, as well as 381 individuals with mild cognitive impairment (MCI) and 153 individuals with dementia. Regression analyses examined whether the number of change scores predicted diagnostic group membership beyond demographic covariates.

Results: Only 4.2% of cognitively normal participants obtained two or more change scores that fell below the 5^th percentile of change scores, compared to 10.6% of the stable MCI participants and 38.6% of those who converted to dementia. After adjusting for age, gender, race/ethnicity, and premorbid estimates, the number of change scores below the 5^th percentile significantly predicted diagnostic group membership.

Conclusions: It was uncommon for older adults to have two or more change scores fall below the 5^th percentile thresholds in a seven-test battery. Higher change counts may identify those showing atypical cognitive decline.

Objective: The purpose of this invited paper was to summarize my clinical research on disturbances of higher order consciousness (i.e., primarily on self-awareness but including anosognosia and impaired awareness of another person's cognitive/emotional state) that contributed to my receiving the Distinguished Career Award from the International Neuropsychology Society.

Methods: I reviewed my early clinical encounters with disturbances in higher order consciousness and then a series of studies performed with various colleagues over the last 45 years to better understand the nature of these disturbances. The findings obtained are also discussed within the context of other researchers' observations during this time frame.

Results: Disturbances in higher order consciousness include classic anosognosia, impaired self-awareness, denial of disability, and denial of ability. Proposed diagnostic features of each of these disturbances are outlined and a model for understanding their complex relationships suggested. Different treatment/rehabilitation approaches for these disturbances are also summarized.

Conclusion: Disturbances in higher order consciousness are often revealed when exploring with the person their subjective experiences of their neurological and neuropsychological functioning following different brain disorders. These subjective experiences have diagnostic value and lead to different rehabilitation approaches. The neuropsychological investigation of disturbances in higher order consciousness should include integrating knowledge from the neurosciences with nonbiological understandings of how cultural and personality features of the person may also influences their subjective experiences associated with a known or suspected brain disorder.

Objective: Identifying persons with HIV (PWH) at increased risk for Alzheimer's disease (AD) is complicated because memory deficits are common in HIV-associated neurocognitive disorders (HAND) and a defining feature of amnestic mild cognitive impairment (aMCI; a precursor to AD). Recognition memory deficits may be useful in differentiating these etiologies. Therefore, neuroimaging correlates of different memory deficits (i.e., recall, recognition) and their longitudinal trajectories in PWH were examined.

Design: We examined 92 PWH from the CHARTER Program, ages 45-68, without severe comorbid conditions, who received baseline structural MRI and baseline and longitudinal neuropsychological testing. Linear and logistic regression examined neuroanatomical correlates (i.e., cortical thickness and volumes of regions associated with HAND and/or AD) of memory performance at baseline and multilevel modeling examined neuroanatomical correlates of memory decline (average follow-up = 6.5 years).

Results: At baseline, thinner pars opercularis cortex was associated with impaired recognition (p = 0.012; p = 0.060 after correcting for multiple comparisons). Worse delayed recall was associated with thinner pars opercularis (p = 0.001) and thinner rostral middle frontal cortex (p = 0.006) cross sectionally even after correcting for multiple comparisons. Delayed recall and recognition were not associated with medial temporal lobe (MTL), basal ganglia, or other prefrontal structures. Recognition impairment was variable over time, and there was little decline in delayed recall. Baseline MTL and prefrontal structures were not associated with delayed recall.

Conclusions: Episodic memory was associated with prefrontal structures, and MTL and prefrontal structures did not predict memory decline. There was relative stability in memory over time. Findings suggest that episodic memory is more related to frontal structures, rather than encroaching AD pathology, in middle-aged PWH. Additional research should clarify if recognition is useful clinically to differentiate aMCI and HAND.

Objective: High-definition transcranial direct current stimulation (HD-tDCS) has the potential to improve cognitive functioning following neurological injury and in neurodegenerative conditions. In this case report, we present the first use of HD-tDCS in a person with severe anterograde amnesia following carbon monoxide poisoning.

Method: The participant underwent two rounds of HD-tDCS that were separated by 3 months (Round 1 = 30 sessions; Round 2 = 31 sessions). We used finite element modeling of the participant's structural MRI to develop an individualized montage that targeted multiple brain regions involved in memory encoding, as identified by Neurosynth.

Results: Overall, the participant's objective cognitive functioning improved significantly following Round 1, declined during the 2 months without HD-tDCS, and again improved following Round 2. Subjective informant reports from family and medical personnel followed this same pattern of improvement following each round with a decline in between rounds. We also provide preliminary evidence of altered brain activity during a learning/memory task using functional near-infrared spectroscopy, which may help establish the physiological effects of HD-tDCS in future work.

Conclusion: Overall, these findings reinforce the potential value of HD-tDCS as a user-friendly method of enhancing cognition following anoxic/hypoxic brain injury.

Objective: To introduce the Emory 10-element Complex Figure (CF) scoring system and recognition task. We evaluated the relationship between Emory CF scoring and traditional Osterrieth CF scoring approach in cognitively healthy volunteers. Additionally, a cohort of patients undergoing deep brain stimulation (DBS) evaluation was assessed to compare the scoring methods in a clinical population.

Method: The study included 315 volunteers from the Emory Healthy Brain Study (EHBS) with Montreal Cognitive Assessment (MoCA) scores of 24/30 or higher. The clinical group consisted of 84 DBS candidates. Scoring time differences were analyzed in a subset of 48 DBS candidates.

Results: High correlations between scoring methods were present for non-recognition components in both cohorts (EHBS: Copy r = 0.76, Immediate r = 0.86, Delayed r = 0.85, Recognition r = 47; DBS: Copy r = 0.80, Immediate r = 0.84, Delayed Recall r = 0.85, Recognition r = 0.37). Emory CF scoring times were significantly shorter than Osterrieth times across non-recognition conditions (all p < 0.00001, individual Cohen's d: 1.4-2.4), resulting in an average time savings of 57%. DBS patients scored lower than EHBS participants across CF memory measures, with larger effect sizes for Emory CF scoring (Cohen's d range = 1.0-1.2). Emory CF scoring demonstrated better group classification in logistic regression models, improving DBS candidate classification from 16.7% to 32.1% compared to Osterrieth scoring.

Conclusions: Emory CF scoring yields results that are highly correlated with traditional Osterrieth scoring, significantly reduces scoring time burden, and demonstrates greater sensitivity to memory decline in DBS candidates. Its efficiency and sensitivity make Emory CF scoring well-suited for broader implementation in clinical research.

Methods: This systematic review was prospectively registered with PROSPERO (CRD42023426005) and the data collected in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The quality of reporting of included studies was evaluated in accordance with the CONSORT statement.

Results: Eleven randomized controlled trials were identified. Evaluation of the reviewed studies revealed low levels of overall compliance with the CONSORT statement highlighting the need for improved reporting. Key areas included insufficient information about - the intervention (for replicability), participant flow, recruitment, and treatment effect sizes. Study discussions did not fully consider limitations and generalizability, and the discussion/interpretation of the findings were often incongruent with the results and therefore misleading. Only two studies reported a significant difference between sham and active tDCS for OCD outcomes, with small effect sizes noted.

Conclusions: The variability in protocols, lack of consistency in procedures, combined with limited significant findings, makes it difficult to draw any meaningful conclusions about the effectiveness of tDCS for OCD. Future studies need to be appropriately powered, empirically driven, randomized sham-controlled clinical trials.

Objective: To evaluate the impact of receptive vocabulary versus years of education on neuropsychological performance of Black and White older adults.

Method: A community-based prospectively enrolled cohort (n = 1,007; 130 Black, 877 White) in the Emory Healthy Brain Study were administered the NIH Toolbox Picture Vocabulary Test and neuropsychological measures. Group differences were evaluated with age, sex, and education or age, sex, and Toolbox Vocabulary scores as covariates to determine whether performance differences between Black versus White participants were attenuated or eliminated.

Results: With vocabulary as a covariate, the main effect of race was no longer significant for the MoCA, Phonemic Fluency, Rey Auditory Verbal Learning Test, and Rey Complex Figure Test immediate and delayed recall. Although still significantly different between groups, the effect sizes for Animal Fluency, Trails B-A, Symbol Digit Modalities Test, and Rey Copy were attenuated, with the greatest reductions occurring for the Multilingual Naming Test and Judgment of Line Orientation.

Conclusions: Findings support the value of using receptive vocabulary as a proxy for premorbid ability level when comparing the cognitive performance of Black and White older adults. The results extend investigations using measures of single word reading to encompass measures assessing word meaning.

Objective: Traumatic brain injury (TBI), mental health conditions (e.g., posttraumatic stress disorder [PTSD]), and vascular comorbidities (e.g., hypertension, diabetes) are highly prevalent in the Veteran population and may exacerbate age-related changes to cerebral white matter (WM). Our study examined (1) relationships between health conditions-TBI history, PTSD, and vascular risk-and cerebral WM micro- and macrostructure, and (2) associations between WM measures and cognition.

Method: We analyzed diffusion tensor images from 183 older male Veterans (mean age = 69.18; SD = 3.61) with (n = 95) and without (n = 88) a history of TBI using tractography. Generalized linear models examined associations between health conditions and diffusion metrics. Total WM hyperintensity (WMH) volume was calculated from fluid-attenuated inversion recovery images. Robust regression examined associations between health conditions and WMH volume. Finally, elastic net regularized regression examined associations between WM measures and cognitive performance.

Results: Veterans with and without TBI did not differ in severity of PTSD or vascular risk (p's >0.05). TBI history, PTSD, and vascular risk were independently associated with poorer WM microstructural organization (p's <0.5, corrected), however the effects of vascular risk were more numerous and widespread. Vascular risk was positively associated with WMH volume (p = 0.004, β=0.200, R² = 0.034). Higher WMH volume predicted poorer processing speed (R² = 0.052).

Conclusions: Relative to TBI history and PTSD, vascular risk may be more robustly associated with WM micro- and macrostructure. Furthermore, greater WMH burden is associated with poorer processing speed. Our study supports the importance of vascular health interventions in mitigating negative brain aging outcomes in Veterans.