Journal of the International Neuropsychological Society最新文献

Objective: Developmental Gerstmann's Syndrome (DGS) is a proposed neurological disorder characterized by finger agnosia, acalculia, right-left disorientation, agraphia, and in some cases, constructional dyspraxia. Case studies of DGS are limited, particularly those reporting on assessments in adults. The present case study demonstrates the presence of DGS symptoms in a young female adult with an autoimmune disorder but no clear history of neurological damage.

Method: This client sought academic accommodations for her undergraduate math classes. She was administered a comprehensive neuropsychological assessment, during which she demonstrated difficulties with mathematical concepts, right-left disorientation, inverted writing, mild finger agnosia, andimpairments in fine motor abilities and visual motor coordination.

Results: The client's symptoms were consistent with DGS, though variability in her performance on assessments suggests compensatory strategies she may have developed throughout her life.

Conclusion: Our client demonstrated similarities with previously reported accounts of DGS as assessed in adults. This case proposes further evidence for DGS as a syndrome and presents challenges to assessing DGS in high-functioning adults. The case highlights a need for a standardized testing battery to assess DGS.

Objective: Despite recent attention to the increased risk of cognitive impairment in older adults with essential tremor (ET), there are only limited data on the trajectories of cognitive change in ET or the demographic and motor predictors of such change.

Method: This study included 148 cognitively normal individuals with ET (mean age = 76.7 ± 9.7 years) at baseline and had at least one follow-up evaluation (mean years of observation = 5.2 ± 1.6). Generalized Estimating Equations examined rates of change in six composite cognitive outcomes as a function of time, as well as demographic (age, sex, and education) and motor predictors (tremor severity, age of tremor onset, presence of rest tremor, cranial tremor, intention tremor, tandem gait) of rates of change. Demographics, medication use, and mood symptoms at baseline were covariates for all models.

Results: Participants evidenced a decline in global cognition, executive function, and attention (p _range = <0.001-0.044) over time. Older age predicted faster decline in all cognitive outcomes except attention (p _range =<0.001-0.025). Tremor severity predicted faster decline in executive function (p = 0.011). Rest tremor predicted faster decline in executive function and attention (p = 0.033, 0.017). Tandem gait missteps predicted faster decline in memory and visuospatial ability (p = 0.026, 0.028).

Conclusions: Results point to a dissociation in the predictive value of different motor features for specific aspects of cognitive decline. These results shed light on the earliest manifestations of cognitive impairment in older adults with ET and implicate different pathways by which heterogeneous cognitive changes emerge.

Objective: The ability to efficiently complete everyday tasks was evaluated with a novel, performance-based test called the Virtual Kitchen Challenge (VKC) in college athletes. Analyses focused on the effect of practice and associations between the VKC and conventional measures of cognition.

Method: 81 college athletes with and without self-reported concussion completed conventional cognitive tests and the VKC, a nonimmersive virtual-reality task that requires manipulating virtual objects on a touch screen to prepare a breakfast and lunch under two conditions: 1) Training condition with feedback and 2) Test condition without feedback. VKC performance was scored for completion time, percent of time working on-screen, number of interactions with target and distractor objects. Paired t-tests compared VKC Training and Test conditions, correlations examined relations between VKC performance and cognitive tests.

Results: VKC performance was significantly better after practice, as noted by faster completion time, fewer screen interactions, and a higher proportion of time spent on-screen during Test vs. Training conditions. Interactions with distractors were too infrequent for analyses. Correlations showed VKC Training was associated with episodic memory abilities whereas VKC Test scores were associated with executive function. VKC scores did not differ between participants with versus without concussion.

Conclusions: The VKC is a promising portable performance-based measure of subtle functional difficulties for young, high-functioning participants. The VKC automated scoring makes it highly efficient for large studies and clinical settings.

Objective: The cerebellar cognitive affective syndrome (CCAS) scale has been developed to screen for possible cognitive and affective impairments in cerebellar patients, but previous studies stressed concerns regarding insufficient specificity of the scale. Also, direct comparisons of CCAS scale performance between cerebellar patients with and without CCAS are currently lacking. The aim of this study was to evaluate the validity of the CCAS scale in cerebellar patients.

Method: In this study, cerebellar patients with CCAS (n = 49), without CCAS (n = 30), and healthy controls (n = 32) were included. The Dutch/Flemish version of the CCAS scale was evaluated in terms of validity and reliability using an extensive neuropsychological assessment as the gold standard for CCAS. Correlations were examined between the CCAS scale and possible confounding factors. Additionally, a correction for dysarthria was applied to timed neuropsychological tests to explore the influence of dysarthria on test outcomes.

Results: Cerebellar patients with CCAS performed significantly worse on the CCAS scale compared to cerebellar controls. Sensitivity was acceptable, but specificity was insufficient due to high false-positive rates. Correlations were found between outcomes of the scale and both education and age. Although dysarthria did not affect the validity of the CCAS scale, it may influence timed neuropsychological test outcomes.

Conclusions: Evaluation of the CCAS scale revealed insufficient specificity. Our findings call for age- and education-dependent reference values, which may improve the validity and usability of the scale. Dysarthria might be a confounding factor in timed test items and should be considered to prevent misclassification.

Objective: To further investigate the "other side of the bell curve" hypothesis, the current study examined the number of low and high scores on a neuropsychological battery: 1) in cognitively unimpaired or impaired older adults, 2) as they relate to biomarkers of Alzheimer's disease (AD), and 3) as they relate to traditional scores on this battery.

Method: In 68 cognitively unimpaired and 97 cognitively impaired participant, the number of low (i.e., ≤ 16^th percentile) and high (i.e., ≥ 75^th percentile) scores on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) were calculated, compared between the two groups, and related to biomarkers of AD (i.e., amyloid deposition, hippocampal volumes, ε4 alleles of Apolipoprotein E (APOE)) and RBANS Total score.

Results: In this cognitively diverse sample, low and high scores were common, with approximately 75% having at least one low score and 86% having at least one high score. Unimpaired participants had significantly more high scores and fewer low scores than their impaired counterparts. The number of low scores was significantly related to more amyloid deposition, smaller hippocampal volume, and having one or more copies of the ε4 allele of APOE. The number of high scores was similarly related with these biomarkers. Low/high scores were comparable to traditional scores on the RBANS in identifying cognitively impaired participants.

Conclusions: Support for the "other side of the bell curve" hypothesis was equivocal in these analyses, with both sides of the bell curve appearing to provide relevant information in a cognitively diverse sample.

Objective: We investigated differences in cognition between variants of progressive supranuclear palsy (PSP) including PSP-Richardson (PSP-RS) and subcortical and cortical variants using updated diagnostic criteria and comprehensive neuropsychological assessment.

Method: We recruited 140 participants with PSP (age = 71.3 ± 6.9 years; education = 15.0 ± 2.8 years; 49.3% female) who completed neurological and neuropsychological assessment. Participants received diagnoses of PSP clinical variants at their evaluation (or retrospectively if evaluated before 2017) according to the Movement Disorder Society PSP criteria. We grouped variants as PSP-RS (62 participants), PSP-Cortical (25 with PSP-speech/language and 9 with PSP-corticobasal syndrome), and PSP-Subcortical (27 with PSP-parkinsonism, 11 with PSP-progressive gait freezing, and 6 with PSP-postural instability). Analysis of covariance adjusted for age assessed for differences in neuropsychological performance between variants across cognitive domains.

Results: PSP-Cortical participants performed worst on measures of visual attention/working memory (Spatial Span Forward/Backward/Total), executive function (Frontal Assessment Battery), and language (Letter Fluency). PSP-RS participants performed worst on verbal memory (Camden Words). There were no significant group differences for the MoCA or indices of visuospatial function. There were no sex or education differences between PSP groups; however, there were differences in age at visit and disease duration.

Conclusions: In a large sample of participants with PSP, there were differences in cognition across PSP-RS, PSP-Subcortical, and PSP-Cortical variants, with PSP-Cortical and, to a lesser extent, PSP-RS, performing worse on tests of attention and executive function. These findings suggest cognitive distinctions among PSP clinical variants and highlight the value of neuropsychological assessment in differential diagnosis of PSP subtypes for more accurate and timely clinical classification.

Objective: We examined cognitive performance in children with complicated mild-severe traumatic brain injury (TBI) versus orthopedic injury (OI) using the National Institutes of Health Toolbox Cognitive Battery (NIH TB-CB).

Method: We recruited children ages 3-18, hospitalized with complicated mild-severe TBI (n = 231) or orthopedic injury (OI, n = 146). Cognition was assessed using the NIH TB-CB at six and twelve months post-injury. We used linear mixed models to assess associations of injury group (TBI versus OI), timepoint (six versus twelve months), and the interaction of injury group and timepoint with NIH TB-CB Total Cognition, Fluid Cognition, and Crystallized Cognition composites, adjusted for sex and socioeconomic status (SES), with Bonferroni correction. We evaluated differences in cognition stratified by injury severity (complicated mild-moderate TBI vs severe TBI) using ANCOVA, adjusting for sex and SES.

Results: Neither injury group nor the interaction of group and timepoint were associated with Total (group: p = 0.50; timepoint*group: p = 0.185), Fluid (group: p = 0.297; timepoint*group: p = 0.842), or Crystallized Cognition (group: p = 0.039; timepoint*group: p = 0.017). However, children with severe TBI performed significantly worse on Fluid and Total Cognition than children with complicated mild-moderate TBI at six months (Fluid: p = 0.004, partial η² = 0.06, moderate effect, Total: p = 0.012 partial η² = 0.03, small-moderate effect) and twelve months post-injury (Fluid: p < 0.001, partial η² = 0.11, moderate-large effect, Total: p = 0.002, partial η² = 0.06, moderate effect).

Conclusions: The NIH TB-CB detects worse cognitive functioning in children with severe TBI six-twelve months post-injury, largely driven by differences in Fluid Cognition. Our findings suggest the NIH TB-CB may be suitable for monitoring cognition in children with TBI.

Objective: Acquired Brain Injury (ABI) is a leading cause of childhood disability, yet educators report a gap in knowledge about supporting students with ABI when they return to school. We tested our TeachABI professional development module to examine how it impacted educators' ABI knowledge and self-efficacy for supporting students with ABI.

Method: Fifty educators filled out questionnaires about their knowledge and self-efficacy at three time points: pre-module, post-module, and 60 days post-module. Score differences were examined across time.

Results: Participants' ABI knowledge, subjective knowledge of the module learning objectives, and self-efficacy increased from pre- to post-module, and these gains were maintained at 60 days.

Conclusions: This suggests that TeachABI is a tool for better equipping educators to support students with ABI.

Objective: To assess for differences in low score frequency on cognitive testing amongst older adults with and without a self-reported history of traumatic brain injury (TBI) in the National Alzheimer's Coordinating Center (NACC) dataset.

Method: The sample included adults aged 65 or older who completed the Uniform Data Set 3.0 neuropsychological test battery (N = 7,363) and was divided by individuals with and without a history of TBI, as well as cognitive status as measured by the CDR. We compared TBI- and TBI + groups by the prevalence of low scores obtained across testing. Three scores falling at or below the 2^nd percentile or four scores at or below the 5^th percentile were criteria for an atypical number of low scores. Nonparametric tests assessed associations among low score prevalence and demographics, symptoms of depression, and TBI history.

Results: Among cognitively normal participants (CDR = 0), older age, male sex and greater levels of depression were associated with low score frequency; among participants with mild cognitive impairment (CDR = 0.5-1), greater levels of depression, shorter duration of time since most recent TBI, and no prior history of TBI were associated with low score frequency.

Conclusions: Participants with and without a history of TBI largely produced low scores on cognitive testing at similar frequencies. Cognitive status, sex, education, depression, and TBI recency showed variable associations with the number of low scores within subsamples. Future research that includes more comprehensive TBI history is indicated to characterize factors that may modify the association between low scores and TBI history.

Background: The impact of chronic pain and opioid use on cognitive decline and mild cognitive impairment (MCI) is unclear. We investigated these associations in early older adulthood, considering different definitions of chronic pain.

Methods: Men in the Vietnam Era Twin Study of Aging (VETSA; n = 1,042) underwent cognitive testing and medical history interviews at average ages 56, 62, and 68. Chronic pain was defined using pain intensity and interference ratings from the SF-36 over 2 or 3 waves (categorized as mild versus moderate-to-severe). Opioid use was determined by self-reported medication use. Amnestic and non-amnestic MCI were assessed using the Jak-Bondi approach. Mixed models and Cox proportional hazards models were used to assess associations of pain and opioid use with cognitive decline and risk for MCI.

Results: Moderate-to-severe, but not mild, chronic pain intensity (β = -.10) and interference (β = -.23) were associated with greater declines in executive function. Moderate-to-severe chronic pain intensity (HR = 1.75) and interference (HR = 3.31) were associated with a higher risk of non-amnestic MCI. Opioid use was associated with a faster decline in verbal fluency (β = -.18) and a higher risk of amnestic MCI (HR = 1.99). There were no significant interactions between chronic pain and opioid use on cognitive decline or MCI risk (all p-values > .05).

Discussion: Moderate-to-severe chronic pain intensity and interference related to executive function decline and greater risk of non-amnestic MCI; while opioid use related to verbal fluency decline and greater risk of amnestic MCI. Lowering chronic pain severity while reducing opioid exposure may help clinicians mitigate later cognitive decline and dementia risk.