Journal of the International Neuropsychological Society最新文献

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.

Objective: Impairments in emotion recognition, a crucial component of social cognition, have been previously demonstrated in patients with behavioral variant frontotemporal dementia (bv-FTD) and Alzheimer's disease (AD). However, to date, it is unclear whether patients with early-stage vascular dementia (VaD) display deficient emotion recognition. We investigated profiles of impairments in emotion recognition and non-social cognitive functions, comparing VaD patients to bv-FTD and AD patients, and healthy control participants (HC).

Method: Eighty-one memory clinic patients with early-stage VaD (n = 30), bv-FTD (n = 21) and AD (n = 30), and 40 HCs were included and performed Ekman 60 Faces Test (EFT; emotion recognition), Auditory Verbal Learning Test (AVLT; memory - encoding and retrieval) and Trailmaking Test (TMT A, TMT B, TMT B/A; information processing speed, executive functions). Differences between groups were analyzed with analysis of variance (ANOVA), using age, education and sex adjusted norm Z scores.

Results: All patient groups performed significantly worse than HCs on EFT (p < .001). Mean performance of VaD patients was in between bv-FTD and AD (only bv-FTD < AD, p < .01). All patient groups were also impaired on AVLT encoding, TMT-B and TMT B/A. Social and non-social neurocognitive functions differed between groups, with specific impairments in processing speed in VaD, emotion recognition in bv-FTD and memory retrieval in AD, and memory encoding and cognitive control impaired in all three groups.

Conclusions: We found significantly different profiles in VaD, bv-FTD and AD. Assessing emotion recognition has additive value in the distinction between patient groups, allowing for more timely and accurate diagnosis in clinical practice.

Objective: Recent functional magnetic resonance imaging (fMRI) studies have shown that interpersonal synchronization of brain activity can be measured between people sharing similar emotional, narrative, or attentional states. There is evidence that odors can modulate the activity of brain regions involved in memory, emotion and social cognition, suggesting a link between shared olfactory experiences and synchronized brain activity in social contexts.

Method: We used fMRI to investigate the effects of a positively-valenced odor on inter-subject correlation (ISC) of brain activity in healthy volunteers watching movies. While being inside an MRI scanner, participants (N = 20) watched short movie clips to induce either positive (happiness, tenderness) or negative (sadness, fear) emotions. Two movie clips were presented for each emotional category. Participants were scanned in two separate randomized sessions, once while watching the movie clips in the presence of an odor, and once without.

Results: When all emotional categories were combined, the odor condition showed significantly higher ISC compared to the control condition in bilateral superior temporal gyri (STG), right middle temporal gyrus, left calcarine, and lingual gyrus. When splitting the movies according to valence, odor-induced increases in ISC were stronger for the negative movies. For the negative movies, ISC in the supramarginal gyrus and STG was larger in the second compared to first movie clips, indicating a time-by odor interaction.

Conclusion: These findings show that odor increases ISC and that its effects depend on emotional valence. Our results further emphasize the critical role of the STG in odor-based social communication.

Objective: Impairments in social interaction are common symptoms of dementia and necessitate the use of validated neuropsychological instruments to measure social cognition. We aim to investigate the Hinting Task - Dutch version (HT-NL), which measures the ability to infer intentions behind indirect speech to assess Theory of Mind, in dementia.

Method: Sixty-six patients with dementia, of whom 22 had behavioral variant frontotemporal dementia (bvFTD), 21 had primary progressive aphasia, and 23 had Alzheimer's disease (AD), and 99 healthy control participants were included. We examined the HT-NL's psychometric properties, including internal consistency, between-group differences using analyses of covariance with Bonferroni-adjusted post hoc comparisons, discriminative ability and concurrent validity using the area under the receiver operating characteristic curve (AUC), and construct validity using Spearman rank correlations with other cognitive tests.

Results: Internal consistency was acceptable (Cronbach's α = 0.74). All patient groups scored lower on the HT-NL than the control group. Patients with bvFTD scored lower than patients with AD dementia. The HT-NL showed excellent discriminative ability (AUC = 0.83), comparable to a test of emotion recognition (ΔAUC = 0.03, p = .67). The HT-NL correlated significantly with a test for emotion recognition (r = .45), and with measures of memory and language (r = [.31, .40]), but not with measures of information processing speed, executive functioning, or working memory (r = [.00, .17]). Preliminary normative data are provided.

Conclusions: The HT-NL is a psychometrically sound and valid instrument and is useful for identifying Theory of Mind impairments in patients with dementia.