Clinical Neuropsychologist最新文献

Objective: This study assessed whether sociodemographic/sociocultural variables were related to dispersion (i.e. intraindividual variability [IIV]) on Spanish-language cognitive testing. Method: Adults residing in the USA completed the Spanish-language NIH Toolbox Cognition Battery (n = 250; M = 38.8 ± 13.7 years-old; 72.0% women; 100% Hispanic), with dispersion calculated using the intraindividual coefficient of variation (ICV) and intraindividual standard deviation (ISD) for crystallized tests, fluid tests, and the total battery using age- and demographic-adjusted scores. Dispersion was compared based on age, gender, education (years), birthplace, education (country), bilingualism, income, and crystallized composite. Results: Fluid test dispersion did not differ based on sociodemographic/sociocultural variables. For the crystallized ICV, participants educated domestically had higher dispersion of age- and demographic-adjusted scores; and participants born domestically and with lower crystalized composites had higher dispersion of demographic-adjusted scores. There were no group differences for the crystallized ISD. For the total ICV and ISD, men had higher dispersion of age-adjusted scores, but not demographic-adjusted scores; and participants born domestically and with lower crystallized composites had higher dispersion of age- and demographic-adjusted scores. For the total ISD, but not the ICV, age-adjusted score dispersion was higher for participants educated domestically and with greater income; and demographic-adjusted score dispersion was higher for participants with greater income. Demographic-adjusted scores showed higher dispersion than age-adjusted scores, with large differences based on score calculation. Conclusions: Some sociodemographic/sociocultural variables were related to dispersion, corresponding with mostly small effect sizes. Demographic adjustments to test scores appeared to substantially increase within-person variability on cognitive testing, which may artificially increase dispersion estimates.

Objective: To provide the Steering Committee's perspective on the challenges, controversies, and missteps that emerged during the development of the Minnesota Conference (MNC) Training Guidelines, with a focus on two primary areas of major discussion: Content and Process. This commentary also highlights emerging issues relevant to the future implementation and evolution of the guidelines. Methods: Meeting records, draft documents, stakeholder feedback, and public commentary were reviewed and synthesized to identify and categorize major areas of controversy and challenges during the development of the Minnesota Guidelines. Results: Process-related issues centered on concerns about the involvement of trainees and early-career neuropsychologists in the conference, perceived lack of transparency and communication throughout the process, unclear role expectations, and challenges surrounding the voting process. Emerging issues post-conference included how to effectively implement the guidelines amid current legal and political challenges. Content-related controversies and challenges included the inclusion of the two-year clinical fellowship requirement, the initial omission of a Brain and Behavior competency, and the broader shift toward a competency-based training model. Further discussions involved the proposed removal of the self-care competency, inclusion of a stand-alone forensic competency, clarification of expectations for scholarly activity, and the presentation of diversity-related language throughout the Guidelines. Conclusion: The development of the Minnesota Guidelines highlighted controversies and challenges related to both content and process, underscoring the complexity of reaching consensus among diverse, multi-level stakeholders. These challenges provide insights and concrete recommendations to prevent similar issues and guide future revisions of the Guidelines.

Objective: AI is rapidly transforming healthcare, yet its integration into clinical neuropsychology remains limited and uneven. This paper explores the current landscape of AI tools applicable to neuropsychological practice and provides practical guidance for clinicians and trainees on their responsible use. Method: We reviewed ambient scribing technologies, large language models (LLMs), and input-based systems for documentation and report generation, with attention to HIPAA compliance, data privacy, billing implications, and responsible use policies. The evolving regulatory environment and ethical considerations surrounding AI integration into clinical workflows are examined. Conclusions: Neuropsychologists can enhance efficiency and accessibility by adopting AI thoughtfully and transparently while preserving the profession's core values of accuracy, contextualization, and patient-centered care. Practical resources are provided to support implementation in real-world settings, including a decision tree, feature comparison table, and "Guidelines for Responsible Use of AI in Clinical Neuropsychology," with special emphasis on maintaining clinical oversight.

Objective: Digit span tests are neurocognitive tests that measure attention and working memory. They depend on language-based auditory input and verbal responses. This study examined the effects of language of digit span administration in a linguistically diverse South African sample. Method: Data were drawn from four South African normative studies (N = 512; ages 8-79) that included a digit span test as part of a broader neuropsychological battery. Data were stratified by age, education level and quality, and language. Forward and backward span scores were analyzed in relation to these variables. Results: For the forward span, amongst the educationally advantaged and disadvantaged children and the advantaged adults, the participants who heard and said the numbers in Afrikaans when it was their first language, scored significantly worse than those who heard and said the numbers in English when English was or was not their first language (t(23) = -4.48, p = <.001 for disadvantaged children; t(117) = -2.2, p = .03 for advantaged children; t(104) = -5.48, p < .001 for advantaged adults). Significant differences were not found for the educationally disadvantaged adults, although there was a trend toward lower scores when the numbers were said in Afrikaans. For the backward span, no significant differences were found when the numbers were or were not heard and said in the participants' first language. Findings suggest that digit span may be sensitive to auditory-linguistic interference in people who speak more than one language, complicated by language proficiency and complexity of number names. Conclusions: In multilingual settings, digit span test performance may be affected by both first language and language of administration. These findings support the need for neuropsychological norms that also stratify for examinees' language and the language of administration. Clinical neuropsychologists should consider factors such as language proficiency and complexity of number names when assessing working memory in linguistically diverse populations.

Objective: This study examined whether rates of symptom and performance validity test (SVT, PVT) failure among assessment-seeking postsecondary students changed during and after the COVID-19 pandemic relative to pre-pandemic levels, and whether such changes co-occurred with increased general psychological distress (GPD). Method: Archival data were analyzed from 1076 students assessed for possible attention-related disorders between 2018 and 2024 at a regional university-based assessment center. Participants completed multiple symptom and performance validity measures, a self-report measure of Attention-Deficit/Hyperactivity Disorder (ADHD), and a higher-order measure of general psychological distress. Students were grouped by assessment timing: pre-COVID (2018-March 1, 2020), during COVID (March 2, 2020-August 2022), or post-COVID (September 2022-September 2024). Results: Failure rates on most PVTs did not differ significantly across time periods, indicating overall stability in performance validity, with one dyslexia-related validity measure showing higher failure rates post-COVID. On a personality assessment, students assessed during and after COVID reported significantly higher Negative Impression Management scores, lower Positive Impression Management scores, and greater GPD. Rates of severe GPD increased from 23% pre-COVID to 38% during and after COVID. Failure on ADHD-specific SVTs also increased significantly post-COVID, indicating higher rates of non-credible ADHD symptom reporting despite stable performance validity. Discussion: Since the onset of COVID-19, postsecondary students have demonstrated heightened psychological distress alongside increased non-credible self-reporting, particularly for ADHD symptoms. These findings reflect parallel trends rather than a direct causal relationship and underscore the importance of incorporating both symptom and performance validity testing when interpreting self-reported symptoms in clinical and psychoeducational assessments.

Objective: Moyamoya disease (MMD) is a rare, progressive occlusive cerebrovascular disorder characterized by stenosis of the internal carotid arteries and compensatory collateral vessel formation, often leading to ischemic or hemorrhagic events. We present the case of a 50-year-old bilingual Filipina woman with a neuroimaging-confirmed diagnosis of MMD (Suzuki grade III) who underwent staged bilateral surgical revascularization procedures (right intracranial bypass and left encephaloduroarteriosynangiosis [EDAS]), with her left EDAS complicated by an acute left anterior cerebral artery (ACA)/middle cerebral artery (MCA) border zone infarct. Post-operatively, she exhibited expressive and receptive aphasia, dysarthria, right hemiparesis, and functional decline requiring extensive rehabilitation.

Methods: A comprehensive medical record review in conjunction with a clinical interview and administration and interpretation of a comprehensive neuropsychological battery was completed approximately 18-months post-surgical intervention.

Results: Neuropsychological evaluation revealed global impairments in memory, executive functioning, processing speed, and visuospatial abilities, with particularly severe language deficits, including a language shift from English to Tagalog, further compounding cognitive and functional decline.

Conclusion: This case report adds to the small body of literature identifying neuropsychological patterns of impairment in MMD. Additionally, in conjunction with prior research, findings emphasize the importance of early detection and timely surgical intervention in order to optimize cognitive and functional outcomes.

Objectives: Cognitive abnormalities have been documented following COVID-19 infection. Using pre-pandemic levels of cognitive functioning, we examined the impact of detectable serologic response to COVID-19 infection on cognitive domain performance in a cohort of people with HIV (PWH). We also evaluated the additional impact of potential risk factors for cognitive deficits in the context of SARS-CoV-2 serostatus, including psychiatric variables, number of medical comorbidities, and HIV biomarkers. Methods: 118 ethnically and racially diverse PWH (mean age 63.6; 50% women) completed comprehensive, in-person neuropsychological and medical assessments before the pandemic (March 2018 to March 2020) and at follow-up (August 2020 to June 2024). All but 4 study participants had been vaccinated against SARS-CoV-2 prior to follow-up assessment. 54 participants had anti-SARS-CoV-2 nucleoprotein antibodies. Mixed design repeated-measures ANOVAs were used to compare longitudinal performance among serological groups (anti-N positive, anti-N negative) on global cognitive function and 7 cognitive domains. Subsequently, multivariate regression models were used to examine the role of risk factors on cognitive functioning stratified by SARS-CoV-2 serostatus. Results: Positive anti-N serostatus did not influence cognitive test performance, self-perceived stress and depressive mood when compared to pre-pandemic levels. When stratified by serostatus, only greater number of medical comorbidities predicted worse motor domain functioning in the anti-N negative group. Conclusion: Serological response to COVID-19 infection had no deleterious cognitive or psychological impact relative to pre-pandemic levels. Number of medical comorbidities and HIV biomarkers may play a more central role on cognitive outcomes.

Objective: Meaningful differences exist in billing and work productivity, as measured using wRVU, associated with psychological intervention versus assessment services. This paper focuses on billing for work completed by psychology trainees and how those services differentially impact supervisors' productivity indicators, potentially threatening the future of psychological and neuropsychological assessment. We provide suggestions on how to address this and related issues affecting supervising neuropsychologists. Methods: A review was performed of the limited literature pertaining to billing practices for psychological services conducted by various levels of trainees. Resources pertaining to productivity associated with trainee services under supervising physicians were also reviewed. Conclusions: Psychotherapy and other psychological intervention services enable supervising psychologists to use "incident to" or supervisory billing, which can confer productivity to the supervisor. In contrast, this is not allowable for most aspects of trainee involvement in neuropsychological evaluation, except when the supervisor is physically present. No clear rationale was uncovered for this striking difference. We propose a call to action for members of our national organizations to advocate for better representation of neuropsychologists' services, with the goal of obtaining parity with our clinical psychologist colleagues in terms of work productivity for supervising trainees.