Clinical Neuropsychologist最新文献

Objective: To provide guidance for implementation of the Minnesota Conference Guidelines (MNC Guidelines) within doctoral, internship, post-doctoral fellowship, and continuing education programs. The development and maintenance of competencies in clinical neuropsychology is the goal of combined training at these four levels. In this paper, implementation guidance uses terminology consistent with the current Clinical Neuropsychology Taxonomy and current competency development concepts in the specialty.

Method: Delegates to the Minnesota 2022 Update Conference on Education and Training in Clinical Neuropsychology (MNC) were invited to participate in the drafting of this document. The MNC Steering Committee organized this process. Delegates were formed into four drafting teams (Doctoral, Internship, Fellowship, and Continuing Education), each with a Team Lead. Teams provided initial drafts that identified training opportunities at each level and provided example training activities to address the 13 MNC Guidelines competencies. The manuscript's lead authors (SC, AYS, RB) then edited and integrated these drafts and worked iteratively with Team Leads to produce the current document.

Results: The paper provides a conceptual framework for the MNC Guidelines, addresses supervision across training levels, discusses training activities that can be implemented to address the MNC Guidelines competencies, and discusses potential challenges to that implementation. The learning activities contained in these guidelines draw heavily upon existing training methods that are already in wide use across the specialty of clinical neuropsychology.

Conclusion: These Implementation Guidelines are intended to provide training programs and individuals with non-prescriptive guidance on training activities designed to develop and maintain competency across all 13 of the MNC competencies.

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: The Minnesota Conference (MNC) Guidelines for Education and Training in Clinical Neuropsychology reflect the specialty's effort to create competency-based training standards aligned with current and future needs. This article summarizes delegate perspectives on the MNC guideline revision process to inform future updates. Method: A feedback survey was distributed to all 55 delegates from June 12-22, 2025. Delegates rated their satisfaction with four aspects of the process: the in-person conference, post-conference writing process, Steering Committee communication, and the delegate role in the writing process. Open-ended feedback was collected and analyzed thematically. The authors (who are delegates) have also integrated reflections throughout the article. Results: The survey received 34 responses (62%). Satisfaction varied across the four domains queried, with the in-person conference receiving the highest satisfaction ratings (59% of respondents reported feeling "satisfied" or "very satisfied") and communication from the Steering Committee receiving the highest dissatisfaction ratings (50% of respondents reported feeling "dissatisfied" or "very dissatisfied"). In addition to several strengths, a recurring recommendation was a desire for increased transparency during the post-conference writing phase and improved communication throughout the entire process. Conclusions: The MNC revision process included years of planning and organization led by the Planning Commission and Steering Committee and was a herculean task that deserves tremendous praise. The present article highlights several strengths of the revision process, challenges regarding procedure and communication, and provides constructive feedback for future revisions. The authors believe these guidelines will advance the field and are optimistic that the recommendations provided can support future guidelines revision efforts.

Objective: This systematic review aimed to assess the neuropsychological, cognitive, and behavioral outcomes in children and adolescents with drug-resistant epilepsy undergoing resective surgery. While epilepsy surgery is often effective in achieving seizure control, post-operative outcomes across neuropsychological, cognitive and behavioral domains remain variable and require further investigation.

Method: Using advanced search terms, a systematic review of electronic databases was conducted, comprising PubMed, PsycINFO, and Scopus. Studies published from January 2010 to March 2025 were included if they involved pediatric patients (≤18 years) undergoing resective epilepsy surgery and reported pre- and/or postoperative neuropsychological, cognitive, or behavioral outcomes. Data were synthesized qualitatively due to study heterogeneity.

Results: Twenty-six studies met the inclusion criteria. Global cognition was generally stable or improved. Verbal memory declined after left temporal resections, while visuospatial and attention deficits were reported after posterior resections, although laterality of resection was not consistently specified. Executive and behavioral improvements were more common in seizure-free patients. Outcomes varied by age at surgery, epilepsy duration, seizure control, and resection extent.

Conclusions: While epilepsy surgery in pediatric populations can lead to neuropsychological, cognitive and behavioral improvements, outcomes remain heterogeneous, reflecting both variability in clinical presentation and the current state of evidence. The available evidence highlights the need to improve methodological quality and reporting standards. Well-designed prospective multicenter trials with adequate follow-up for long-term outcomes are essential to accurately assess outcomes. Establishing standardized core outcome measures across centers would facilitate higher quality evidence and support more informed decision-making for clinicians, patients, and families regarding surgical intervention and expected post-operative trajectories.

Objective: The prevalence of neuroendocrine dysfunction (NED) following mild traumatic brain injury (mTBI) remains obscure, with widely varying prevalence estimates. This study aimed to determine prevalence of NED among central hypogonadism, central hypothyroidism, and growth hormone deficiency (GHD) in active-duty military service members (SMs) receiving comprehensive TBI and psychological health care and characterize TBI burden, neurobehavioral symptom severity, and NED associations. Methods: Retrospective analysis of baseline, fasting morning serum screening labs of thyroid, gonadal, and growth hormone axes obtained from SMs attending a 4-week treatment program for TBI. NED prevalence was characterized in those who completed full tri-axis screening as well as GHD and central hypogonadism screening independently. Results: Of 1,832 TBI-screened SMs, 493 completed full neuroendocrine testing. Dual-clinician review confirmed NED in 45 (9.1%; 95% CI [6.9%, 12.0%]). Central hypogonadism (n = 33, 6.7%) was most common, followed by central hypothyroidism (n = 10, 2.0%); Screen-positive suspected GHD was 0.2% (1/493); no cases were confirmed by dynamic stimulation testing, so the true prevalence of GHD cannot be determined in this cohort. NED was associated with increased time since injury (OR = 4.15, p<.001) and fewer lifetime TBIs (OR = 0.66, p=.008), but not neurobehavioral symptoms or cognitive function. Conclusions: In the largest military TBI cohort with full NED screening to date, confirmed post-traumatic hypopituitarism prevalence was 9.1%. GHD was least common by IGF-1 (0.2%) screening, but its true prevalence remains indeterminate without systematic stimulation testing. Findings refine prevalence estimates for NED after military mTBI and emphasize the need for standardized diagnostic approaches prioritizing gonadal and thyroid axes.

Background: Technological advancements have boosted neuropsychology development. Recently, the term Digital Neuropsychology (DN) has been introduced to describe the assessment and training of cognitive functions using digital tools. However, little is known about the development and implementation of these tools, particularly in low-and middle-income countries. This study aimed to synthesize state-of-the-art DN tools in Latin America (LA).

Method: Following PRISMA guidelines, a scoping review was conducted between June and December 2024. Three electronic databases were searched: PubMed/MEDLINE, SciELO, and RedALyC. A gray literature search was also performed using Google Scholar and university thesis repositories. Studies published between 2014 and 2024 in English or Spanish were included.

Results: Of the 662 screened studies, 28 met the inclusion criteria and were fully reviewed. Brazil and Chile accounted for the highest number of studies. A likelihood ratio test indicated no significant deviation from equal distribution across countries. Cognitive assessment was the primary focus in 57.1% of studies, and serious video games were the most used technology (39.3%). Tablets (42.9%) and personal computers (32.1%) were the most frequently employed devices. No associations were found between technology and purpose, technology and device type, or country and purpose. Memory and attention were the most frequently assessed cognitive domains (32.1%).

Conclusions: The increasing body of research highlights the potential of digital technology for cognitive assessment in LA. However, the development of DN in the region faces challenges, including the need for ecological validation studies, more extensive and diverse samples, and the establishment of normative data.

Objective: Major innovations are underway in the practice of clinical neuropsychology, as they are in the neurosciences and psychology more generally. Artificial intelligence (AI) is poised to offer numerous advantages over traditional neuropsychological practices, the most important of which is to improve clinical decision-making and thereby reduce diagnostic errors. However, the emergence, rapid availability, and adoption of AI, like other technological advances, has ethical implications. The purpose of this article is to present the ethical issues of primary importance in the adoption and application of AI in clinical neuropsychology and further advance the discussion of AI, ethics, and neuropsychology. Method: Benefits and risks of AI use in clinical neuropsychology are examined in the context of general bioethical principles. Results: Some of the primary anticipated risks that may lead to harmful outcomes for patients include: (1) threats to privacy and security, (2) bias in AI models, (3) lack of professional competence, (4) limitations to informed consent, (5) inequity in access to AI, (6) overreliance on AI, and (7) lack of accountability. Conclusions: Awareness and understanding of the ethical implications of technological advances, including AI, are essential for maintaining patient welfare at the center of clinical care and for preparing clinicians to anticipate ethical challenges and avoid dilemmas or address them effectively when they are encountered. Advanced preparation enables neuropsychologists to promote the ethical and responsible use of AI, for the benefit of both practitioners and patients.

Objectives: This study investigated the validity and reliability of subtle errors and slowing in simple everyday tasks (Naturalistic Action Test [NAT]) to assess mild functional difficulties in older adults with mild cognitive impairmen (MCI). Method: Older adults (N = 111, MAge= 73.45; SD= 6.53) classified as having healthy cognition (HC) or MCI completed neuropsychological testing and two NAT tasks (breakfast and lunch) twice, separated by 4-6 wk. NATs were scored for subtle, inefficient actions (i.e., micro-errors) and the average time (in sec) to complete a task step. Results: Participants with MCI made significantly more micro-errors [F (1, 109) = 8.78, p = .004, partial η² = 0.07] and had a significantly longer average time per step [F (1, 109) = 13.98, p < .001, partial η² = 0.11] than participants with HC. Micro-errors correlated with tests of episodic memory (r = -0.237, p = .012) and executive functioning (r = -0.201, p = .035), whereas average time per step correlated only with episodic memory (r = -0.300, p = .0001). Test-retest reliability was good for average time per step (ICC = .872, p < .001) and moderate for micro-errors (ICC = .675, p < .001). Conclusions: Measures of inefficient actions and performance time in familiar everyday tasks demonstrated strong to adequate construct and concurrent validity, as well as test-retest- and inter-rater reliability, supporting their use for the quantifying mild functional difficulties. Future studies should explore this scoring approach to develop early markers of functional disability or dementia risk.

Objective: The Trail Making Test (TMT) is a widely used neuropsychological tool for assessing executive functions. This study aimed to establish regression-based normative data for TMT performance in a Turkish population aged 18-80, accounting for the effects of age, education, and sex on both basic (TMT A and TMT B) and derived scores (TMT B-A and TMT B/A). Method: A total of 462 participants were recruited, with 409 included in the final analysis after applying exclusion criteria. Participants completed the international version of the TMT. Pearson correlation analyses and multiple linear regression models assessed relationships between TMT scores and demographic variables. Education was treated as a continuous variable, and regression-based norms were developed for all TMT scores. Results: Age and education were significant predictors of TMT performance. Age primarily affected TMT A scores, while education was the strongest predictor for TMT B, TMT B-A, and TMT B/A scores. The regression models explained 36-38% of the variance in basic scores and 6-24% in derived scores. Women performed better than men on the TMT B/A ratio score, but overall, sex had a less pronounced effect than age and education. Conclusions: This study provides the first regression-based normative data for the TMT in a Turkish population. These norms are crucial for improving the accuracy of neuropsychological assessments in Turkey and facilitating cross-cultural comparisons in cognitive research. The findings emphasize the importance of adjusting for demographic factors in clinical and research settings to ensure precise evaluations of cognitive functioning.

Objective: At times, patients with Long COVID fail performance validity tests (PVTs) for cognitive measures and symptom validity tests (SVTs) embedded in formal personality measures. This is the first study, to our knowledge, to examine whether self-reported symptoms on the Personality Assessment Inventory (PAI) and the Modified Fatigue Impact Scale (MFIS) were related to performance validity in Long COVID patients. Method: Participants were 175 individuals diagnosed with Long COVID who completed four PVTs, the MFIS, and the PAI. There was evidence for nots based on medical records review for 25.71% of the patients. Based on PVT performances, patients were assigned to one of three groups: Pass group (no PVT failures), Intermediate group (1 PVT failure), or Fail group (2+ PVT failures). Results: 84.57% of participants were in the Pass group, 9.14% in the Intermediate group, and 6.29% in the Fail group. There was a not a significant difference in external incentive frequency between groups. Only one significant group difference on the PAI scales and subscales was found, with slightly greater somatization symptoms (SOM-S) reported in the Fail group relative to the Pass group (η² = .03). The MFIS was not significantly different between groups. Conclusions: These findings suggest that PVT failure is not associated with fatigue or PAI responses, except on the somatization subscale.