Clinical Neuropsychologist最新文献

Objective: Adults with type 1 diabetes (T1D) face an increased risk for cognitive decline and dementia. Diabetes-related and vascular risk factors have been linked to cognitive decline using detailed neuropsychological testing; however, it is unclear if cognitive screening batteries can detect cognitive changes associated with aging in T1D. Method: 1,049 participants with T1D (median age 59 years; range 43-74) from the Diabetes Control and Complications Trial (DCCT), and the follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) study, completed the NIH Toolbox Cognition Battery (NIHTB-C) and Montreal Cognitive Assessment (MoCA). Neuropsychological assessments, depression, glycated hemoglobin levels (HbA1c), severe hypoglycemia, T1D complications, and vascular risk factors were assessed repeatedly over 32 years to determine associations with current NIHTB-C performance. Available cognitive data was clinically adjudicated to determine cognitive impairment status. Results: NIHTB-C scores had moderate associations (r = 0.36-0.53) with concurrently administered neuropsychological tests. In multivariate models, prior severe hypoglycemic episodes, depression symptoms, nephropathy, lower BMI, and higher HbA1c and LDL cholesterol were associated with poorer NIHTB-C Fluid Cognition Composite scores. The NIHTB-C adequately detected adjudicated cognitive impairment (Area Under the Curve = 0.86; optimal cut score ≤90). The MoCA performed similarly (Area Under the Curve = 0.83; optimal cut score ≤25). Conclusions: The NIHTB-C is sensitive to the cognitive effects of diabetes-related and vascular risk factors, correlated with neuropsychological testing, and accurately detects adjudicated cognitive impairment. These data support its use as a screening test in middle to older aged adults with T1D to determine if referral for detailed neuropsychological assessment is needed.

Objective: We examined work relative value units (wRVUs) and associated revenue of current procedural terminology (CPT) codes for evaluation and management (E&M) services, neuropsychological evaluation (NPE), psychological evaluation (PE), and psychotherapy. Method: CPT code wRVUs were aggregated for E&M (99202-99215), NPE (96116, 96132, 96133, 96136, and 96137), PE (90791, 96130, 96131, 96136, and 96137), and psychotherapy (90791 and 90832-90837 with and without the complexity modifier, 90785). Per minute wRVUs were calculated for each CPT code. The Centers for Medicare and Medicaid Services 2023 conversion factor ($33.8872) was multiplied by wRVUs to examine reimbursement per hour and per prototypical four-hour clinic slot. Results: The wRVUs per minute showed the following ranges: 0.032-0.07 for E&M services, 0.015-0.063 for NPE, 0.015-0.124 for PE, and 0.043-0.135 for psychotherapy. Average hourly revenue ranged from $72 for NPE to $132 for psychotherapy with the complexity modifier. Revenue for prototypical four-hour clinics ranged from $283 for NPE to $493 for psychotherapy with the complexity modifier. PE and psychotherapy services were valued at 124-184% of NPE. Conclusions: E&M code wRVUs increase with case complexity reflecting greater work intensity, and a modifier to PE and psychotherapy captures additional effort needed in complex cases. In contrast, NPE codes lack a complexity modifier, and NPE wRVUs are lower than those of PE and psychotherapy, the latter of which can be billed by master's level providers. NPE is undervalued compared to PE and psychotherapy based on wRVUs currently assigned to the CPT codes used for the respective services.

Objective: Neuropsychological evaluation is critical to detection and management of cognitive and neuropsychiatric changes associated with Huntington disease (HD). Accurate assessment of non-motor complications of HD is critical given the prominent impact on functional disability, frequently commensurate with or exceeding that of motor symptoms. The increasing emphasis on developing disease-modifying therapies targeting cognitive decline in HD requires consensus on clinical neuropsychological assessment methods. The Neuropsychology Working Group (NPWG) of the Huntington Study Group (HSG) sought to provide evidence and consensus-based, practical guidelines for the evaluation of cognitive and neuropsychiatric symptoms associated with HD. Method: The NPWG recruited a multi-disciplinary group of neuropsychologists, neurologists, and psychiatrists to inform best practices in assessing, diagnosing, and treating the non-motor symptoms in HD. A review was circulated among the NPWG, and in an iterative process informed by reviewed literature, best practices in neuropsychological evaluation of patients with HD were identified. Results: A brief review of the available literature and rational for a clinical consensus battery is offered. Conclusion: Clinical neuropsychologists are uniquely positioned to both detect and characterize the non-motor symptoms in HD, and further, provide neurologists and allied health professions with clinically meaningful information that impacts functional outcomes and quality of life. The NPWG provides guidance on best practices to clinical neuropsychologists in this statement. A companion paper operationalizing clinical application of previous research-based non-motor diagnostic criteria for HD is forthcoming, which also advises on non-motor symptom screening methods for the non-neuropsychologist working with HD.

Objective: Some attorneys claim that to adequately cross examine neuropsychological experts, they require direct access to protected test information, rather than having test data analyzed by retained neuropsychological experts. The objective of this paper is to critically examine whether direct access to protected test materials by attorneys is indeed necessary, appropriate, and useful to the trier-of-fact. Method: Examples are provided of the types of nonscientific misinformation that occur when attorneys, who lack adequate training in testing, attempt to independently interpret neurocognitive/psychological test data. Results: Release of protected test information to attorneys introduces inaccurate information to the trier of fact, and jeopardizes future use of tests because non-psychologists are not ethically bound to protect test content. Conclusion: The public policy underlying the right of attorneys to seek possibly relevant documents should not outweigh the damage to tests and resultant misinformation that arise when protected test information is released directly to attorneys. The solution recommended by neuropsychological/psychological organizations and test publishers is to have protected psychological test information exchanged directly and only between clinical psychologist/neuropsychologist experts.

Objective: Recent studies on Long COVID found that patients report prominent emotional distress and significant correlations between distress and cognitive performance have been identified, raising the question of how to manage or treat these issues. To understand psychological functioning in Long COVID further, this study examined personality responses on the Personality Assessment Inventory (PAI) to compare psychological functioning in a Long COVID group with a post-concussion syndrome (PCS) group, a syndrome with a significant psychological component. Participants and methods: Participants included 201 consecutive Long COVID outpatients (Mean age = 48.87 years, mean education = 14.82, 71.6% Female, 82.6% White) and a comparison group of 102 consecutively referred PCS outpatients (Mean age = 46.08, mean education = 14.17, 63.7% Female, 88.2% White). Effect sizes and t-tests were calculated using the PAI validity, clinical, interpersonal, and treatment consideration scales as well as clinical subscales. Results: The results replicated earlier findings on the PAI in Long COVID by demonstrating that both Long COVID and PCS groups had the highest mean elevations on SOM and DEP scales but no statistically significant between group differences in mean scale elevations. Results support similarities in psychological functioning between Long COVID and PCS patients emphasizing the importance of evaluating psychological functioning in neuropsychological evaluations for these populations. Further, results suggest that psychological treatment strategies for PCS patients may be helpful for Long COVID patients, but more research is needed.

Objective: The capacity to take another person's visual perspective is pivotal for solving mindreading tests, such as Theory of Mind (ToM) tasks, but most of them heavily rely on domain-general abilities (e.g., language, executive functions). Here we present a novel battery of visual perspective-taking tests for child neuropsychological assessment, the Perspective Battery (PERBAT), which poses a limited load on domain-general abilities.

Methods: The battery includes four tests: i) Block Building; ii) Hide and Seek; iii) Deceptive Figures; iv) Double-Sided Shelf. We administered the PERBAT to 126 typically developing preschoolers (65 males; 3-6-year-old); the participants also performed classical tests of social cognition, language, and nonverbal abstract reasoning.

Results: The scores of all the PERBAT tests were significantly and positively related with age and scores of the classical social cognition tests, but not with scores of the language and nonverbal abstract reasoning tests.

Conclusions: The PERBAT could represent a useful neuropsychological tool providing a comprehensive assessment of visual perspective-taking skills in preschool children. Future investigation is needed to examine the validity of the PERBAT with neurotypical samples across countries, race, ethnicity, and language as well as with clinical populations. Longitudinal studies are also encouraged to examine whether early visual perspective-taking weaknesses are associated with later development of mindreading skills.

Objective: To evaluate the latent structure, internal consistency, convergent and discriminant validity, diagnostic accuracy, and criterion validity of the Montreal Cognitive Assessment's auditory items (MoCA-22), which has previously been evaluated in small samples if at all. Methods: 11,284 participants completed the MoCA over 1-2 visits to an Alzheimer Disease Research Center (M_age = 69.2, M_education = 15.9, 57.6% women, 92.4% non-Hispanic white). MoCA-22 items were probed with alpha, omega, confirmatory factor analysis, and test-retest correlations. Scores were related to measures of neurocognition, daily functioning, behavioral-psychological symptoms (BPS), and vision performance for convergent-discriminant and criterion validity. Dementia stage was used to calculate area under the receiver operating characteristic (AUC-ROC) curves and cutoffs for mild cognitive impairment (MCI) and dementia. Results: A single-factor had good fit (CFI = .961; TLI = .945; RMSEA = .061; SRMR = .031), with good internal consistency (Omega total = .83) and test-retest consistency (ICC = .92 at 2.7 years). The strongest convergent correlations were with general cognition and executive functioning, while discriminant validity was demonstrated with its weakest and negative correlations being with BPS. There was strong classification accuracy in distinguishing MCI from normal cognition (AUC = .79; optimal cutoff point < 18), and mild-to-moderate dementia from MCI (AUC = .85; optimal cutoff point < 13). Furthermore, the MoCA-22 had negligible-to-small differences among those with and without vision limitations. Conclusions: These findings add to the evidence of the MoCA-22's utility and it serves as a useful cognitive screening tool with sound reliability and validity.

Objective: Despite being common following a brain injury, post-concussive symptoms (PCS) are highly prevalent in healthy and non-concussed individuals. Psychosocial factors likely subserve the maintenance of symptoms, and numerous studies have identified prominent risk factors associated with post-concussive symptom reporting (e.g. history of depression). However, few studies have investigated protective factors in this context. The aim of the current study was to examine the relationship between resilience and PCS, and to identify the factors subserving resilience within this relationship. Method: Healthy and non-concussed participants (n = 283, M_age = 22.70 years) completed questionnaires examining PCS (Rivermead Post-Concussion Symptom Questionnaire) and resilience (Resilience Scale for Adults), together with a screener of background demographic/clinical factors. Results: Resilience negatively predicted PCS above and beyond the effect of demographic and clinical factors previously implicated in the reporting of PCS. Interestingly, heightened "perception of self" was the resilience factor uniquely associated with PCS symptoms. The final model accounted for 33% of the variance in PCS. Overall, female gender, a history of headaches, and diagnoses of ADHD and depression, and reduced "perception of self" were all predictive of greater PCS (ps < .05). Conclusion: Resilience, particularly perception of self, is a positive protective factor in the reporting of PCS. These findings highlight the importance of early identification of less resilient individuals following trauma-such as an mTBI and provide a potential rationale for the incorporation of resilience-based rehabilitation programs into the recovery process, particularly those that promote greater self-efficacy and self-competency.