Clinical Neuropsychologist最新文献

Objective: Older adults with cognitive impairment are at risk of medication-taking errors. This study assessed the impact of providing medication adherence feedback to cognitively impaired older adults. Methods: Forty participants with mild cognitive impairment or mild dementia had their medication adherence electronically monitored for 8 weeks. They were provided with verbal and visual feedback about their adherence results. Initial participant reactions were elicited using a Motivational Interviewing approach, and self-reported behavior changes were assessed during a follow-up interview. Quantitative analyses assessed relationships among electronically monitored and self-rated adherence, initial reactions to adherence feedback, and subsequently reported medication self-management changes. Thematic analysis determined facilitators and barriers to making self-management changes. Results: Although self-rated adherence was high, electronic monitoring revealed that 20% of the sample had suboptimal adherence (took the recommended dose on <80% of monitored days). Fifty-three percent of the sample reported feeling surprised by their adherence results, and 45% endorsed initial motivation to change self-management behaviors. Motivated participants demonstrated worse electronically monitored adherence than unmotivated peers, and those who were surprised by their medication-taking errors expressed greater initial motivation to change. At follow-up, 50% reported having made changes, and 82.4% of them indicated that this study played a role. Facilitators of making changes included awareness of medication-taking errors and cognitive impairment, whereas barriers included lack of perceived difficulty/need. Conclusions: Adherence monitoring with feedback is feasible and impactful in cognitively impaired older adults. Increasing awareness of medication-taking errors fosters motivation to improve medication self-management and results in participant-reported behavior change.

Objective: Obstructive sleep apnea (OSA) has been associated with structural and functional brain changes and cognitive impairment in sleep clinic samples. Persons with traumatic brain injury (TBI) are at increased risk of OSA compared to community samples, and many experience chronic cognitive disability. However, the impact of OSA on cognitive outcome after TBI is unknown. The purpose of this study was to examine the relationship between polysomnographic sleep parameters on neuropsychological performance 2 years following TBI. We hypothesized that oxygen desaturation, sleep fragmentation, and sleep depth would predict neuropsychological performance. Method: Participants (N = 123) were persons with moderate-to-severe TBI who underwent Type 1 Polysomnography during acute neurorehabilitation. At 2 years post-TBI, participants completed telephone-based neuropsychological testing (the Brief Test of Adult Cognition by Telephone). General linear models were fit to investigate the relationship between sleep parameters and neuropsychological performance, controlling for demographics and posttraumatic amnesia. Results: When controlling for demographics, injury characteristics, and other sleep parameters, greater percent of Stage 1 sleep time predicted poorer cognitive performance (Overall BTACT composite, p = 0.0078, η_p2 = 6.6%; Verbal Memory composite, p = 0.0407, η_p2 = 3.9%; Executive Function composite, p = 0.0215, η_p2 = 4.9%). Oxygen desaturation, cortical arousals, Stage 3 sleep, and the obstructive apnea-hypopnea index were not significantly associated with cognitive outcome. Conclusions: Reduced sleep depth was associated with cognitive outcome in persons with TBI; these findings require replication. Future research should examine whether improving sleep (e.g. increasing deep sleep) during acute recovery can improve cognitive recovery following TBI.

Objective: Despite significant progress in understanding the factors influencing cognitive function in Parkinson's disease (PD), there is a notable gap in data representation for the Latinx population. This study aims to evaluate the contributors to and disparities in cognitive performance among Latinx patients with PD. Methods: A retrospective analysis was conducted based on cross-sectional data encompassing demographic, environmental, motor, and non-motor disease characteristics from the Latin American Research Consortium on the Genetics of PD (LARGE-PD) and the Parkinson's Progression Markers Initiative (PPMI) cohorts. Linear regression multivariable models were applied to identify variables affecting Montreal Cognitive Assessment (MoCA) scores, accounting for age, sex, and years of education. Results: The analysis comprised of 3,054 PD patients (2,041 from LARGE-PD and 1,013 from PPMI) and 1,303 Latinx-controls. Latinx-PD patients (mean age 63.0 ± 11.8, 56.8% male) exhibited a significantly lower average MoCA score (p < .001) compared to white Non-Hispanic PD patients from PPMI (mean age 67.5 ± 9.9, 61.7% male). This difference persisted when comparing the Latinx-PD to the Latinx-controls (mean age 58.7 ± 9.3, 33.2% male; p < .001). Factors significantly associated with better MoCA scores in Latinx-PD included unilateral symptom onset (p = .009), and higher educational attainment (p < .001). Conversely, those associated with worse scores included the use of dopamine agonists (p = .01), previous tobacco use (p = .01), older age (p < .001), and a higher Hoehn and Yahr scale score (p < .001). Conclusions: Latinx-PD patients demonstrated significantly lower cognitive scores compared to their white non-Hispanic PD counterparts and Latinx-controls. These results highlight the importance of interpreting MoCA scores in a nuanced manner within diverse populations.

Objective: Few performance validity tests exist for youth undergoing baseline testing for the management of sport-related concussion. This study provides an initial validation of a reliable span calculation from the Wechsler Intelligence Scale for Children-Fourth Edition Letter-Number Sequencing (LNS) subtest as a performance validity indicator for youth baseline testing (Reliable Letter-Number Span; RLNS). Method: Youth athletes (n = 173) underwent baseline concussion testing for the management of sport-related concussion. We classified participants as valid (n = 153) or invalid performance (n = 20) based on several well-established performance validity tests. We calculated RLNS by summing the spans of alphanumeric characters across two items within the Letter-Number Sequencing subtest, similar to the Reliable Digit Span. To better determine the utility of RLNS, we also examined other novel reliable span metrics and established summary scores from the Letter-Number Sequencing as potential validity indicators. Results: Analyses revealed excellent classification accuracy for RLNS, with an area under the curve of .88 (95% CI [.81, .96]). The optimal cutoff for RLNS (≤6) yielded .55 sensitivity and .95 specificity. Results showed similar but slightly lower classification accuracy statistics (areas under the curve of .77-.86) for the other LNS validity indicators. Conclusion: Initial findings support the criterion validity of RLNS as an embedded validity indicator. This measure is among the few extant performance validity tests that may be appropriate for youth baseline concussion testing. RLNS may also be appropriate for other types of pediatric evaluations. However, additional support is necessary before neuropsychologists can use RLNS clinically.

Objective: The aim of this study was to create demographically-adjusted norms for Rey-Osterrieth Complex Figure Test (RCFT) for Sri Lankan adults. Method: Four-hundred and twenty-two healthy, adult participants (age: 19-83 years, education: 5-23 years, 202 men) underwent the RCFT copy, 3-min and 30-minute-recall trials. Age- and education-stratified percentile-based norms and demographically-adjusted regression-based norms were created for copy-trial scores and recall trial scores, respectively. Results: There was a ceiling effect of the copy scores where the maximum possible score (i.e. 36) reached between 25th and 90th percentile depending of the age and the education band. Age, years of education and sex accounted for 25.0% of the variance of the RCFT 3-min-recall scores (adjusted R² = 0.25, p < .0001). The age and years of education explained 25.1% of the variance of the 30-minute recall score (adjusted R² = 0.251, p < .0001). Age accounted for 7%-8% and years of education accounted for 10%-11% of the variances of the recall trial scores. Sex only affected the 3-min recall scores and accounted for only about 1% of the variance. No significant differences in RCFT scores were observed among different ethnic groups. Conclusions: These RCFT norms for Sri Lankan adults fill a hiatus in neuropsychological assessment of visuospatial construction and visual memory. The percentile tables and accompanying software-based calculator with embedded regression equations help clinicians more readily interpret individual test results and account for the RCFT performance variability introduced by demographic variables.

Objective: While it is generally assumed that common neurobehavioral assessments, such as the Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV), function similarly in clinical and non-clinical populations, this has not been validated in adults with congenital heart disease (CHD). In this study, we examined the latent factor structure of the WAIS-IV in adults with d-transposition of the great arteries (d-TGA) who participated in the Boston Circulatory Arrest Study. Method: The WAIS-IV was administered as part of a larger assessment battery. Confirmatory factor analysis was used to fit one-, two-, and four-factor models of general cognitive ability, as well as a second order Full Scale IQ factor, as published in the WAIS-IV manual. Results: Eighty-seven adults with d-TGA were assessed. The four-factor model and second-order models both fit the data well, with all subtests loading significantly and in expected directions onto four latent factors (Verbal Comprehension, Perceptual Reasoning, Working Memory, Processing Speed), similar to the normative population. Conclusions: Among adults with d-TGA, the latent factor structure of the WAIS-IV is similar to the normative sample, suggesting that the WAIS-IV is an appropriate tool to use in adults with d-TGA and, potentially, in other CHD subgroups.

Objective: The Rey Auditory Verbal Learning Test (RAVLT) is a classic test used to assess episodic verbal memory in research and clinical practice. We aimed to adapt the RAVLT materials into Russian, provide performance norms across the adult lifespan for the Russian adaptation, and develop a mobile application for automated RAVLT administration across languages. Method: We created three psycholinguistically matched alternative versions of the RAVLT materials in Russian and incorporated them into a new RAVLT World tablet application. We tested 354 neurologically healthy 21-to-89-year-old Russian speakers, modeled their performance using multivariate multiple regression, and calculated demographically adjusted norms. We also tested the equivalence of performance across the three alternative Russian versions and between the pen-and-paper and digital form. Results: Performance across three alternative versions and between the pen-and-paper and digital form was equivalent, although test-retest reliability measured via intraclass correlation coefficients was limited. Older age, male gender and fewer years of education were associated with lower performance on both raw trial scores (R² = .515) and composite scores (R² = .961). Demographically adjusted norms are now available in a paper form and as part of the RAVLT World application. Conclusions: The new RAVLT adaptation can be used to assess verbal memory in Russian-speaking adults, serving their clinical needs and diversifying research on verbal memory. The equivalent alternative versions can serve for repeated testing in longitudinal designs. The RAVLT World tablet application, with automated administration and scoring, makes the test more accessible to patients and allows to incorporate multiple language versions.

Objective: As the field of neuropsychology continues expanding efforts to better recruit providers and serve individuals from diverse populations, understanding the training and practice experiences of neuropsychologists from diverse backgrounds is crucial. Given the diversity of Asian populations, the experiences of Asian neuropsychologists offer a unique opportunity to reflect on the progress made in addressing issues related to diversity, equity, and inclusion (DEI). This information will help address challenges related to education, training, and clinical practice, particularly in meeting growing demands for neuropsychological evaluations among Asian populations and addressing unique challenges. Methods: Survey data from 69 Asian neuropsychologists encompassed demographic factors, educational background, clinical duties, research focuses, and advocacy/leadership work. Information regarding experiences of discrimination, barriers, and gaps was also gathered. Results: Asian neuropsychologists are a diverse group comprising South, Southeast, and East Asian communities with various levels of bilingualism. Clinical and training experiences span a spectrum of settings, programs, and responsibilities, though notably, there are still many gaps. Our sample endorsed experiences of discrimination associated with institutional, systemic, and social barriers (e.g. absence of training opportunities, unfair wages) as well as more general barriers in neuropsychology. Conclusions: This study overviews Asian neuropsychologists' demographic background, training, and practice experiences. Despite progress in the field's growing recognition and understanding of Asian neuropsychology, there remain unique experiences, challenges, and needs that are not well understood or addressed. Understanding these experiences and insights is essential for enhancing culturally sensitive neuropsychological services for individuals of Asian descent worldwide and advancing DEI efforts.

Objective: Anxiety disorders are the most prevalent psychiatric disorders experienced by individuals in the United States, and anxiety is often assessed with anxiety symptom inventories. At present, though, there are no anxiety symptom inventories that include symptom validity indices. The present study sought to develop a symptom validity index for the most commonly used anxiety symptom inventory in neuropsychological practice, the Beck Anxiety Inventory (BAI). Method: A sample of 244 veterans seeking outpatient neuropsychological assessments were included in the study. Participants were divided into valid and invalid groups based on external criterion symptom validity tests. The valid participants were then divided into clinical subgroups (Current Anxiety, Lifetime Anxiety, and No Anxiety). A validity index derived from the BAI total score was examined for the total sample and all subgroups. Results: A cutoff of ≥ 29 was identified when utilizing the Valid Full Sample, which resulted in a 0.91 specificity rate and 0.54 sensitivity rate. However, cutoffs had to be adjusted when applied to the clinical subgroups. The Valid Current Anxiety subgroup required the largest cutoff increase (i.e. ≥ 36), which resulted in a 0.91 specificity rate and a 0.42 sensitivity rate. Conclusions: This is the first published article to develop a symptom validity index for the BAI. To minimize false positive errors, a BAI total score of ≥ 36 is recommended.