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Neurocognitive change over the course of a multiday external lumbar drain trial in patients with suspected normal pressure hydrocephalus. 对疑似正常压力脑积水患者进行多日腰椎外引流试验过程中的神经认知变化。
IF 3 3区 心理学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-10-01 Epub Date: 2024-02-15 DOI: 10.1080/13854046.2024.2315737
Michael Brook, James Reilly, Alexander Korutz, Matthew C Tate, John-Christopher A Finley, Emma Pollner, Ketan Yerneni, Caterina Mosti, Constantine Karras, Siting Joy Trybula, John Stratton, Zoran Martinovich

Objective: To characterize neurocognitive response to cerebrospinal fluid (CSF) diversion during a multiday external lumbar drainage (ELD) trial in patients with suspected normal pressure hydrocephalus (NPH). Methods: Inpatients (N = 70) undergoing an ELD trial as part of NPH evaluation participated. Cognition and balance were assessed using standardized measures before and after a three-day ELD trial. Cognitive change pre- to post-ELD trial was assessed in relation to change in balance, baseline neuroimaging findings, NPH symptoms, demographics, and other disease-relevant clinical parameters. Results: Multiday ELD resulted in significant cognitive improvement (particularly on measures of memory and language). This improvement was independent of demographics, test-retest interval, number of medical and psychiatric comorbidities, NPH symptom duration, estimated premorbid intelligence, baseline level of cognitive impairment, cerebrovascular disease burden, degree of ventriculomegaly, or other NPH-related morphological brain alterations. Balance scores evidenced a greater magnitude of improvement than cognitive scores and were weakly, but positively correlated with cognitive change scores. Conclusions: Findings suggest that cognitive improvement associated with a multiday ELD trial can be sufficiently captured with bedside neurocognitive testing. These findings support the utility of neuropsychological consultation, along with balance assessment, in informing clinical decision-making regarding responsiveness to temporary CSF diversion for patients undergoing elective NPH evaluation. Implications for the understanding of neuroanatomical and cognitive underpinnings of NPH are discussed.

目的在对疑似正常压力脑积水(NPH)患者进行为期多天的腰椎外引流(ELD)试验期间,了解神经认知对脑脊液(CSF)引流的反应。研究方法作为 NPH 评估的一部分,接受 ELD 试验的住院患者(N = 70)参加了此次试验。在为期三天的 ELD 试验前后,使用标准化测量方法对认知和平衡能力进行评估。评估ELD试验前后的认知变化与平衡变化、基线神经影像检查结果、NPH症状、人口统计学和其他疾病相关临床参数的关系。结果:多日 ELD 使认知能力显著提高(尤其是在记忆和语言方面)。这种改善与人口统计学、重测间隔、医疗和精神并发症数量、NPH症状持续时间、估计病前智力、认知障碍基线水平、脑血管疾病负担、脑室肥大程度或其他与NPH相关的脑形态学改变无关。平衡评分的改善幅度大于认知评分,与认知变化评分呈弱正相关。结论:研究结果表明,床旁神经认知测试可充分反映与多日 ELD 试验相关的认知改善情况。这些研究结果支持了神经心理学咨询和平衡评估的实用性,可为临床决策提供依据,以确定接受择期 NPH 评估的患者对临时 CSF 分流的反应。本文还讨论了对 NPH 神经解剖学和认知基础的理解所产生的影响。
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引用次数: 0
A case report of long-term effects of Delayed post-hypoxic leukoencephalopathy (DPHL) following benzodiazepine overdose. 过量服用苯并二氮杂卓后迟发性缺氧后白质脑病(DPHL)长期影响的病例报告。
IF 3 3区 心理学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-10-01 Epub Date: 2024-02-20 DOI: 10.1080/13854046.2024.2315746
Jared B Hammond, Jennifer Peraza, Christopher A Pierce

Objective: We report a neuropsychological evaluation for a 39-year-old, right-handed, white female who 8 years ago developed delayed post-hypoxic leukoencephalopathy (DPHL), a rare demyelinating syndrome, two-weeks following an anoxic brain injury due to an overdose from benzodiazepines. Methods: An extensive record review documenting her medical timeline and treatment over the last 8 years was conducted using the available EMR system, which also included both EEG and neuroimaging data. Eight years post injury, a comprehensive neuropsychological battery was administered with corrected normative data for age, race, education, and other demographic factors when available. Collected data was compared with other case reports of DPHL. Results: The neuropsychological profile indicated difficulties across multiple cognitive domains that appeared driven by executive dysfunction, likely related to fronto-subcorto-striatal dysfunction. Conclusion: As a rare disease, the process by which DPHL occurs is not fully understood. Our results revealed similar findings in the literature for learning and memory, attention, processing speed, and executive functions. This is discussed in the context of available neuroimaging while highlighting the value of comprehensive neuropsychological assessment in DPHL even years post-injury.

目的:我们报告了对一名 39 岁右撇子白人女性进行的神经心理学评估。8 年前,她因过量服用苯二氮卓类药物导致缺氧性脑损伤,两周后出现迟发性缺氧后白质脑病 (DPHL),这是一种罕见的脱髓鞘综合征。治疗方法利用现有的电子病历系统对她过去 8 年的医疗时间表和治疗进行了广泛的病历审查,其中还包括脑电图和神经影像学数据。伤后八年,对她进行了全面的神经心理测试,并根据年龄、种族、教育程度和其他人口统计学因素(如果有的话)提供了校正常模数据。收集的数据与其他 DPHL 病例报告进行了比较。结果:神经心理分析表明,患者在多个认知领域都存在困难,这些困难似乎是由执行功能障碍引起的,很可能与前交叉-后交叉-纹状体功能障碍有关。最后得出结论:作为一种罕见疾病,DPHL的发病过程尚未完全明了。我们的研究结果揭示了文献中关于学习和记忆、注意力、处理速度和执行功能的类似发现。我们结合现有的神经影像学资料对这一问题进行了讨论,同时强调了对DPHL进行全面神经心理评估的价值,即使是在伤后数年。
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引用次数: 0
Does the presence of chronic pain affect scores on cognitive screening tests/brief cognitive measures for dementia? A systematic review and meta-analysis. 慢性疼痛是否会影响痴呆认知筛查测试/简易认知测量的得分?系统回顾与荟萃分析。
IF 3 3区 心理学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-10-01 Epub Date: 2024-02-18 DOI: 10.1080/13854046.2024.2315739
Alex Fradera, Jessica McLaren, Lisa Gadon, Breda Cullen, Jonathan Evans

Objective: Cognitive screening tests can identify potential dementia by indicating a concerning level of cognitive impairment. The older populations for whom this is most relevant are more likely to experience chronic pain, which also impairs cognitive function, but pain's impact on cognitive screening tests specifically remains unknown.

Method: We conducted a systematic review and meta-analysis (SR/MA) following PRISMA guidelines evaluating cognitive screening scores in studies involving participants with chronic pain compared with a pain-free control group. Our question was whether the presence of chronic pain (self-reported or based on diagnosis) was associated with poorer performance on these screens, and to identify the heterogeneity across groups and screens.

Results: The 51 studies identified yielded 62 effect size estimates. The pooled g was 0.76 (95% confidence interval 0.57 to 0.95). Heterogeneity was high for the full model (= 93.16%) with some reductions in sub-analyses. Around half of the studies were identified as being at a low risk of bias. There was no evidence of publication bias.

Conclusions: As a whole, this analysis suggests medium to large effect sizes on cognitive screen performance when people are living with chronic pain. We suggest that clinicians should consider the effect of chronic pain when cognitive screens are employed to investigate dementia. Further research could clarify the effect pain has on different screen sub-domains to aid their effective use with these populations.

目的:认知筛查测试可以通过显示认知障碍的相关程度来识别潜在的痴呆症。与此最相关的老年人群更有可能经历慢性疼痛,而慢性疼痛也会损害认知功能,但疼痛对认知筛查测试的具体影响仍不得而知:我们按照 PRISMA 指南进行了一项系统回顾和荟萃分析(SR/MA),评估了与无痛对照组相比,有慢性疼痛参与者参与的研究中的认知筛查得分。我们的问题是,慢性疼痛的存在(自我报告或基于诊断)是否与这些筛查的较差表现有关,并确定不同组别和筛查之间的异质性:51 项研究得出了 62 个效应大小估计值。汇总的 g 为 0.76(95% 置信区间为 0.57 至 0.95)。完整模型的异质性很高(=93.16%),但在子分析中异质性有所降低。约有一半的研究被认定为存在低偏倚风险。没有证据表明存在发表偏倚:总体而言,这项分析表明,当人们患有慢性疼痛时,认知屏幕表现会产生中等到较大的影响。我们建议临床医生在使用认知筛查来调查痴呆症时应考虑慢性疼痛的影响。进一步的研究可以明确疼痛对不同筛查子域的影响,从而帮助这些人群有效使用筛查。
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引用次数: 0
A systematic review of the utility of continuous performance tests among adults with ADHD. 对患有多动症的成年人进行连续性表现测试的实用性进行系统回顾。
IF 3 3区 心理学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-10-01 Epub Date: 2024-02-29 DOI: 10.1080/13854046.2024.2315740
Jacob L Varela, Anna T Magnante, Holly M Miskey, Anna S Ord, Adrienne Eldridge, Robert D Shura

Objective: The clinical utility of continuous performance tests (CPTs) among adults with attention-deficit/hyperactivity disorder (ADHD) has increasingly been brought under question. Therefore, the objective of this study was to systematically review the literature to investigate the clinical utility of various commercially available CPTs, including the Conner's Continuous Performance Test (CCPT), Test of Variables of Attention (TOVA), Gordon Diagnostic System (GDS), and Integrated Visual and Auditory Continuous Performance Test (IVA) in the adult ADHD population.

Methods: This systematic review followed the a priori PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Articles were gathered from PsycINFO, PsycARTICLES, Academic Search Complete, and Google Scholar on 11 April 2022. Sixty-nine articles were included in the final review. Risk of bias was assessed using the National Institute of Health Quality Assessment Took for Observational Cohort and Cross-Sectional Studies.

Results: Most articles demonstrated high risk of bias, and there was substantial heterogeneity across studies. Overall, the reviewed CPTs appeared to have limited diagnostic utility and classification accuracy. Although many studies showed differing scores between adults with ADHD and comparison groups, findings were not consistent. Characteristics of CPT performances among adults with ADHD were mixed, with little consistency and no evidence of a clear profile of performances; however, CCPT commission errors appeared to have the most utility when used a treatment or experimental outcome measure, compared to other CCPT scores.

Conclusion: Overall, CPTs should not be used in isolation as a diagnostic test but may be beneficial when used as a component of a comprehensive assessment.

目的:注意力缺陷/多动症(ADHD)成人患者的连续表现测试(CPT)的临床实用性越来越受到质疑。因此,本研究旨在系统回顾文献,调查各种市售连续表现测试(CPT)在成人注意力缺陷/多动症人群中的临床实用性,包括康纳连续表现测试(CCPT)、注意力变量测试(TOVA)、戈登诊断系统(GDS)和视听综合连续表现测试(IVA):本系统性综述事先遵循了 PRISMA(系统性综述和元分析首选报告项目)指南。文章于 2022 年 4 月 11 日从 PsycINFO、PsycARTICLES、Academic Search Complete 和 Google Scholar 收集而来。69篇文章被纳入最终综述。采用美国国立卫生研究院的观察性队列和横断面研究质量评估表对偏倚风险进行了评估:结果:大多数文章的偏倚风险较高,而且不同研究之间存在很大的异质性。总体而言,所审查的 CPT 似乎诊断效用和分类准确性有限。尽管许多研究显示患有多动症的成人与对比组之间的得分存在差异,但研究结果并不一致。成人多动症患者的CPT表现特征参差不齐,几乎没有一致性,也没有证据表明有明确的表现特征;然而,与其他CCPT评分相比,CCPT佣金误差在作为治疗或实验结果测量时似乎最有用:总之,CPTs 不应单独作为诊断测试使用,但作为综合评估的一个组成部分使用时可能会有所裨益。
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引用次数: 0
Test-retest reliability and reliable change index of the Philips IntelliSpace Cognition digital test battery. 飞利浦 IntelliSpace 认知数字测试电池的重测可靠性和可靠变化指数。
IF 3 3区 心理学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-10-01 Epub Date: 2024-02-15 DOI: 10.1080/13854046.2024.2315747
Laura Klaming, Mandy Spaltman, Stefan Vermeent, Gijs van Elswijk, Justin B Miller, Ben Schmand

Objective: This article provides the test-retest reliability and Reliable Change Indices (RCIs) of the Philips IntelliSpace Cognition (ISC) platform, which contains digitized versions of well-established neuropsychological tests.

Method: 147 participants (ages 19 to 88) completed a digital cognitive test battery on the ISC platform or paper-pencil versions of the same test battery during two separate visits. Intraclass correlation coefficients (ICC) were calculated separately for the ISC and analog test versions to compare reliabilities between administration modalities. RCIs were calculated for the digital tests using the practice-adjusted RCI and standardized regression-based (SRB) method.

Results: Test-retest reliabilities for the ISC tests ranged from moderate to excellent and were comparable to the test-retest reliabilities for the paper-pencil tests. Baseline test performance, retest interval, age, and education predicted test performance at visit 2 with baseline test performance being the strongest predictor for all outcome measures. For most outcome measures, both methods for the calculation of RCIs show agreement on whether or not a reliable change was observed.

Conclusions: RCIs for the digital tests enable clinicians to determine whether a measured change between assessments is due to real improvement or decline. Together, this contributes to the growing evidence for the clinical utility of the ISC platform.

目的:本文介绍了飞利浦 IntelliSpace Cognition(ISC)平台的重复测试可靠性和可靠变化指数(RCIs):方法:147 名参与者(19 至 88 岁)分别在两次访问中完成了 ISC 平台上的数字认知测试或纸笔版的相同测试。分别计算 ISC 和模拟测试版本的类内相关系数 (ICC),以比较不同施测方式的可靠性。使用实践调整 RCI 和标准化回归法(SRB)计算了数字测试的 RCI:ISC测试的重测信度从中等到优秀不等,与纸笔测试的重测信度相当。基线测试成绩、重测间隔时间、年龄和教育程度都能预测第 2 次测试的成绩,其中基线测试成绩对所有结果测量的预测作用最大。对于大多数结果指标而言,两种计算 RCIs 的方法在是否观察到可靠变化方面显示出一致性:结论:数字测试的 RCIs 使临床医生能够确定两次评估之间测得的变化是由于真正的改善还是下降。总之,这为 ISC 平台的临床实用性提供了越来越多的证据。
{"title":"Test-retest reliability and reliable change index of the Philips IntelliSpace Cognition digital test battery.","authors":"Laura Klaming, Mandy Spaltman, Stefan Vermeent, Gijs van Elswijk, Justin B Miller, Ben Schmand","doi":"10.1080/13854046.2024.2315747","DOIUrl":"10.1080/13854046.2024.2315747","url":null,"abstract":"<p><strong>Objective: </strong>This article provides the test-retest reliability and Reliable Change Indices (RCIs) of the Philips IntelliSpace Cognition (ISC) platform, which contains digitized versions of well-established neuropsychological tests.</p><p><strong>Method: </strong>147 participants (ages 19 to 88) completed a digital cognitive test battery on the ISC platform or paper-pencil versions of the same test battery during two separate visits. Intraclass correlation coefficients (ICC) were calculated separately for the ISC and analog test versions to compare reliabilities between administration modalities. RCIs were calculated for the digital tests using the practice-adjusted RCI and standardized regression-based (SRB) method.</p><p><strong>Results: </strong>Test-retest reliabilities for the ISC tests ranged from moderate to excellent and were comparable to the test-retest reliabilities for the paper-pencil tests. Baseline test performance, retest interval, age, and education predicted test performance at visit 2 with baseline test performance being the strongest predictor for all outcome measures. For most outcome measures, both methods for the calculation of RCIs show agreement on whether or not a reliable change was observed.</p><p><strong>Conclusions: </strong>RCIs for the digital tests enable clinicians to determine whether a measured change between assessments is due to real improvement or decline. Together, this contributes to the growing evidence for the clinical utility of the ISC platform.</p>","PeriodicalId":55250,"journal":{"name":"Clinical Neuropsychologist","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139742733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Survey of evaluation policies and procedures in clinical neuropsychology postdoctoral fellowship programs. 临床神经心理学博士后奖学金项目的评估政策和程序调查。
IF 3 3区 心理学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-10-01 Epub Date: 2024-02-20 DOI: 10.1080/13854046.2024.2315731
Julie K Janecek, Brittany Lang, Sakina Butt, Laura Kenealy, Amy Heffelfinger

Objective: The objectives of this study were to examine current procedures that are used to evaluate competency development in clinical neuropsychology at the postdoctoral level and to investigate policies and procedures for the management of performance that is below expectations during the postdoctoral fellowship.

Method: Clinical neuropsychology fellowship program directors were invited via email with multiple reminders to participate in an online survey between 1/26/2023 and 3/31/2023.

Results: Most programs administer a competency-based written evaluation of fellow performance (92%) and have a written policy for managing performance that is below expectations (86%). However, greater variability was reported regarding the use of other evaluation tools, including fellow self-assessments (46% of programs), program evaluations (57% of programs), supervisor evaluations (73% of programs), and exit interviews (82% of programs). Moreover, there was variability between programs with regard to the specific competencies that were measured and how performance that is below expectations is managed.

Conclusions: Competency-based evaluations and clear, written policies and procedures for management of performance that is below expectations are recommended. Such tools and policies provide clear expectations for fellowship outcomes, promote regular communication between fellows and supervisors, foster early identification of gaps in training, facilitate program quality improvement, and increase opportunities to support and intervene during the course of fellowship training.

研究目的本研究的目的是检查目前用于评估博士后临床神经心理学能力发展的程序,并调查在博士后研究期间对低于预期表现的管理政策和程序:方法:通过电子邮件多次提醒临床神经心理学研究项目主任在 2023 年 1 月 26 日至 2023 年 3 月 31 日期间参与在线调查:大多数项目都对研究员的表现进行了基于能力的书面评估(92%),并制定了管理低于预期表现的书面政策(86%)。然而,其他评估工具的使用情况差异较大,包括研究员自我评估(46%的项目)、项目评估(57%的项目)、主管评估(73%的项目)和离职面谈(82%的项目)。此外,在衡量的具体能力以及如何管理低于预期的绩效方面,不同项目之间存在差异:结论:建议采用基于能力的评估以及明确的书面政策和程序来管理低于预期的绩效。这些工具和政策明确了对研究金成果的期望,促进了研究员与导师之间的定期沟通,有助于及早发现培训中的不足,促进项目质量的提高,并增加了在研究金培训过程中提供支持和干预的机会。
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引用次数: 0
Nocturnal hypoglycemia is associated with next day cognitive performance in adults with type 1 diabetes: Pilot data from the GluCog study. 夜间低血糖与 1 型糖尿病成人患者第二天的认知表现有关:来自 GluCog 研究的试验数据。
IF 3 3区 心理学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-10-01 Epub Date: 2024-02-21 DOI: 10.1080/13854046.2024.2315749
Miranda Zuniga-Kennedy, Olivia H Wang, Luciana M Fonseca, Michael J Cleveland, Jane D Bulger, Elizabeth Grinspoon, Devon Hansen, Zoë W Hawks, Laneé Jung, Shifali Singh, Martin Sliwinski, Alandra Verdejo, Kellee M Miller, Ruth S Weinstock, Laura Germine, Naomi Chaytor

Objective:  Individuals with type 1 diabetes (T1D) have increased risk for cognitive dysfunction and high rates of sleep disturbance. Despite associations between glycemia and cognitive performance using cross-sectional and experimental methods few studies have evaluated this relationship in a naturalistic setting, or the impact of nocturnal versus daytime hypoglycemia. Ecological Momentary Assessment (EMA) may provide insight into the dynamic associations between cognition, affective, and physiological states. The current study couples EMA data with continuous glucose monitoring (CGM) to examine the within-person impact of nocturnal glycemia on next day cognitive performance in adults with T1D. Due to high rates of sleep disturbance and emotional distress in people with T1D, the potential impacts of sleep characteristics and negative affect were also evaluated.

Methods:  This pilot study utilized EMA in 18 adults with T1D to examine the impact of glycemic excursions, measured using CGM, on cognitive performance, measured via mobile cognitive assessment using the TestMyBrain platform. Multilevel modeling was used to test the within-person effects of nocturnal hypoglycemia and hyperglycemia on next day cognition.

Results:  Results indicated that increases in nocturnal hypoglycemia were associated with slower next day processing speed. This association was not significantly attenuated by negative affect, sleepiness, or sleep quality.

Conclusions:  These results, while preliminary due to small sample size, showcase the power of intensive longitudinal designs using ambulatory cognitive assessment to uncover novel determinants of cognitive fluctuation in real world settings, an approach that may be utilized in other populations. Findings suggest reducing nocturnal hypoglycemia may improve cognition in adults with T1D.

目的: 1 型糖尿病(T1D)患者认知功能障碍的风险增加,睡眠障碍的发生率也很高。尽管采用横断面和实验方法研究了血糖与认知能力之间的关系,但很少有研究在自然环境中评估这种关系,或夜间低血糖与白天低血糖的影响。生态瞬间评估(EMA)可以帮助人们深入了解认知、情感和生理状态之间的动态关联。目前的研究将 EMA 数据与连续血糖监测 (CGM) 结合起来,研究 T1D 成人患者夜间血糖对第二天认知能力的影响。由于 T1D 患者的睡眠障碍和情绪困扰发生率较高,因此还评估了睡眠特征和负面情绪的潜在影响: 这项试验性研究利用 18 名 T1D 成人患者的 EMA 来研究血糖偏移对认知能力的影响,血糖偏移是通过 CGM 测量的,而认知能力是通过使用 TestMyBrain 平台的移动认知评估测量的。研究采用多层次模型来检验夜间低血糖和高血糖对第二天认知能力的影响: 结果表明,夜间低血糖的增加与次日处理速度的减慢有关。负性情绪、嗜睡或睡眠质量都不会明显降低这种关联: 由于样本量较小,这些结果只是初步的,但它们展示了利用非卧床认知评估进行强化纵向设计的能力,从而发现了现实环境中认知波动的新决定因素,这种方法可用于其他人群。研究结果表明,减少夜间低血糖可改善患有 T1D 的成年人的认知能力。
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引用次数: 0
The Sport Concussion Assessment Tool: A multidimensional symptom model for detecting elevated post-concussion symptoms. 运动脑震荡评估工具:用于检测脑震荡后症状加重的多维症状模型。
IF 3 3区 心理学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-10-01 Epub Date: 2024-02-18 DOI: 10.1080/13854046.2024.2315735
Eric O Ingram, Justin E Karr

Objective: Investigate whether a four-factor model of post-concussion symptoms (i.e. cognitive, physical, affective, and sleep-arousal) aids in identifying student-athletes with persistent concerns not reflected by a total symptom score. Method: Collegiate student-athletes (N = 32,066) from the Concussion Assessment Research and Education consortium completed the Sport Concussion Assessment Tool, 3rd edition Symptom Evaluation at baseline and two post-injury follow-ups (i.e. beginning RTP and 6-month). Confirmatory factor analysis was used to compare a one- and four-factor model of post-concussion symptoms. Normative reference data were compared across stratifications (e.g. sex, prior concussions, and number of pre-existing conditions) using Mann-Whitney U tests, and elevation rates (i.e. 84th percentile) for subscales and the total score were recorded. Results: The four-factor model fit well before and after injury (CFIs > .95). Greater symptom severity on the subscale and total scores was associated with female sex (ps<.001, r range: .07 to .14) and more pre-existing conditions (ps<.001, η2 range: .01 to .04), while having more prior concussions was only related to total symptom scores (ps<.001, η2<.01). After a concussion, a sizeable portion of student-athletes (i.e., RTP = 11.8%; 6-month = 8.3%) had subscale elevations despite no total score elevation. Physical subscale elevations at RTP were the most common (i.e., 11.9%), driven by head and neck pain. Conclusion: After a sport-related concussion, a four-factor symptom model can be used to assess persistent symptoms in collegiate student-athletes. Identifying athletes with domain-specific elevations may help clinicians identify areas for further assessment and, in some cases, personalized rehabilitation plans.

目标: 研究脑震荡后症状的四因素模型(即认知、身体、情感和睡眠唤醒)是否有助于识别未反映出持续问题的学生运动员:调查脑震荡后症状的四因素模型(即认知、躯体、情感和睡眠唤醒)是否有助于识别症状总分无法反映的持续性问题的学生运动员。方法:来自脑震荡评估研究与教育联盟的大学生运动员(32,066 人)在基线和两次伤后随访(即开始 RTP 和 6 个月)时完成了运动脑震荡评估工具第 3 版症状评估。采用确证因子分析来比较脑震荡后症状的单因子和四因子模型。使用 Mann-Whitney U 检验比较了不同分层(如性别、既往脑震荡情况和既往病症数量)的正常参考数据,并记录了分量表和总分的升高率(即≥84 百分位数)。结果受伤前后的四因素模型拟合良好(CFIs > .95)。分量表和总分的症状严重程度与女性性别(psr范围:.07至.14)和更多的原有病症(psη2范围:.01至.04)有关,而更多的先前脑震荡仅与症状总分有关(psη2结论:运动相关脑震荡后,四因素症状模型可用于评估大学生运动员的持续症状。识别特定领域升高的运动员可帮助临床医生确定需要进一步评估的领域,并在某些情况下制定个性化的康复计划。
{"title":"The Sport Concussion Assessment Tool: A multidimensional symptom model for detecting elevated post-concussion symptoms.","authors":"Eric O Ingram, Justin E Karr","doi":"10.1080/13854046.2024.2315735","DOIUrl":"10.1080/13854046.2024.2315735","url":null,"abstract":"<p><p><b>Objective:</b> Investigate whether a four-factor model of post-concussion symptoms (i.e. cognitive, physical, affective, and sleep-arousal) aids in identifying student-athletes with persistent concerns not reflected by a total symptom score. <b>Method:</b> Collegiate student-athletes (<i>N</i> = 32,066) from the Concussion Assessment Research and Education consortium completed the Sport Concussion Assessment Tool, 3rd edition Symptom Evaluation at baseline and two post-injury follow-ups (i.e. beginning RTP and 6-month). Confirmatory factor analysis was used to compare a one- and four-factor model of post-concussion symptoms. Normative reference data were compared across stratifications (e.g. sex, prior concussions, and number of pre-existing conditions) using Mann-Whitney <i>U</i> tests, and elevation rates (i.e. <math><mrow><mo>≥</mo></mrow></math>84th percentile) for subscales and the total score were recorded. <b>Results:</b> The four-factor model fit well before and after injury (CFIs > .95). Greater symptom severity on the subscale and total scores was associated with female sex (<i>ps</i><.001, <i>r</i> range: .07 to .14) and more pre-existing conditions (<i>ps</i><.001, <math><mrow><mi>η</mi></mrow></math><sup>2</sup> range: .01 to .04), while having more prior concussions was only related to total symptom scores (<i>ps</i><.001, <math><mrow><mi>η</mi></mrow></math><sup>2</sup><.01). After a concussion, a sizeable portion of student-athletes (i.e., RTP = 11.8%; 6-month = 8.3%) had subscale elevations despite no total score elevation. Physical subscale elevations at RTP were the most common (i.e., 11.9%), driven by head and neck pain. <b>Conclusion:</b> After a sport-related concussion, a four-factor symptom model can be used to assess persistent symptoms in collegiate student-athletes. Identifying athletes with domain-specific elevations may help clinicians identify areas for further assessment and, in some cases, personalized rehabilitation plans.</p>","PeriodicalId":55250,"journal":{"name":"Clinical Neuropsychologist","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11330539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139900952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Atypical language organization in a Spanish-speaking adolescent with drug-resistant epilepsy: a multicultural case report. 一名讲西班牙语的青少年耐药性癫痫患者的非典型语言组织:一份多元文化病例报告。
IF 3 3区 心理学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-09-30 DOI: 10.1080/13854046.2024.2405086
Jenna A Chiang, Laura K Winstone-Weide, Dave F Clarke, Rosario C DeLeon

Objective: Epilepsy disproportionally affects children from Hispanic/Latino backgrounds, particularly among those born outside the U.S. Longstanding health-related disparities associated with ethnicity (e.g. language use) further contribute to gaps in care. Neuropsychologists are beginning to outline best practices when working with non-English speakers; however, the lack of appropriately normed/validated measures for pre-surgical language evaluation is a limiting factor. This report informs practices among neuropsychologists by discussing atypical language organization in a non-English speaker using a multicultural framework and collaborative therapeutic assessment process. Method: The current study presents a 16-year-old, right-handed, monolingual Spanish-speaking, Latina designated female with drug-resistant focal seizures with impaired awareness. Comprehensive presurgical epilepsy workup included: CBC, video EEG, brain MRI, functional MRI, PET, MEG, baseline neuropsychological evaluation by bilingual Spanish-English providers, and Wada testing. Results: Neuropsychological testing revealed the most pronounced deficits in language, working memory, and processing speed domains. Functional MRI showed bilateral language activation, which Wada testing confirmed along with bilateral memory representation. Conclusion: Diagnosis, treatment, surgical intervention, and post-operative status are discussed. The clinical course is examined through a multicultural lens, highlighting limitations in international health services, barriers accessing health care in the U.S., and patient-specific factors that were considered as a part of the clinical decision-making process. Targeted recommendations related to culturally-informed care are offered.

目的:癫痫对西班牙裔/拉丁美洲裔儿童的影响尤为严重,尤其是那些在美国境外出生的儿童。与种族(如语言使用)相关的长期健康相关差异进一步加剧了护理方面的差距。神经心理学家已开始概述与非英语人士合作时的最佳实践;然而,手术前语言评估缺乏适当的规范/验证措施是一个限制因素。本报告通过使用多元文化框架和合作治疗评估流程讨论非英语使用者的非典型语言组织,为神经心理学家的实践提供参考。方法:本研究介绍了一名 16 岁、右撇子、单语西班牙语的拉丁裔女性患者,她患有耐药性局灶性癫痫发作且意识受损。手术前的全面癫痫检查包括全血细胞计数、视频脑电图、脑核磁共振成像、功能性核磁共振成像、正电子发射计算机断层扫描、MEG、由西班牙语和英语双语医疗人员进行的基线神经心理评估以及 Wada 测试。结果:神经心理学测试表明,患者在语言、工作记忆和处理速度方面存在最明显的缺陷。功能磁共振成像显示双侧语言激活,Wada 测试证实了这一点以及双侧记忆表征。结论本文讨论了诊断、治疗、手术干预和术后状况。从多元文化的视角审视了临床过程,强调了国际医疗服务的局限性、在美国获得医疗服务的障碍以及临床决策过程中考虑的患者特定因素。此外,还提供了与文化知情护理相关的针对性建议。
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引用次数: 0
Disinhibition, rather than moderate-to-severe traumatic brain injury, moderates the impact of anger provocation on subjective emotional experience. 抑制作用,而非中度至重度脑外伤,可调节激怒对主观情绪体验的影响。
IF 3 3区 心理学 Q2 CLINICAL NEUROLOGY Pub Date : 2024-09-24 DOI: 10.1080/13854046.2024.2406042
Michelle Mendez, Jodie Logan, Michaela Filipčíková, Skye McDonald, Travis Wearne

Objective: Altered reactivity to emotional stimuli is common after traumatic brain injury (TBI), which is suggested to reflect difficulties with emotion regulation. While disinhibition is common after moderate-to-severe TBI, limited research has investigated the link between disinhibition and emotional reactivity in this clinical group. The aim of this research, therefore, was to investigate the relationship between disinhibition and TBI to anger provocation.

Method: Thirty-five individuals with moderate-to-severe TBI and thirty-one controls completed an anger induction task. Participants rated their experience of emotions and subjective arousal before and after the induction. Heart rate, respiration and skin conductance were also measured. Disinhibition was measured using the Frontal Systems Behavior Scale.

Results: In the full sample, the mood induction led to increased skin conductance, respiration, and self-reported anger, tension, arousal and negative mood. There were no differences between those with TBI and controls. Disinhibition interacted with the impact of anger provocation on subjective, but not objective, outcomes such that those elevated in disinhibition reported increased feelings of anger and tension in response to the mood induction. Disinhibition did not interact with TBI across any subjective and objective emotional measures examined in response to mood induction.

Conclusions: While anger causes emotional changes for all individuals, these changes are particularly pronounced among those who are disinhibited, irrespective of whether an individual has sustained a TBI. This is an important consideration when examining emotional regulation post-TBI as the degree of disinhibition appears to alter subjective interpretations of emotional events, which could lead to emotion dysregulation.

目的:创伤性脑损伤(TBI)后对情绪刺激的反应性改变很常见,这被认为反映了情绪调节方面的困难。虽然中度至重度创伤性脑损伤后普遍存在抑制作用减弱的现象,但对这一临床群体抑制作用减弱与情绪反应之间关系的研究却十分有限。因此,本研究旨在调查抑制能力丧失与创伤性脑损伤激怒之间的关系:方法:35 名中重度创伤性脑损伤患者和 31 名对照组患者完成了一项愤怒诱发任务。参与者在诱导前后对自己的情绪体验和主观唤醒程度进行评分。同时还测量了心率、呼吸和皮肤电导。抑制行为采用额叶系统行为量表进行测量:结果:在所有样本中,情绪诱导导致皮肤传导、呼吸、自我报告的愤怒、紧张、唤醒和消极情绪增加。创伤性脑损伤患者与对照组之间没有差异。抑制与激怒对主观结果(而非客观结果)的影响相互影响,因此抑制水平较高的受试者在情绪诱导下的愤怒和紧张情绪有所增加。在对情绪诱导进行的主观和客观情绪测量中,抑制与创伤性脑损伤没有相互作用:结论:虽然愤怒会导致所有人的情绪变化,但这些变化在抑制失调者中尤为明显,与是否受过创伤性脑损伤无关。在研究创伤后的情绪调节时,这是一个重要的考虑因素,因为抑制的程度似乎会改变对情绪事件的主观解释,从而导致情绪失调。
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引用次数: 0
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Clinical Neuropsychologist
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