Clinical Neuropsychologist最新文献

Objective: Objective cognitive impairment has been shown in a minority of hospitalized COVID-19 patients, and longitudinal studies with a relatively long follow-up duration are scarce. We sought to investigate the presence and long-term change of objective cognitive functioning. Method: Forty-six initially hospitalized (18 ± 19 days) COVID-19 survivors (male/female: 30/16; age: 61 ± 11) underwent extensive neuropsychological assessment (including performance validity) approximately 1 (T1) and 2.5 years (T2) post-infection. Cognitive domains assessed were: memory, attention, executive functioning, processing speed, and language (n = 14 (sub)tests). We used normative data to derive age, sex, and education-adjusted T-scores (T ≤ 35 [≤-1.5SD], deficit cut-off). Repeated measures AN(C)OVAs were used to investigate cognitive functioning over time. Results: Mean neuropsychological performance (n = 14 tests) was within normal range at both timepoints, and number of individuals with objective cognitive deficits ranged from 0-20% (T1), and 2-22% (T2). Number of subjective cognitive complaints remained unchanged. A minority (17%) showed objective cognitive deficits on ≥2 tests at both 1 and 2.5 years post-infection, but not consistently within one cognitive domain. Longitudinal analyses on the total sample showed improvement in performance over time on phonemic fluency (p<.001), but stable cognitive performance on all other tests, independent of prior comorbidities, subjective cognitive complaints, depressive symptoms, and ICU admission. Conclusions: There were no consistent objective cognitive deficits or major cognitive disorders years after SARS-CoV-2 infection in the majority of cases. Neuropsychological functioning remained essentially unchanged over time. Future larger longitudinal studies are necessary to unravel COVID-19-related cognitive phenotypes of persisting deficits and how these can be modulated.

Objective: Technology is increasingly critical for performing daily activities, which has multiple implications for the practice of clinical neuropsychology. This study sought to characterize use of digital and traditional analog approaches to instrumental activities of daily living (iADLs) among samples of younger and older adults and identify cognitive factors associated with self-perceived errors in using digital approaches. Method: Sixty community-dwelling adults aged 50 and older and 46 younger healthy adults aged 35 and younger completed a telephone-based research evaluation including demographics, mood, general health, and neurocognitive functioning. Participants also completed a questionnaire on frequency of usage and perceived errors in completing nine iADLs via digital and analog approaches. Results: Participants overall reported using digital more frequently than analog approaches at a very large effect size, with a digital preference most obvious for activities such as navigation and financial account management. The younger group reported using digital approaches more frequently than the older group at a large effect size. Better cognitive performance was associated with less frequent use of analog, but not digital, approaches. Furthermore, better cognition was associated with moderately less frequent self-reported digital errors in the older, but not the younger, groups. Conclusions: Younger and older adults are increasingly adopting digital approaches to performing daily tasks. This highlights both the need and opportunity for the field of clinical neuropsychology to better understand how technology impacts the ability to perform daily tasks and develop assessment tools that adequately capture how patients are functioning in a digitally enriched environment.

Objective: The importance of well-being, including burnout and professional fulfillment, in the workplace is increasingly recognized. However, experiences of burnout and fulfillment, and the factors that support or detract from well-being for neuropsychologists, specifically, are poorly understood. The current study aims to fill this gap by exploring experiences of well-being among neuropsychologists and trainees in neuropsychology in order to provide empirically supported strategies to improve well-being in the field of neuropsychology. Method: Trainees in neuropsychology (N = 109) and practicing neuropsychologists (N = 373) were recruited to complete surveys through professional listservs examining their levels of burnout and professional fulfillment. Surveys also examined the factors that positively and negatively contribute to their sense of well-being and the strategies they use to support their well-being at work. Results: Trainees in neuropsychology and early career neuropsychologists reported high levels of burnout and low levels of fulfillment. Pediatric providers and those in an academic medical or VA setting also reported higher levels of burnout. Autonomy, flexibility, and workplace culture emerged as important contributors to well-being upon examination of both quantitative and qualitative responses. Conclusions: Findings suggest that neuropsychologists, and trainees in particular, are at risk for challenges related to well-being, for which increased resources are recommended.

ΑBSTRACTObjectives: The Trail Making Test (TMT) is widely used for the assessment of mental flexibility in older individuals, but those with limited education are often unable to perform Part B; thus, we explored its clinical utility in assessing an older cohort with low education. Moreover, we explored the clinical utility of speedy reciting of the months of the year (MY) backwards (MB) as an alternative. Methods: We administered the TMT and MY to a sample of cognitively healthy individuals >64 years old and individuals with dementia who participated in a population-based epidemiological study, the Hellenic Longitudinal Investigation of Aging and Diet. Results: Of those who completed TMT-Part A (n = 1270), 69.6% of the cognitively healthy and 34.6% of the dementia group also completed Part B, while of those who successfully recited the months of the year forward (MF, n = 701), 95.1% of the cognitively healthy and 62.1% of the dementia group recited the months backwards. Group differences emerged on all test variables (Cohen's ds: -1.922 to -0.475) except TMT-Part B. Correlations revealed better performance on all test variables with higher levels of education and lower age, respectively, but associations with sex were inconsistent. Diagnostic group was a predictor, along with education and age, on all test variables, but not sex. ROCs suggested better diagnostic value for the MB, compared to TMT-Part B. Normative data are provided for MY. Conclusions: Our findings support the use of MB, rather than TMT-Part B, for assessing mental flexibility in older individuals with low levels of education.

Objective: There are few attention deficit/hyperactivity disorder (ADHD)-specific symptom validity tests (SVTs) available. The revised Dissimulation ADHD scale (Ds-ADHD-r) was developed to identify noncredible reporting on the Minnesota Multiphasic Personality Inventory (MMPI). The current study examines whether the Ds-ADHD-r can identify noncredible performance and reporting in a clinical sample. Method: Participants (N = 113) completed neuropsychological evaluations in an university clinic, including the Conners' Adult ADHD Rating Scale (CAARS), MMPI-2-RF or MMPI-3, at least one standalone performance validity test (PVT), and at least four embedded PVTs. Noncredible groups were created based on falling above or below the cutoff on at least one PVT or falling above or below the cutoff on one SVT. Results: Those who scored above the SVT cutoffs scored higher on both the RBS and the Ds-ADHD-r compared to those who scored below the SVT cutoffs, while PVT performance groups did not differ on either the RBS or Ds-ADHD-r. The Ds-ADHD-r demonstrated greater utility in identifying symptom overreporting when compared to the MMPI RBS. The Ds-ADHD-r did not show utility in detecting noncredible performance. In correlation analyses, the Ds-ADHD-r was more strongly correlated to MMPI F and F scales as compared to FBS and RBS. Conclusions: Results support the utility of the Ds-ADHD-r to detect symptom overreporting in adults seeking evaluation for ADHD, though validation in additional, more diverse samples are needed.

Background/Objective: Understanding the biological cascade which results from a mild traumatic brain injury (mTBI) is essential to determine outcomes over time. Acute plasma levels of brain-related injury markers (BRIMS; ubiquitin carboxy-terminal hydrolase L1 [UCH-L1], total tau[t-tau], neurofilament light chain [NfL], S100 calcium-binding protein β [S100β], glial fibrillary acidic protein [GFAP]) are typically elevated in patients post-mTBI, and relate to injury severity, distinguish neuroimaging findings, and to some degree, relate to functional outcomes. However, acute assessment of biomarkers post-injury is not always feasible, and studies assessing biomarkers in the chronic phase of mTBI have yielded less consistent findings. Method: This review aims to (1) summarize the current literature on the most frequently examined BRIMS in mTBI, (2) review prior research in chronic assessment of BRIMS post-mTBI, (3) discuss the relationship between chronically assessed BRIMS and outcomes post-injury, (4) discuss the relationship between chronically assessed BRIMS and cognition including use by neuropsychologists, (5) discuss limitations to chronic assessment, and (6) discuss recent advances in measurement. Results: There is some evidence that NfL and various inflammatory markers may continue to be elevated and differentiate mTBI from controls during the chronic phase of mTBI; however, findings are inconsistent. During the chronic phase, biomarkers such as UCH-L1, S100β, GFAP, and t-tau appear to be mostly comparable between mTBI and controls. Conclusion: Given the limitations in the chronic assessment of plasma biomarkers after mTBI, researchers should continue efforts in discovery-based methods to identify biomarkers which are more reflective of the pathological processes occurring within the chronic phase of mTBI.

Objective Inconsistency, or intra-individual variability in performance across time (IIV-I), is a possible marker of subtle cognitive weakness. Little neuropsychological research on IIV-I has occurred, and its neurocognitive underpinnings remain unclear. Some hypothesize IIV-I is a unique construct that taps into specific neuroanatomic/cognitive processes, regardless of the task from which IIV-I was derived. However, IIV-I could also be a novel approach to measuring the same constructs being measured by the tasks from which IIV-I was derived. The present study sought to investigate IIV-I's (a) construct validity (i.e., its relationships with standard clinical measures of cognition) and (b) incremental utility beyond mean performance on the same task to help elucidate the clinical utility of IIV-I variables. Method A sample of 72 community-dwelling older adults completed clinical measures and computerized tasks used to derive IIV-I that tapped into processing speed, inhibition, and working memory (i.e., domains that have demonstrated associations with IIV-I). Results In multiple linear regressions, IIV-I variables demonstrated associations with clinical measures with shared neurocognitive underpinnings as the task from which the IIV-I variable was derived. Additionally, in hierarchical regressions, one IIV-I variable demonstrated potential for incremental utility beyond mean performance. Conclusions The present findings suggest that IIV-I may not be an independent construct that shows consistent associations with particular cognitive processes, regardless of how it is measured. Rather, IIV-I variables may tap into the cognitive constructs being measured by the task from which they are derived. Additionally, the incremental utility of IIV-I must continue to be established.

Objective: There is immense excitement and fear regarding the potential of artificial intelligence, particularly large language models (LLMs), to transform healthcare services. In this paper, we aim to provide a future-oriented commentary on how neuropsychologists might consider integrating LLMs into clinical practice ethically, safely, and effectively. Methods: In Part 1, we provide a narrative review of the emerging applications of generative transformer-based LLMs in neuropsychological assessment, including how these technologies may support clinicians with data collection, clinical decision making, and documentation. In Part 2, we analyze the key ethical considerations using the framework of the American Psychological Association (APA) Ethical Principles of Psychologists and Code of Conduct (2017) and Ethical Guidance for AI in the Professional Practice of Health Service Psychology (2025) to formulate recommendations for future research, policy, and clinical integration. Conclusions: LLMs display promise for enhancing neuropsychological practice along a number of lines, such as extracting data from medical records and natural communication, automating test scoring, supporting differential diagnosis and treatment planning, developing test items, and generating text summaries of interviews and empirical literature. However, the rapid progress in LLMs over recent years has left little time for regulation, ethical discourse, and sufficient validation. Key barriers include privacy concerns, risk of bias, limited model transparency, threats to test security, and insufficient research supporting the validity and reliability across specialized tasks. We advise neuropsychologists to help shape regulation, lead empirical validation efforts, and augment educational resources to effectively integrate LLMs into clinical practice while maintaining high ethical standards.

Objective: This systematic review and meta-analysis aims to synthesize the performance of older adults with and without neurocognitive impairment on the Auditory Verbal Learning Test (AVLT). Specifically, the study seeks to characterize the main features of AVLT versions used in older populations, identify the most frequently assessed psychometric measures and process-based indices, and evaluate how varying levels of neurocognitive impairment affect AVLT scores.

Method: This systematic review and meta-analysis was registered in PROSPERO and was conducted following PRISMA 2020 guidelines. A total of 44 studies were included in the review, with 42 included in the meta-analysis. Effect sizes were calculated using Hedges' g, and moderation and meta-regression analyses were performed.

Results: The most reported version was the Rey AVLT with 15-word lists, five learning trials, and a 20-minute delay interval. Process-based indices were underreported. Individuals with neurocognitive disorders (ND) showed significantly lower AVLT scores than healthy controls, with performance worsening in line with ND severity, particularly in delayed recall. Differences in Mini-Mental State Examination scores significantly moderated total learning effect sizes, while age significantly moderated recognition hits.

Conclusions: The AVLT, particularly delayed recall, may be a robust tool for distinguishing among normal aging, mild and major ND. However, variability in AVLT administration reduces the diagnostic potential of AVLT. The diagnostic potential of process-based indices has not been explored adequately. Future research should prioritize the standardization of AVLT protocols and the integration of process-based indices to maximize its clinical utility in detecting and tracking neurocognitive decline.

Objective: Limbic Predominant Age-Related TDP43 Encephalopathy (LATE-NC) is a recently defined (2019) degenerative transactive response DNA binding TDP43 proteinopathy whose prevalence increases after age 80, marked by an amnestic presentation. Anatomically, atrophy predominantly occurs in the hippocampal region, in a unilateral or bilateral manner, yet workup is negative for amyloid and phosphorylated tau (e.g. PET scan; cerebrospinal fluid). Postmortem immunohistochemical data revealing neurofibrillary tangles accumulation initially occurring in the limbic (e.g. amygdala) region with subsequent gradual diffusion throughout the brain in a hierarchical manner (e.g. hippocampus, entorhinal cortex, subcortical, cortical).

Method: Case report methodology focused on a 76-year-old, Black, right-handed male who presented with slowly progressive memory decline over the past year, in the context of a negative beta-amyloid PET result and MRI findings of bilateral hippocampal atrophy (left > right).

Results: Neuropsychological assessment revealed a gentleman of above-average premorbid intellect who performed within normal limits on a cognitive screening measure, yet further assessment revealed prominent memory retrieval deficits with more notable learning and memory deficits seen with rising demands. He also displayed subtle executive (e.g. processing speed, problem-solving; fluency switching) deficits, along with basic construction weaknesses.

Conclusion: The relatively intact global cognition, with memory retrieval deficits and intact semantic fluency, in the context of negative amyloid PET scans, aligns with the neurocognitive profile indicative of LATE. Neuropsychologists should be aware of this newly defined neurodegenerative disorder. Neurocognitive assessment may play a pivotal role in distinguishing between degenerative diseases and allowing for tailored treatment options.