Clinical Neuropsychologist最新文献

Objective: The present study aimed to better understand key conceptualizations and operationalizations of intraindividual variability (IIV). We expected that differing types and metrics of IIV would relate to one another and predict outcomes (academic achievement) similarly. Method: The sample comprised 238 young adults. IIV was computed within and across six measures - three related to math and three more generally cognitive; in each case, score was separated from response time. We computed three types of IIV (inconsistency, dispersion, and dispersion of inconsistency), across several metrics (standard deviation, coefficient of variability, residualized standard deviation), and assessed their interrelations, and their prediction of academic achievement. Results: Differing metrics of variability were related to one another, but variably so. For prediction, whether or not inconsistency IIV metrics were significant was highly dependent on the measure they were derived from, with or without the primary score for a given measure also included. For dispersion of inconsistency and dispersion, variability metrics were often significant, though this was eliminated in most cases when score was also included in models. Conclusions: By concurrently examining multiple metrics and types of IIV within the same set of measures, this study highlights the need to (a) clarify the type of IIV utilized and why; (b) clarify the rationale for the kinds of measures used to compute IIV, particularly dispersion; and (c) include score alongside timing. Doing so will likely improve the generalizability of IIV findings, and prompt future research avenues, both psychometric- (e.g. simulations) and clinical-related (e.g. across ages and populations).

Objective: To analyze the functional and structural reorganization of language over a six-month period in a pediatric patient with drug-resistant focal epilepsy (DRE), using functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI) tractography. Methods: We report a right handed, 7 year old boy with nonlesional drug resistant epilepsy; seizures began at age 7, and the epileptogenic zone localized to the left temporoparietal junction. Pre-surgical fMRI studies were performed to assess language lateralization, and DTI was employed to evaluate structural connectivity changes in language-related pathways. In addition, stereo-electroencephalography (SEEG) was carried out to delineate the epileptogenic zone and to validate functional findings through cortical mapping. Results: Baseline fMRI demonstrated typical left-hemispheric language dominance. Six months later, the laterality index had reversed, indicating functional reorganization toward the right hemisphere. DTI revealed increased fractional anisotropy (FA) in the right arcuate fasciculus and reduced connectivity on the left. SEEG confirmed the feasibility of surgical resection without significant language decline. Neuropsychological testing in the acute postoperative phase showed no major changes in test scores, including the Intelligence Quotient, and no significant alterations in language performance. Conclusions: This case illustrates early brain plasticity and its contribution to functional reorganization of language in response to epileptogenic activity, as well as its potential protective role for cognitive function. The integration of fMRI, DTI, and SEEG is essential for surgical planning in pediatric drug-resistant epilepsy.

Objective: Teleneuropsychology (TeleNP) shows promise as an alternative visit type for patients in which face-to-face (FTF) neuropsychological evaluation is not a viable option. Undergoing FTF presurgical deep brain stimulation (DBS) neuropsychological evaluations may represent a hardship for some patients with movement disorders, yet comparison of performance for TeleNP and FTF for the commonly used Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) has not been studied in this population. The current study aimed to examine RBANS performance of FTF and TeleNP administration in a cohort of movement disorders patients in a clinical setting, hypothesizing similar performance regardless of modality. Method: Four hundred six patients with Parkinson's disease or essential tremor completed the RBANS between two medical centers between 2020 and 2024 as part of standard clinical care within their presurgical assessment for candidacy for DBS or High-Intensity Focused Ultrasound thalamotomy. Results: The TeleNP sample was significantly older than the FTF sample (p = .02). There were no statistical differences in gender (p = .18) or education (p = .66) between the samples. After controlling for age and motor diagnosis differences between the two groups, 9 of the 11 RBANS subtests were comparable, with the TeleNP group performing significantly better on the Picture Naming subtest and the FTF group performing significantly better on the Figure Recall subtest. The effect size of these differences were small, indicating relatively low clinical meaningfulness. Conclusions: The findings of the current study suggest the two methods of administration were associated with broadly comparable performances in this movement disorder population, suggesting TeleNP may be a viable option for presurgical evaluation.

Objective: Visual perception is frequently impaired in individuals with cerebral palsy (CP). Little is known about the range of visual perceptual impairments that may occur in adults with CP, and few studies have investigated performance at the individual level. Here, we aim to characterize visual perceptual functions in a group of adults with CP.

Method: 21 participants with CP and 40 neurotypical control participants, aged 18-40 years, were assessed with a range of visual perceptual tests commonly used in neuropsychological practice. The tests were selected to make sure that individuals with all severities of CP would be able to take part in the study. The analyses were pre-registered prior to data collection on Open Science Framework: https://doi.org/10.17605/OSF.IO/S7KBE. Results were analyzed both at the group level and at an individual level using single case methodology.

Results: Most participants with CP were able to complete the full test battery, despite some having severe motor impairments. The participants with CP performed worse than the control group on indexes of face recognition, reading and visuospatial functions, while there was no difference on an object recognition index. At the individual level, three participants were impaired on ≤ 1 test, while 18 of 21 participants with cerebral palsy were impaired on more than two tests (range: 3-15).

Conclusions: Overall, adults with CP can have a wide range of visual perceptual impairments, even when evaluated using screening tests. The participants with impaired visual perceptual functions showed signs of both dorsal and ventral stream dysfunction.

Objective: Ecological momentary assessment (EMA) is a popular method for analyzing intra-individual variability (IIV) of psychological constructs, including cognition. Multilevel modeling (MLM) is a widely used method for analyzing EMA data in intensive longitudinal designs. This systematic review examines how psychologists use and report MLM in EMA studies. It evaluates (1) adherence to the Checklist for Reporting EMA Studies (CREMAS) guidelines, (2) common factors reported in addition to the CREMAS guidelines, and (3) consistency in reporting MLM to analyze EMA data, aiming to improve research design and reporting consistency in the field. Method: Phase 1 searched research databases to explore the commonly used statistical analyses for EMA data. Subsequently, a systematic review was conducted of psychological research articles published between January 2021 and February 2023 which used MLM as the primary method to analyze EMA data. Phase 2 comprised an updated systematic review of articles published from November 2024 to April 2025 to examine whether reporting patterns improved across time. Results: Phase 1 confirmed MLM is the most often statistical procedure used to analyze EMA. 43 articles were reviewed and found (1) generally strong adherence to the CREMAS guidelines, (2) additional components commonly reported, and (3) varied reporting of MLM data preparation and analysis. Phase 2 reviewed 14 articles and found similar results as Phase 1. Conclusions: To further increase transparency and standardize reporting, we recommend several additions to the CREMAS guidelines and a set of Reporting MLM in EMA studies (REMMES) guidelines for future research.

Objective: This study aimed to assess the relationship between occupational skillsets and neuropsychological performance in older adults to explore the use of life-long occupational demands as a possible biopsychosocial contributor to cognitive reserve. We hypothesized that individuals' whose careers emphasized verbal skillsets would predict higher cognitive performance as compared to other occupations that emphasized visuospatial, learning and memory, or executive functioning/processing speed abilities. Method: A sample of 182 participants (79 male, 103 female; M_age = 75.75, SD = 10.72) completed full neuropsychological evaluations, with cognitive performance broken down into four domains: verbal, learning and memory, visuospatial, and executive functioning/processing speed. Their reported careers were coded based on variables provided by O*NET (U.S. Department of Labor). A series of hierarchical linear regressions were used to examine if participants with higher verbal occupational skills performed better on neuropsychological testing, above and beyond well-established predictors of age, education, and gender. Results: Those who had careers with higher verbal skillsets showed better performance in verbal (r = .15) and executive functioning/processing speed (r = .18) domains over and above the robust effect of education. Other job skills (e.g. visuospatial skills, learning, and memory) did not relate. Conclusion: Our results support the potential contribution of specific occupational skillsets to cognitive reserve, especially occupations high in verbal demands. Discussion focuses on limits of the study to investigate directionality of verbal job skills and cognitive functioning, and the potentially confounding role of IQ-a critical agenda for future research requiring a longitudinal design-as well as potential implications for preservation of cognitive functioning.

Objective: Type 2 diabetes mellitus (T2DM) is associated with cognitive decline, but its impact on social cognition remains poorly understood. This study investigated whether individuals with T2DM exhibit impairments in facial emotion recognition and empathy for pain, two domains crucial for daily interpersonal functioning that are often overlooked in neuropsychological assessments. Method: Seventy-six participants (37 with T2DM and 39 matched healthy controls) completed two validated social cognition tasks: a dynamic Facial Emotion Morphing Test and an empathy-for-pain task involving 25 animated scenarios (intentional, accidental, and neutral harm). Groups were matched for age, sex, and education. Analyses of covariance were conducted using Montreal Cognitive Assessment (MoCA) scores as covariates to control for global cognitive status. Results: Compared to controls, individuals with T2DM showed significantly lower overall emotion recognition accuracy (η_p² = 0.10) and fear recognition accuracy (η_p² = 0.06). In the empathy-for-pain task, they exhibited reduced intentionality comprehension (η_p² = 0.05, d = 0.73), increased attribution of harmful intent (η_p² = 0.05, d = -0.60), and harsher punishment judgments (η_p² = 0.08). These effects were of medium magnitude and were not explained by demographic, cognitive, or clinical factors. Conclusions: T2DM is associated with selective impairments in social cognition, even in the absence of global cognitive decline. These findings underscore the clinical utility of assessing social cognition in patients with T2DM, as such deficits may compromise interpersonal functioning and quality of life. Incorporating ecologically valid social cognition measures into neuropsychological evaluations may support early detection of brain dysfunction in metabolic conditions and inform interventions aimed at preserving social cognitive health.

Objective: Vestibular dysfunction is common following mild-to-moderate traumatic brain injury (TBI) and impacts quality of life. However, little is known regarding the persistence and stability of vestibular symptoms over time and their effects on cognition. This study examined self-reported vestibular symptoms 1 to 2 years following mild-to-moderate TBI in a Military/Veteran cohort. We further evaluated the association of vestibular symptoms with 5-year post-TBI cognitive outcomes. Method: Military service members and Veterans enrolled in the VA TBI Model Systems (TBIMS) completed follow-up interviews at 1-, 2-, and 5-years post-TBI, with valid symptom and performance validity. Study 1 examined vestibular symptom change from 1 to 2 years with the Neurobehavioral Symptom Inventory (N = 76). Study 2 examined the association between year 2 vestibular symptoms and year 5 cognitive performance on Brief Test of Adult Cognition by Telephone (BTACT), controlling for demographics, posttraumatic amnesia duration, and mood symptoms (N = 67). Results: Vestibular symptoms were stable between 1- and 2-year follow-up (88% with no reliable change, 63% with disruptive vestibular symptoms at both time points). Year 2 vestibular symptoms did not predict year 5 BTACT Verbal Memory or Executive Function composites after controlling for covariates. Older age and greater depression symptoms predicted worse executive function. Conclusions: Although vestibular symptoms did not predict cognitive performance, we describe chronic disruptive vestibular symptoms and mood effects on executive functioning for years following mild-to-moderate TBI. Despite study limitations, large effect size differences between TBI-severity groups warrants further exploration to potentially mitigate influence of persistent vestibular symptoms on health outcomes.

Objective: This study compared and contrasted the various achievement-based scoring systems-guidelines assessing accuracy and placement of details-and process-based scoring systems-those which assess organization and drawing approach-for the copy trial of the Rey-Osterrieth Complex Figure Test. Method: A sample of 90 US military veterans referred for outpatient evaluation in a general dementia clinic (age M = 73.0, SD = 6.7) was administered the complex figure as well as other neuropsychological measures of visuospatial, executive functioning, and memory skills. Results: Many scoring systems possessed comparably good properties. When clinical effectiveness and efficiency of use were taken into consideration, the achievement scoring guidelines by Loring et al. and process scoring guidelines by Bylsma performed strongly. Conclusions: Both achievement and process scores contributed uniquely to the clinical interpretation of the Rey-Osterrieth Complex Figure in a dementia clinic setting, and both relate to each clinical domain to some degree. Some simpler scoring approaches had psychometric and clinical characteristics that were comparable to or better than the most complex methods.

Introduction: This study expanded on prior literature by evaluating the classification accuracy of an embedded symptom validity test (SVT) within the PTSD Checklist for the DSM-5 (PCL-5), the PCL-5 Symptom Severity (PSS) SVT, in a civilian population referred for outpatient neuropsychological evaluation due to attention complaints. Moreover, this study examined the effect of elevated risk for posttraumatic stress, as defined by ≥4 adverse childhood events (ACEs), on optimal cutoffs. Methods: 496 adult patients evaluated at an academic medical center were included. Several criterion groupings (i.e. valid, possible overreporting 1/2/3 elevations, definite overreporting), were created using the five Minnesota Multiphasic Personality Inventory-2-Restructured Form/Multiphasic Personality Inventory-3 overreporting validity scales. The valid group was further divided into high (≥4 ACEs) or low (<4 ACEs) prior risk for posttraumatic stress. Receiver operating characteristic analyses determined classification accuracy across groups. Results: The PSS reached adequate classification accuracy in all groupings. Regardless of possible versus definite classification, a cutoff of ≥39 was optimal. However, in those with more trauma exposure and higher risk for PTSD (i.e. high-ACEs), a higher cutoff of ≥41 was needed, while a lower cutoff of ≥34 was needed for the low-risk group. Finally, supplemental analysis comparing definite to possible symptom overreporting further increased the cutoff to ≥55. Conclusions: This study extended the use of the PSS to broader civilian populations. However, the current variability of cutoffs with prior literature examining veteran samples suggests the need to replicate in samples with high base rates of PTSD.