Clinical Neuropsychologist最新文献

Objective: We provide a case report, narrative literature review, and clinical guidance addressing the complexities of differential diagnosis of psychosis among young adults who present for neuropsychological evaluation. We highlight the potential for misdiagnosis of Huntington's Disease (HD) as schizophrenia or other neuropsychiatric conditions and describe implications for clinical neuropsychology practice. Method: We present the case of a 31-year-old male with eighth grade education initially diagnosed with schizophrenia who was ultimately found to have HD of probable juvenile onset via genetic testing following a neuropsychological evaluation. Family history of HD was not known to the patient until his late 20s due to being raised in an adoptive setting. Results: The patient had a history of apathy, anxiety, aggression, and academic challenges in childhood, with increasing need for assistance with activities of daily living and recent-onset gait instability, dysarthria, dysphagia, auditory hallucinations, compulsive behaviors, and depressive symptoms. Neuropsychological evaluation revealed difficulties with attention and set shifting, ideational dyspraxia, variable memory performance, slowed processing speed, blunted affect and impaired affect perception, shuffling unstable gait with reduced arm swing, and a subcortical pattern on language testing. Illness onset and course, neurocognitive, neuropsychiatric, and motor symptomatology, and genetic findings were suggestive of juvenile onset HD (JHD). Conclusions: This case exemplifies the complexities involved in diagnosing HD in young adults who present with neuropsychiatric symptoms. Valuable insights into the neuropsychological and neuropsychiatric profile of young adults with HD are shared, and clinical guidance regarding differential diagnosis is provided with an emphasis on HD and schizophrenia.

Objective: This study aimed to enhance the psychometric robustness and normative utility of the Italian Face-Name Association Test (ItFNAT), designed to assess cross-modal associative memory, by validating three parallel versions and introducing scores adjusting formula and equivalent scores (ESs) for clinical application. Method: A total of 286 cognitively healthy Italian adults (ages 20-89) completed one of three equivalent ItFNAT versions, evaluating Immediate Recall (IRs), Delayed Free Recall (DFRs) and Delayed Total Recall (DTRs). Four derived indices were also computed. Internal consistency, test-retest reliability, principal component analysis (PCA), and regression-based demographic adjustments were performed. Convergent validity was examined using the Montreal Cognitive Assessment (MoCA). Results: All three versions showed strong psychometric performance, with high internal consistency and robust test-retest reliability. PCA confirmed a stable one-factor structure. Significant correlations with MoCA supported convergent validity. Regression models identified age (linear or transformed) as the only consistent predictor across all scores. Accordingly, adjustment spreadsheet and ES were developed. Derived indices revealed age-related shifts in memory strategies and error types, suggesting their clinical interpretability. Conclusions: The ItFNAT is a reliable and valid tool for assessing associative memory in Italian adults. Its three parallel forms and corrected norms support its clinical and research use, particularly for repeated assessments and early detection of memory impairment in neurodegenerative disorders.

Objective: Intra-individual variability (IIV) is an emerging marker of cognitive weakness and incipient decline. However, much of the IIV literature does not distinguish between the two IIV subtypes, inconsistency and dispersion, which may be distinct constructs that are differentially sensitive to neurocognitive decline. Little investigation comparing these subtypes has occurred, and the existing literature utilizes a range of methodological approaches, which may obfuscate patterns across studies. The present scoping review focuses on literature investigating inconsistency and dispersion in preclinical/subjective cognitive decline (P/SCD), mild cognitive impairment (MCI), and dementia to (1) characterize current methodological approaches and (2) explore whether inconsistency and dispersion are predictive of diagnostic conversion and can discriminate between diagnostic groups along the neurodegenerative spectrum.

Method: A scoping review was conducted using PsycInfo and PubMed to identify empirical studies published in peer-reviewed journals that examined differences between diagnostic groups or longitudinal diagnostic conversion using inconsistency or dispersion.

Results: Fifty-seven studies were identified (34 inconsistency, 25 dispersion, with two studies including both subtypes). A wide range of methodological approaches was observed. Group differences in both inconsistency and dispersion were identified along the neurodegenerative spectrum. Inconsistency had most studies with group differences at earlier stages of decline, whereas the evidence for dispersion is relatively equally spread across groups.

Conclusions: Evidence suggests that both forms of IIV yield differences between cognitive groups, but there are substantial differences in study methodologies that may affect results. Several gaps in the literature must be the focus of future research before these patterns can be confirmed.

Objective: Meaningful differences exist in billing and work productivity, as measured using wRVU, associated with psychological intervention versus assessment services. This paper focuses on billing for work completed by psychology trainees and how those services differentially impact supervisors' productivity indicators, potentially threatening the future of psychological and neuropsychological assessment. We provide suggestions on how to address this and related issues affecting supervising neuropsychologists. Methods: A review was performed of the limited literature pertaining to billing practices for psychological services conducted by various levels of trainees. Resources pertaining to productivity associated with trainee services under supervising physicians were also reviewed. Conclusions: Psychotherapy and other psychological intervention services enable supervising psychologists to use "incident to" or supervisory billing, which can confer productivity to the supervisor. In contrast, this is not allowable for most aspects of trainee involvement in neuropsychological evaluation, except when the supervisor is physically present. No clear rationale was uncovered for this striking difference. We propose a call to action for members of our national organizations to advocate for better representation of neuropsychologists' services, with the goal of obtaining parity with our clinical psychologist colleagues in terms of work productivity for supervising trainees.

Objective: This study aimed to evaluate the clinical implications, limitations, and potential risks of lecanemab treatment for posterior cortical atrophy (PCA) by conducting a comparative analysis of two cases.

Method: We retrospectively analyzed two patients with biomarker-confirmed PCA-pure who met the eligibility criteria for lecanemab. Clinical history, neuropsychological profiles, imaging findings, and treatment outcomes for more than 1 year were comprehensively reviewed.

Results: At treatment initiation, Patients 1 and 2 were one year post-onset and five years post-onset, respectively, with comparable baseline Mini-Mental State Examination (25-26) and Clinical Dementia Rating (0.5) scores. Patient 1, who exhibited prominent agraphia with left-dominant parieto-occipital atrophy, began lecanemab early and maintained stable daily functioning despite a gradual decline in reading, figure copying, and visual cancelation tasks. Patient 2, with right-dominant posterior atrophy and more severe visuospatial deficits, including simultanagnosia and prosopagnosia, developed parkinsonism and hallucinations after treatment initiation, followed by rapid functional decline, possibly due to mixed pathology, ultimately leading to treatment discontinuation. Patient 1 reported high treatment satisfaction, whereas Patient 2 expressed regret.

Conclusion: These cases raise concerns regarding the direct application of treatment eligibility criteria developed for typical Alzheimer's disease to PCA. Clinical decision-making in PCA requires visual cognition-specific assessments that are less vulnerable to floor effects and tailored to phenotypic heterogeneity and hemispheric lateralization. Coexisting pathologies may influence the treatment response and complicate the interpretation of outcomes. A tailored, multimodal approach that integrates longitudinal neuropsychological assessments with advanced imaging is essential to ensure appropriate use of disease-modifying therapies for PCA.

Objective: Cognitive dispersion (CD) or neuropsychological test score variability has been associated with more rapid cognitive decline, and the development of mild cognitive impairment (MCI) and Alzheimer's disease (AD). The predictive utility of global (cross-domain) versus domain-specific dispersion remains understudied. We examined whether baseline global versus domain-specific CD better predicted conversion to MCI or dementia over time.

Methods: 1,595 participants (Mage = 71.41, SD = 7.73) from the National Alzheimer's Coordinating Center (NACC) dataset were followed for ≥4 visits. Baseline CD was calculated using standardized neuropsychological test scores, with global dispersion defined as the intraindividual standard deviation (ISD) across 10 NACC scores. Domain-specific dispersion was calculated by constructing composites with ISD across tests within three domains (Memory, Language, and Executive functioning/attention/processing speed [EFAS]). Multinomial logistic regression model fit statistics were compared across four dispersion models (global, EFAS, language, memory) in predicting progression to MCI and dementia in (1) the full non-dementia sample and (2) those cognitively normal at baseline only, controlling for demographics, APOE4 status, and MMSE. Model fit was evaluated using LRT and AIC. Follow-up hierarchical regressions assessed the incremental value of the most successful dispersion metric beyond mean EFAS and memory composite scores.

Results: In the full sample, 25% were considered to have MCI at follow-up, and 20% developed dementia, whereas among those considered cognitively normal at baseline (n = 1166), 17.6% progressed to MCI, and 11% progressed to dementia in their follow-up. In the overall sample, global dispersion was the only significant predictor of dementia diagnosis (AIC = 2504.27, p < .001) with moderate classification accuracy: 62.6%. Adding global dispersion to a model with covariates + mean EFAS and memory composite performances did not improve prediction (Δχ² = 1.803, p = .179). Among cognitively normal at baseline, only EFAS dispersion predicted dementia conversion, and classification accuracy remained moderate, though it was increased (71.7%). Adding EFAS dispersion to a model with covariates and mean composite performance also did not improve prediction (Δχ² = .614, p = .433). None of the dispersion metrics predicted conversion to MCI.

Conclusions: Dispersion (global in a non-dementia sample or domain-specific [EFAS] among cognitively asymptomatic individuals) may show limited predictive value for dementia conversion, but it does not exceed traditional mean-based cognitive performance, highlighting its complementary, rather than superior, role in diagnostic prediction.

Objective: The Houston Conference Policy Statement established an integrated model of training for clinical neuropsychologists and has been widely implemented. However, developments and needs related to professional competencies, cultural/linguistic diversity, and technology prompted the need to update training guidelines. In 2021, an interorganizational Planning Commission (PC), with Commissioners from 17 organizations within clinical neuropsychology, was formed to develop a process by which training guidelines would be comprehensively updated via the Minnesota 2022 Conference to Update Educational and Training Guidelines in Clinical Neuropsychology, held 12-16 September 2022.

Method: The PC met virtually from June 2021 through August 2022, and responsibilities included conference site selection, fundraising, Delegate selection, and conference goals, schedule, and policies. The PC also defined the roles and responsibilities for the conference and subsequent activities among the Delegates, Steering Committee, and Content Panels.

Conclusion: The PC set the stage for the participants of the Minnesota Conference to undertake a generational updating of training guidelines. The 25 years since the Houston Conference and the long process of completing the Minnesota guidelines underscore the need to update training guidelines with greater frequency.

Objective: Oppositional defiant disorder (ODD) frequently co-occurs with attention-deficit/hyperactivity disorder (ADHD) and may impact sex differences in clinical and executive function (EF) phenotypes of ADHD. This study examines whether clinical symptoms and "hot" and "cold" EF task performance differs among children with ADHD with and without ODD relative to typically developing (TD) children. Method: Participants included 372 8-12-year-old children: 158 with ADHD without ODD (28% girls), 74 with ADHD + ODD (28% girls), and 140 TD (34% girls). Parent- and self-report questionnaires assessing ADHD symptoms, externalizing and internalizing problems, emotional lability, and irritability were obtained. Children completed delay discounting, go/no-go (GNG), and spatial span tasks to assess hot and cold EF. Results: Relative to same-sex children with ADHD, girls with ADHD + ODD showed higher inattention symptoms, whereas boys with ADHD + ODD showed higher hyperactive/impulsive symptoms. Emotional lability and irritability were higher in children with ADHD + ODD than ADHD, regardless of sex. For EF tasks, greater delay discounting was observed in girls with ADHD + ODD compared to TD girls, whereas boys with ADHD only showed poorer visual-spatial working memory compared to boys with ADHD + ODD. Boys and girls with ADHD (regardless of ODD) showed higher GNG reaction time variability than TD children, whereas only boys with ADHD (regardless of ODD) made more inhibition errors than TD boys. Conclusions: While symptom measures consistently differentiated ADHD from ADHD + ODD groups regardless of sex, hot and cool EF differences varied across measures and by sex, demonstrating their value in understanding sex differences in youth with ADHD with and without co-occurring ODD.

Objective: This manuscript provides a comprehensive overview of the Minnesota 2022 Conference to Update Education and Training Guidelines in Clinical Neuropsychology (MNC), detailing its development, structure, and outcomes. It outlines the preparatory activities undertaken by Delegates, the defined roles of participants-including the Steering Committee, Content Panelists, Delegates, Observers, and Volunteers-and the extensive logistical planning that supported the event. The manuscript reviews the conference's multi-day agenda, which combined plenary sessions, breakout groups, and synthesis meetings to develop a draft to the MNC updated guidelines.

Method: Conference planning documents, meeting notes, internal communications, and delegate materials were reviewed to provide a detailed overview of the MNC. This included review of participant roles, the multi-day agenda, and the processes used to draft the updated training guidelines. Post-conference activities, such as revisions and dissemination efforts, were also reviewed.

Conclusion: Key outcomes, both during and after the conference, are described, highlighting the collaborative process and the resulting training document. Finally, the manuscript discusses post-conference activities aimed at finalizing and publishing the MNC Training Guidelines.

Objective: To examine the interaction between early cognition and motor functioning when predicting functional independence, community participation, homeboundness, and return-to-work 1 year after traumatic brain injury (TBI). Method: Data from 101 adults (M age = 39.6 years) across two TBI Model Systems sites. Cognitive performance (Brief Test of Adult Cognition by Telephone) and motor functioning (FIM-Motor score/Continuity Assessment Record and Evaluation) were collected at inpatient rehabilitation discharge. Functional independence (Glasgow Outcome Scale-Extended, GOS-E), community participation (Participation Assessment with Recombined Tools-Objective-17, PART-O-17), homeboundness, and return-to-work were collected at 12-month follow-up. Motor functioning was hypothesized to moderate the relationship between cognition and 1-year outcomes. Results: Using multiple regression, early cognitive performance significantly predicted community participation, whereas motor functioning significantly predicted functional independence. Surprisingly, neither cognition nor motor functioning significantly predicted later employment or homeboundness. Rehabilitation length of stay and higher income were the only relevant predictors of return to work. The interaction between cognition and motor functioning did not meaningfully contribute to predicting outcomes at 1 year post-injury. Conclusions: Cognition and motor functioning offer distinct and independent contributions to rehabilitation outcomes among people with TBI. These findings underscore the importance of interventions that address post-TBI cognitive impairments as an avenue to improve participation after TBI. Critically, this study demonstrates that such interventions may be equally important for people with TBI across varying levels of motor functioning. Future studies should examine the impact of outpatient rehabilitation interventions on the predictive relationship between early cognition and post-TBI functional outcomes.