Clinical Neuropsychologist最新文献

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.

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.