Clinical Neuropsychologist最新文献

Objective: Computerized assessment of cognitive functioning has gained significant popularity over recent years, yet options for clinical assessment of executive functioning (EF) are lacking. One computerized testing platform, CNS Vital Signs (CNS-VS), offers tests designed to measure EF but requires further validation. The goal of the present study was to validate CNS-VS executive scores against standard clinical measures of EF. We also sought to determine whether a modified CNS-VS composite score that included variables purported to measure inhibition, switching, and working memory would outperform the currently available CNS-VS Executive Function Index. Method: A sample of 73 cognitively healthy older adults completed four tests from the Delis-Kaplan Executive Function System, the Digit Span subtest from the Wechsler Adult Intelligence Scale-fourth edition, and three CNS-VS tasks purported to measure inhibition, switching, and working memory. Results: Performances on the CNS-VS tests were predicted by performances on standard paper-and-pencil measures. Although the currently available CNS-VS Executive Function Index predicted unique variance in a well-validated paper-and-pencil EF composite score, our Modified CNS-VS EF composite accounted for unique variance above and beyond the original CNS-VS Executive Function Index, while the reverse was not true. Conclusions: The present results support the construct validity of CNS-VS EF tests but also suggest that modifications to their current composite scores would improve the prediction of EF performance.

Objective: Diagnosis coding is a core clinical competency. A basic understanding of the structure of the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), the conventions and rules for diagnosis coding, and what constitutes accurate coding, is fundamental to the clinician's knowledge base. This commentary seeks to provide a practical framework for clinicians to perform accurate diagnosis coding of neurocognitive disorders. Method: This paper: (1) summarizes the structure of the ICD-10-CM, (2) describes the rules and conventions of diagnosis coding for diagnostic categories relevant to neurocognitive disorders, (3) presents clinical examples and pragmatic recommendations to help readers improve their day-to-day use of diagnosis codes, and (4) describes limitations and discrepancies in the diagnosis coding advice for neurocognitive disorders presented within the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) and the DSM-5-TR Neurocognitive Disorders Supplement. Its content originates from the ICD-10-CM itself and its companion document, the ICD-10-CM Official Guidelines for Coding and Reporting. Conclusion: The ICD-10-CM classification scheme is logically organized and easy to navigate for users who understand its structure and rules. Many neuropsychologists rely on the DSM-5-TR diagnosis coding advice, however that advice is limited with respect to the range of diagnosis codes relevant to neurocognitive disorders and their underlying causes. Relying on the ICD-10-CM directly for diagnosis coding of neurocognitive disorders, rather than the DSM-5-TR or other secondary sources, is therefore preferable and aids clinicians in accurate diagnosis coding.

Objective: Research demonstrates that college educated, English language dominant bilinguals underperform relative to English speaking monolinguals on tests of verbal ability. We investigated whether accepting responses in their two languages would reveal improved performance in bilinguals, and whether such improvement would be of sufficient magnitude to demonstrate the same performance level as monolinguals. Method: Participants were college students attending the same university. Spanish-English bilinguals were compared to English speaking monolinguals on the Bilingual Verbal Ability Tests (BVAT), which include Picture Vocabulary, Oral Vocabulary, and Verbal Analogies. Results: When given the opportunity to respond in Spanish to items failed in English, bilinguals obtained significantly higher scores on all three subtests, and their performance matched that of monolinguals on Oral Vocabulary and Verbal Analogies. Conclusion: An "either-language" scoring approach may enable optimal measurement of verbal abilities in bilinguals. We provide normative data for use in applying the either-language scoring approach on subtests of the BVAT. We discuss the findings in the context of clinical assessment.

Objective: To investigate the risk of impairment in cognitive instrumental activities of daily living (IADL) for people with Parkinson's (PwP) identifying as sexual and/or gender minorities (SGM). Method: Data were obtained from Fox Insight, an online, longitudinal study with self/informant-report questionnaires from PwP and people without Parkinson's. Groups consisted of PwP without cognitive IADL impairment at baseline, identifying as (1) SGM with female sex assigned at birth (SGM-F, n = 75); (2) cisgender, heterosexual with female sex assigned at birth (CH-F, n = 2046); (3) SGM with male sex assigned at birth (SGM-M, n = 84); (4) cisgender, heterosexual with male sex assigned at birth (CH-M, n = 2056). Impairment in cognitive IADL was based on Penn Parkinson's Daily Activities Questionnaire-15 (PDAQ-15). Group differences for PDAQ-15 and impairment likelihood during follow-up were assessed with unadjusted models and adjusting for variables that differed between the groups. Results: SGM-F were the youngest at Parkinson's diagnosis; SGM-M had the lowest PDAQ-15 at baseline (p ≤ .014 for all). Scores declined more for males than females in unadjusted and adjusted models (p < .001 for both). In unadjusted models, SGM-M had a higher impairment risk than PwP identifying as cisgender and heterosexual (p ≤ .018). In adjusted models, females had a lower impairment risk than males (p < .001). Age, education, and discrimination level were significant moderators (p < .001 for all). Conclusions: SGM-M can be at a higher risk for impairment in cognitive IADL, associated with social determinants. Female sex assigned at birth may be associated with a lower level of impairment risk, although this advantage can disappear with social determinants.

Objective: Our study aimed to explore whether physical condition might affect the association between genetic predisposition for Alzheimer's Disease (AD) and AD incidence. Methods: The sample of participants consisted of 561 community-dwelling adults over 64 years old, without baseline dementia (508 cognitively normal and 53 with mild cognitive impairment), deriving from the HELIAD, an ongoing longitudinal study with follow-up evaluations every 3 years. Physical condition was assessed at baseline through walking time (WT), while a Polygenic Risk Score for late onset AD (PRS-AD) was used to estimate genetic predisposition. The association between WT and PRS-AD with AD incidence was evaluated with Cox proportional hazard models adjusted for age, sex, education years, global cognition score and APOE ε-4 genotype. Then, the association between WT and AD incidence was investigated after stratifying participants by low and high PRS-AD. Finally, we examined the association between PRS-AD and AD incidence after stratifying participants by WT. Results: Both WT and PRS-AD were connected with increased AD incidence (p < 0.05), after adjustments. In stratified analyses, in the slow WT group participants with a greater genetic risk had a 2.5-fold higher risk of developing AD compared to participants with lower genetic risk (p = 0.047). No association was observed in the fast WT group or when participants were stratified based on PRS-AD. Conclusions: Genetic predisposition for AD is more closely related to AD incidence in the group of older adults with slow WT. Hence, physical condition might be a modifier in the relationship of genetic predisposition with AD incidence.

Introduction: In February 2023, a work group began to develop a new North American organization in neuropsychology to represent and support practicum-training sites. While other training-focused organizations such as the Association of Postdoctoral Programs in Clinical Neuropsychology (APPCN) and the Association of Internship Training in Clinical Neuropsychology (AITCN) have existed for many years, no organization exists to promote and support practicum level training outside of doctoral degree programs. The work group developed such an organization, subsequently named the North American Association of Practicum Sites in Neuropsychology (NAPSN), beginning with a mission statement and general purpose of the organization. Methods: The work group divided members into five task forces focused on various tasks needed to start the organization, including Mission/Vision, Administrative Structure, Membership, Financials, and Bylaws. The entire work group met monthly with additional meetings and work via email for the various task forces, which resulted in the development of a mission statement and bylaws, as well as a framework for program administration, membership requirements and financial needs. Conclusions: The group developed NAPSN primarily as a resource to support diverse practicum programs in urban, suburban, and rural areas in the US and Canada to provide optimal graduate level clinical training in neuropsychology. Didactics aimed specifically at practicum students was one need identified early in the process. NAPSN is developing a website-based resource in collaboration with other training organizations to increase the didactic offerings to practicum students. Other initiatives and collaborative efforts will be undertaken over time as circumstances warrant.

Objective: Cognitive impairment is experienced by 40-70% of multiple sclerosis patients, with information processing speed and memory most affected. Until now, cognitive results classified patients as impaired and not impaired. With this dichotomous approach, it is difficult to identify, in a heterogeneous group of patients with cognitive impairment, which cognitive domain(s) are most altered. This study aims to identify cognitive phenotypes in a clinical cohort of adult patients with Relapsing-Remitting Multiple Sclerosis (RRMS) using the International Classification of Cognitive Disorders in MS (IC-CoDiMS) and to characterize their clinical features. Methods: Three hundred patients with RRMS underwent neuropsychological assessment with the Brief Repeatable Battery of Neuropsychological Tests (BRBN-T) and the Brief International Cognitive Multiple Sclerosis (BICAMS). Results: In our cohort, the mean age was 41.38 [11.48 SD] years, and 205 [68.3%] were women. At the -1 SD threshold, 49% were cognitively intact, 25% had uni-domain impairment, 17% had bi-domain impairment, and 9% had multi-domain impairment. Processing speed was the most frequent single-domain impairment, followed by memory and verbal fluency. At the -1.5 SD threshold, 74.7% were cognitively intact, 17% had uni-domain impairment, 6% had bi-domain impairment, had bi-domain impairment, and 3.0% had multi-domain impairment. Memory was the most frequent single-domain impairment, followed by processing speed and verbal fluency. Conclusions: This study corroborates the importance of determining cognitive phenotypes through taxonomy (IC-CoDiMS). In addition, it contributes to improving the classification of cognitive phenotypes in patients with RRMS to enhance the development of more effective treatments and cognitive interventions.

Objective: Despite the prevalence of socio-cognitive disturbances, and their important diagnostic/therapeutic implications, the assessment of these disturbances remains scarce. This systematic review aims to identify available social cognition tools for adult assessment that use multimodal and/or dynamic social cues, specifying their strengths and limitations (e.g. from a methodological, psychometric, ecological, and clinical perspective). Method: An electronic search was conducted in Pubmed, PsychINFO, Embase and Scopus databases for articles published up to the 3^th of January 2023 and the first 200 Google Scholar results on the same date. The PRISMA methodology was applied, 3884 studies were screened based on title and abstract and 329 full texts were screened. Articles using pseudo-dynamic methodologies (e.g. morphing), reported only subjective or self-reported measures, or investigated only physiological or brain activity responses were excluded. Results: In total, 149 works were included in this review, representing 65 assessment tools (i.e. 48% studying emotion recognition (n = 31), 32% Theory of Mind (n = 21), 5% empathy (n = 3), 1.5% moral cognition/social reasoning (n = 1), and 14% being multimodal (n = 9)). For each study, the tool's main characteristics, psychometric properties, ecological validity indicators and available norms are reported. The tools are presented according to social-cognitive process assessed and communication channels used. Conclusions: This study highlights the lack of validated and standardized tools. A few tools appear to partially meet some clinical needs. The development of methodologies using a first-person paradigm and taking into account the multidimensional nature of social cognition seems a relevant research endeavour for greater ecological validity.

Objective: We examined work relative value units (wRVUs) and associated revenue of current procedural terminology (CPT) codes for evaluation and management (E&M) services, neuropsychological evaluation (NPE), psychological evaluation (PE), and psychotherapy. Method: CPT code wRVUs were aggregated for E&M (99202-99215), NPE (96116, 96132, 96133, 96136, and 96137), PE (90791, 96130, 96131, 96136, and 96137), and psychotherapy (90791 and 90832-90837 with and without the complexity modifier, 90785). Per minute wRVUs were calculated for each CPT code. The Centers for Medicare and Medicaid Services 2023 conversion factor ($33.8872) was multiplied by wRVUs to examine reimbursement per hour and per prototypical four-hour clinic slot. Results: The wRVUs per minute showed the following ranges: 0.032-0.07 for E&M services, 0.015-0.063 for NPE, 0.015-0.124 for PE, and 0.043-0.135 for psychotherapy. Average hourly revenue ranged from $72 for NPE to $132 for psychotherapy with the complexity modifier. Revenue for prototypical four-hour clinics ranged from $283 for NPE to $493 for psychotherapy with the complexity modifier. PE and psychotherapy services were valued at 124-184% of NPE. Conclusions: E&M code wRVUs increase with case complexity reflecting greater work intensity, and a modifier to PE and psychotherapy captures additional effort needed in complex cases. In contrast, NPE codes lack a complexity modifier, and NPE wRVUs are lower than those of PE and psychotherapy, the latter of which can be billed by master's level providers. NPE is undervalued compared to PE and psychotherapy based on wRVUs currently assigned to the CPT codes used for the respective services.

Objective: Adults with type 1 diabetes (T1D) face an increased risk for cognitive decline and dementia. Diabetes-related and vascular risk factors have been linked to cognitive decline using detailed neuropsychological testing; however, it is unclear if cognitive screening batteries can detect cognitive changes associated with aging in T1D. Method: 1,049 participants with T1D (median age 59 years; range 43-74) from the Diabetes Control and Complications Trial (DCCT), and the follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) study, completed the NIH Toolbox Cognition Battery (NIHTB-C) and Montreal Cognitive Assessment (MoCA). Neuropsychological assessments, depression, glycated hemoglobin levels (HbA1c), severe hypoglycemia, T1D complications, and vascular risk factors were assessed repeatedly over 32 years to determine associations with current NIHTB-C performance. Available cognitive data was clinically adjudicated to determine cognitive impairment status. Results: NIHTB-C scores had moderate associations (r = 0.36-0.53) with concurrently administered neuropsychological tests. In multivariate models, prior severe hypoglycemic episodes, depression symptoms, nephropathy, lower BMI, and higher HbA1c and LDL cholesterol were associated with poorer NIHTB-C Fluid Cognition Composite scores. The NIHTB-C adequately detected adjudicated cognitive impairment (Area Under the Curve = 0.86; optimal cut score ≤90). The MoCA performed similarly (Area Under the Curve = 0.83; optimal cut score ≤25). Conclusions: The NIHTB-C is sensitive to the cognitive effects of diabetes-related and vascular risk factors, correlated with neuropsychological testing, and accurately detects adjudicated cognitive impairment. These data support its use as a screening test in middle to older aged adults with T1D to determine if referral for detailed neuropsychological assessment is needed.