Clinical Neuropsychologist最新文献

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.

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: 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.