Clinical Neuropsychologist最新文献

Objective: Chronic Traumatic Encephalopathy (CTE) has received significant media coverage as a major health concern for collision sport athletes and combat veterans. This survey study investigated neuropsychologists' perspectives of CTE.Methods: Neuropsychologists (N = 325) were contacted via electronic advertisement posted to popular neuropsychology professional listservs and completed a survey regarding their perspectives of: the proposed sequelae of repeated concussions, the strength of the CTE research base, and its media coverage.Results: Most respondents (91%) were at least somewhat familiar with the concept of CTE. Moderate uncertainty was reported (i.e. up to 30%) regarding the effects of repeated concussions. Most felt the research in support of CTE was unreliable (80%) and weak regarding claims that repeated concussions cause CTE (91%), independently cause behavioral/emotional/cognitive dysfunction (86%), or increase the risk for neurodegeneration (79%). Respondents agreed patients are concerned about CTE (92%), concerns are influenced by the media (96%) that presents a biased/alarmist view of CTE (96%), and patient recovery is influenced by their CTE beliefs (82%).Conclusions: There was strong agreement that the media presents an alarmist/biased view of CTE that influences patients concerns and outcomes following concussion. This presentation is incongruent with the perceptions of surveyed neuropsychologists who find the research in support of CTE to be weak and unreliable. More research is needed to determine the potential effects of repeated (sub)concussive events. As public knowledge will continue to be influenced by the media and health care professionals, future research should explore CTE perceptions across other health care disciplines.

Objective: The long-term health of former athletes with a history of multiple concussions and/or repetitive head impact (RHI) exposure has been of growing interest among the public. The true proportion of dementia cases attributable to neurotrauma and the neurobehavioral profile/sequelae of multiple concussion and RHI exposure among athletes has been difficult to determine. Methods: Across three exposure paradigms (i.e. group comparisons of athletes vs. controls, number of prior concussions, and level of RHI exposure), this review characterizes the prevalence of neurodegenerative/neurological disease, changes in cognitive and psychiatric function, and alterations on neuroimaging. We highlight sources of variability across studies and provide suggested directions for future investigations. Results: The most robust finding reported in the literature suggests a higher level of symptom endorsement (general, psychiatric, and cognitive) among those with a greater history of sport-related concussion from adolescence to older adulthood. Pathological processes (e.g. atrophy, tau deposition, and hypometabolism) may be more likely to occur within select regions (frontal and temporal cortices) and structures (thalamus and hippocampus). However, studies examining concussion(s) and RHI exposure with imaging outcomes have yet to identify consistent associations or evidence of a dose-response relationship or a threshold at which associations are observed. Discussion: Studies have not observed a simple dose-response relationship between multiple concussions and/or RHI exposure with cognitive, psychiatric, or in vivo neurobiological outcomes, particularly at lower levels of play. The relationship between prior concussion and RHI exposure with long-term outcomes in former athletes is complex and likely influenced by -several non-injury-related factors.

Objective: The purpose of this review is to summarize the long-term cognitive, psychological, fluid biomarker, and neuroimaging outcomes following repetitive concussive and subconcussive blast exposures sustained through a military career. Method/Results: A review of the literature was conducted, with 450 manuscripts originally identified and 44 manuscripts ultimately included in the review. The most robust studies investigating how repetitive concussive and subconcussive exposures related to cognitive performance suggest there is no meaningful impact. Although there are minimal studies that suggest some small impacts on neuroimaging and fluid biomarkers, most findings have been in very small samples and fail to replicate. Both repetitive blast mTBI and subconcussive blasts appeared to be associated with increased self-reported symptoms. Many of the studies suffered from small sample size, failure to correct for multiple comparisons, and inappropriate control groups. Conclusions: Overall, there is little evidence to support that repetitive blast mTBIs or subconcussive blast exposures have a lasting impact on cognition, neuroimaging, or fluid biomarkers. In contrast, there does appear to be a relationship between these exposures and self-reported psychological functioning, though it is unclear what mechanism drives this relationship. Small sample size, lack of correction for multiple comparisons, limited control groups, lack of consideration of important covariates, limited diversity of samples, and lack of reliable and valid measures for assessment of blast exposure are major limitations restricting this research. Patients should be encouraged that while research is ongoing, there is little to currently suggest long-term cognitive or neurological damage following repetitive blast exposure.

Objective: The long-recognized association of brain injury with increased risk of dementia has undergone significant refinement and more detailed study in recent decades. Chronic traumatic encephalopathy (CTE) is a specific neurodegenerative tauopathy related to prior exposure to repetitive head impacts (RHI). We aim to contextualize CTE within a historical perspective and among emerging data which highlights the scientific and conceptual evolution of CTE-related research in parallel with the broader field of neurodegenerative disease and dementia.

Methods: We provide a narrative state-of-the-science update on CTE neuropathology, clinical manifestations, biomarkers, different types and patterns of head impact exposure relevant for CTE, and the complicated influence of neurodegenerative co-pathology on symptoms.

Conclusions: Now almost 20 years since the initial case report of CTE in a former American football player, the field of CTE continues evolving with increasing clarity but also several ongoing controversies. Our understanding of CTE neuropathology outpaces that of disease-specific clinical correlates or the development of in-vivo biomarkers. Diagnostic criteria for symptoms attributable to CTE are still being validated, but leveraging increasingly available biomarkers for other conditions like Alzheimer's disease may be helpful for informing the CTE differential diagnosis. As diagnostic refinement efforts advance, clinicians should provide care and/or referrals to providers best suited to treat an individual patient's clinical symptoms, many of which have evidence-based behavioral treatment options that are etiologically agnostic. Several ongoing research initiatives and the gradual accrual of gold standard clinico-pathological data will pay dividends for advancing the many existing gaps in the field of CTE.

Objective: The present study aimed to examine the impact of lifetime blast exposure (LBE) on neuropsychological functioning in service members and veterans (SMVs). Method: Participants were 282 SMVs, with and without history of traumatic brain injury (TBI), who were prospectively enrolled in a Defense and Veterans Brain Injury Center (DVBIC)-Traumatic Brain Injury Center of Excellence (TBICoE) Longitudinal TBI Study. A cross-sectional analysis of baseline data was conducted. LBE was based on two factors: Military Occupational Speciality (MOS) and SMV self-report. Participants were divided into three groups based on LBE: Blast Naive (n = 61), Blast + Low Risk MOS (n = 96), Blast + High Risk MOS (n = 125). Multivariate analysis of variance (MANOVA) was used to examine group differences on neurocognitive domains and the Minnesota Multiphasic Personality Inventory-2 Restructured Form. Results: There were no statistically significant differences in attention/working memory, processing speed, executive functioning, and memory (Fs < 1.75, ps > .1, η_p²s < .032) or in General Cognition (Fs < 0.95, ps > .3, η_p²s < .008). Prior to correction for covariates, lifetime blast exposure was related to Restructured Clinical (F(18,542) = 1.77, p = .026, η_p² = .055), Somatic/Cognitive (F(10,550) = 1.99, p = .033, η_p² = .035), and Externalizing Scales (F(8,552) = 2.17, p = .028, η_p² = .030); however, these relationships did not remain significant after correction for covariates (Fs < 1.53, ps > .145, η_p²s < .032). Conclusions: We did not find evidence of a relationship between LBE and neurocognitive performance or psychiatric symptoms. This stands in contrast to prior studies demonstrating an association between lifetime blast exposure and highly sensitive blood biomarkers and/or neuroimaging. Overall, findings suggest the neuropsychological impact of lifetime blast exposure is minimal in individuals remaining in or recently retired from military service.

Background: Exposure to repetitive head impacts (RHI), such as those experienced in American football, is linked to cognitive dysfunction later in life. Traumatic encephalopathy syndrome (TES) is a proposed clinical syndrome thought to be linked to neuropath-ology of chronic traumatic encephalopathy (CTE), a condition associated with RHI from football. Cognitive intra-individual variability (d-CIIV) measures test-score dispersion, indicating cognitive dysfunction. This study examined d-CIIV in former football players and its associations with TES diagnosis, RHI exposure, and DTI and CSF biomarkers. Methods: Data included 237 males (45-74 years) from DIAGNOSE CTE Research Project, including former professional and college football players (COL) (n = 173) and asymptomatic men without RHI or TBI (n = 55). Participants completed neuropsychological tests. TES diagnosis was based on 2021 NINDS TES criteria. Years of football play and a cumulative head impact index (CHII) measured RHI exposure. Lumipulse technology was used for CSF assays. DTI fractional anisotropy assessed white matter integrity. Coefficient of variation (CoV) measured d-CIIV. ANCOVA compared d-CIIV among groups (football versus control; TES-status). Pearson correlations and linear regressions tested associations between d-CIIV, RHI exposure, and CSF and DTI biomarkers. Results: Former professional players had higher d-CIIV than controls (F(7, 194) = 2.87, p = .007). d-CIIV was associated with TES diagnosis (F(8, 146) = 9.063, p < .001), with highest d-CIIV in TES Possible/Probable-CTE. Higher d-CIIV correlated with higher CHII scores (r = 0.19), reduced CSF Aβ_1-42 (β = -0.302), increased p-tau₁₈₁ (β = 0.374), and reduced DTI FA (β = -0.202). Conclusion: d-CIIV is linked to RHI exposure and TES diagnosis in former football players, with associated changes in CSF biomarkers and white matter integrity.

Objective: Cognitive impairment is a core feature of traumatic encephalopathy syndrome (TES), the putative clinical syndrome of chronic traumatic encephalopathy-a neuropathological disease associated with repetitive head impacts (RHI). Careful operationalization of cognitive impairment is essential to improving the diagnostic specificity and accuracy of TES criteria. We compared single- versus two-test criteria for cognitive impairment in their associations with CSF and imaging biomarkers in male former American football players. Method: 169 participants from the DIAGNOSE CTE Research Project completed neuropsychological tests of memory and executive functioning. Cognitive impairment was identified by single-test criteria (z≤-1.5 on one test) and two-test criteria (z<-1 on two tests within a domain). ANCOVAs adjusting for age, race, education, body mass index, word-reading score, and APOE ε4 status assessed whether single- or two-test criteria predicted CSF markers (Aβ_1-42, p-tau₁₈₁, p-tau₁₈₁/Aβ_1-42, total tau, neurofilament light [NfL], glial fibrillary acidic protein [GFAP]) and MRI markers (hippocampal volume, cortical thickness, white matter hyperintensities). Results: Ninety-nine participants met single-test criteria for cognitive impairment. Sixty-six met two-test criteria. Participants who met two-test criteria had greater exposure to RHI than those who did not (p=.04). Two-test criteria were -associated with higher CSF p-tau₁₈₁/Aβ_1-42 (q=.02) and CSF NfL (q=.02). The association between two-test criteria and CSF NfL remained after excluding amyloid-positive participants (q=.04). Single-test criteria were not associated with any biomarkers (q's>.05). Conclusions: Two-test but not single-test criteria for cognitive impairment were associated with markers of neurodegeneration. Future clinical research in TES may benefit from applying two-test criteria to operationalize cognitive impairment.

Objective: This study explored the relationship between concussion history and cognition/mood in former collegiate athletes in middle-to-later adulthood. Method: 407 former collegiate athletes aged 50+ (M = 61.4; 62.7% male) participated in the College Level Aging AThlete Study (CLEAATS) and completed the Cognitive Function Instrument (CFI), 40-item Telephone Interview for Cognitive Status (TICS-40), PHQ-8, GAD-7, and self-report questionnaires, including concussion history. Kruskal-Wallis tests assessed for differences among groups based on concussion history (0, 1-2, 3-4, 5+ concussions). Hierarchical multiple regressions including demographic factors as covariates examined relationships between concussion history, emotional symptoms, and subjective/objective cognition. Results: Participants with 5+ concussions reported significantly greater subjective cognitive concerns and depressive symptoms than other concussion groups, but no differences were found in objective cognition. Hierarchical regression revealed concussion history and emotional symptoms explained 29% and 15% of the variance in subjective and objective cognition, respectively. The number of concussions accounted for unique variance in subjective cognition but was not significantly associated when mood symptoms were added to the model. Neither diagnosed concussions nor emotional symptoms were associated with objective cognition. Conclusions: When accounting for concussion history, those with 5+ concussions reported greater subjective cognitive symptoms than those with 0-2 concussions, and greater depressive symptoms than those with 0 concussions. Concussion history was not significantly related to subjective cognition when compared to mood, and concussion history and mood symptoms were not associated with objective cognition. Results highlight the importance of considering mood symptoms when evaluating the relationship between concussion history and cognition in former athletes.

Objective: Spina Bifida (SB) is a medical and neurodevelopmental disability that impacts multiple health and functional systems, including cognitive and neuropsychological functioning. Neuropsychological assessment and monitoring are integral components of SB-related clinical care, as outlined in the Spina Bifida Association's (SBA) Neuropsychological Care Guidelines for People with Spina Bifida. However, practice-based research indicates that access to SB-informed neuropsychological care is limited in the United States. This white paper is intended to address this gap and propose methods to expand the availability of high-quality neuropsychological care and resources for persons with SB and their families. Method: The Spina Bifida and Hydrocephalus Neuropsychology Collaborative, a voluntary assembly of pediatric and lifespan neuropsychologists, organized an expert convening in March 2023 to address these issues. Results: This white paper summarizes the consensus recommendations of the Collaborative, which aim to improve neuropsychological care for individuals with SB and facilitate the implementation of the SBA's 2020 Guidelines. To this end, the Collaborative proposes three levels of clinical care: Universal Care, which involves developing a well-vetted collection of information and resources for SB patients and their families; Core Care, which focuses on establishing coordinated neuropsychological assessment approaches and test batteries; and Optimal Care, which integrates neuropsychological consultation and insights into broader multidisciplinary medical care. These recommendations were reviewed and approved by the SBA's Professional Advisory Committee as an official position paper. Conclusion: The goal of these recommendations is to enhance access to neuropsychological care and improve the lives of individuals with SB.

Objective: Due to a lack of time-efficient standardized assessments, there is a high risk of unidentified visual perception difficulties in stroke survivors. The Oxford Visual Perception Screen (OxVPS) is a 15-min performance-based screen for visual perception difficulties through tasks like picture naming and face recognition. This study evaluates the inter-rater reliability, convergent, and discriminant validity of OxVPS. Method: In this cross-sectional study, 161 stroke survivors within 8 weeks of their stroke, sufficient understanding of English, ability to concentrate for 15 min, and capacity to consent took part across three UK rehabilitation units. Video-recordings of OxVPS assessments were rated by an independent rater for inter-rater reliability. Convergent validity was assessed by comparing OxVPS scores with the Rivermead Perceptual Assessment Battery (RPAB), a 45-90-min battery of visual perceptual tasks. Discriminant validity compared OxVPS scores with performance on the Blind Montreal Cognitive Assessment (MOCA-B) for cognition and with the Visual Impairment Screening Assessment (VISA) for sensory vision. Results: Inter-rater reliability showed equivalent ratings (N = 107, t(106) = -14.77, p < .001) and mean difference of -0.01 point on a 10-point scale in a Bland-Altman analysis (95% confidence interval [CI]: -0.14 to 0.13). Convergent and discriminant validity demonstrated a high correlation of 0.78 (N = 58, 95% CI: 0.65-0.86) between OxVPS and RPAB, lower correlations of 0.52 with MOCA-B scores (N = 113, 95% CI: 0.37-0.64) and .39 with VISA scores (N = 110, 95% CI: 0.22-0.54). Conclusions: Data indicate good inter-rater reliability and evidence that OxVPS predominantly measures visual perception difficulties (convergent validity) in stroke survivors and less so cognition or sensory vision (discriminant validity).