Clinical Neuropsychologist最新文献

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: 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).

Objective: White matter hyperintensities (WMH), imaging markers of small vessel cerebrovascular disease, are associated with risk of dementia, including Alzheimer's disease (AD). Cognitive intraindividual variability (IIV) has emerged as a sensitive measure of future decline. We examined associations between IIV-dispersion, beta-amyloid (Aß) positivity, and WMH in older adults. Method: We included 819 participants (mean age = 72.01) without dementia from the Alzheimer's Disease Neuroimaging Initiative. IIV-dispersion was calculated as the intraindividual standard deviation across 6 neuropsychological scores. WMH volume was quantified on T2-weighted fluid attenuated inversion recovery images. Regression models examined interactions between IIV-dispersion and Aß status on WMH, adjusting for age, sex, and education. Results: Amyloid status moderated associations between IIV-dispersion and WMH, such that higher IIV-dispersion was associated with greater WMH in Aß+ individuals whether WMH was examined as a continuous (B = 0.30, ß = 0.13, p = .006) or a dichotomous variable based on quartiles (odds ratio [OR] = 2.41, p < .001). Sensitivity analyses to adjust for the effects of individual mean cognition in the models modified findings such that greater IIV-dispersion was again associated with greater WMH in Aß+ individuals when WMH was examined dichotomously (OR = 2.13, p = .018) but the effect was attenuated for continuous WMH. Conclusions: Greater IIV-dispersion was associated with greater WMH among Aß+ individuals. IIV-dispersion may be an early marker of cerebrovascular changes in AD although future research is needed to further establish its incremental utility.

Objective: There are diagnostic disparities in dementia across ethno-racial communities. The potential contribution of measurement bias in cognitive assessments was investigated by examining the factor structure and measurement invariance of the Uniform Data Set neuropsychological battery (UDS3-NB) across ethno-racial groups as well as Spanish and English speakers along a cognitive continuum. Methods: Data were from the National Alzheimer's Coordinating Center (NACC) and the 1Florida Alzheimer's Disease Research Center (1FLADRC). Confirmatory factor analyses were conducted in NACC (n = 29,462; M age = 71.0, SD = 10.4; 58.5% female, M education = 15.8, SD = 3.0; 68.6% non-Hispanic White, 5.3% -primary Spanish speaking) to determine the UDS3-NB factor structure. Measurement invariance was tested in NACC and separately within 1FLADRC (n = 829; M age = 69.9, SD = 8.5; 56.5% female; M education = 14.6, SD = 3.5 years; 33.3% non-Hispanic White, 33.8% primary Spanish speaking), across ethno-racial (non-Hispanic White, Hispanic White, Black/African American), primary language (English, Spanish), and cognitive status (cognitively normal, mild cognitive impairment, dementia). Invariance was assessed at configural, metric, scalar, and strict levels. Results: A 4-factor model (memory, processing speed/executive functioning, language, attention) demonstrated acceptable to good fit in NACC (CFI = 0.97, TLI = 0.96, RMSEA = 0.07, SRMR = 0.03) and 1FLADRC (CFI = 0.97, TLI = 0.96, RMSEA = 0.05, SRMR = 0.04). Standardized factor loadings ranged from 0.43-0.87. Metric invariance was supported across all contrasts in both cohorts. Higher levels of invariance were cohort-dependent: CN vs. MCI achieved strict invariance in both cohorts, whereas non-Hispanic White vs. Hispanic White and English vs. Spanish only achieved strict invariance in NACC. Conclusions: The UDS3-NB demonstrates structural validity and metric equivalence across ethno-racial, linguistic, and cognitive status groups.

Objectives: The primary objective of this case report was to provide a case example of what neuropsychological testing may look like in an asymptomatic patient with Alice in Wonderland Syndrome (AIWS). AIWS is characterized by episodic distortions in the perception of one's body schema, surroundings, and sense of time. Given the understudied nature of the syndrome, the secondary objective of this report was to provide basic information about AIWS (via brief literature review) and provide some context for why neuropsychological evaluation may be valuable in the case of patients with AIWS. Methods: A literature review was conducted of studies involving AIWS, only one of which discussed cognitive symptoms of a patient with AIWS. Basic information about AIWS was summarized. A comprehensive neuropsychological evaluation was conducted on a patient with AIWS seeking academic accommodations. Results: The patient demonstrated exceptionally low range performance on measures of construction and memory of a complex figure. Below-average range performances were also noted on measures of processing speed. Discussion: To our knowledge, this is only the second formal documentation of possible cognitive deficits in an AIWS patient. Given the lack of literature examining both the syndrome and its cognitive profile within this patient population, our results suggest that further investigation of cognition in patients with AIWS is warranted.

Objective: Cognitive intra-individual variability (IIV) is a commonly used research method to estimate how dispersed or inconsistent an examinee's test scores are across measures that comprise a test battery or trial-by-trial responses on a single task. Elevated IIV has been hypothesized to reflect a failure of executive control due to alterations in brain activity or central nervous system integrity. Measures of IIV have a rich history. Growing empirical evidence supports their construct validity and potential for research and clinical applications. However, guidelines for calculating, interpreting, and implementing IIV measures in clinical practice are lacking. Here, we outline the history of IIV and its use in clinical research, summarize metrics for its calculation, review psychometric limitations, and explore future avenues of investigation, with a specific focus on dispersion-based (i.e., variability across tasks) IIV. Methods: A narrative review and commentary on the literature. Conclusions: IIV reliably differentiates clinical populations from healthy groups and predicts disease progression, everyday functioning, and mortality. Questions pertaining to the optimal methodology for IIV, its cognitive architecture, and its incremental validity remain unanswered. The evidence suggests that IIV has the potential to be used as a method of neuropsychological inference in traditional neuropsychological assessment and with ecological momentary assessments. We conclude this review with recommendations for best practices for employing IIV measures in research.

Objective: This study uses a temporal convolutional network with contrastive pretraining (TCN-CL) on smart home ambient sensor data to classify older adults into healthy and mild cognitive impairment (MCI) categories. We aim to overcome limitations of traditional machine learning (ML) methods, logistic regression, and decision tree, by employing deep learning to capture complex temporal dependencies and extract high-level features. We -hypothesize that a pre-trained deep network will improve diagnostic accuracy across diverse, multi-resident environments.

Method: Participants were 137 community-dwelling older adults, classified as healthy older adults (HOA, n = 76) or individuals with MCI (n = 61). A set of 34 digital markers related to sleep, time out of home, activity level, and behavior regularity were derived over a 30-day period from ambient sensors installed in individuals' homes. Diagnosis predictions were examined with traditional ML classifiers and a deep network with contrastive loss (TCN-CL).

Results: TCN-CL significantly outperformed baseline classifiers (logistic regression and decision tree) in predicting cognitive diagnoses. TCN-CL achieved high accuracy (85%), sensitivity (.77), -specificity (.92), and a Matthews correlation coefficient (.71), demonstrating its effectiveness in classifying MCI using smart home sensor data. Baseline models performed poorly, with logistic regression showing marginal improvement over random guessing, and decision tree performing worse.

Conclusion: The TCN-CL, pretrained on a larger dataset, offered a robust approach for early cognitive decline detection using smart home ambient sensors. Continuous monitoring of subtle behavioral patterns through ambient sensor data holds potential to complement and enhance clinical decision-making, enabling accurate and timely diagnoses.

Objective: A commonly held rule in neuropsychology is that two performance validity test (PVT) failures are required to determine response invalidity. This study assessed whether there are exceptions to this rule based on the PVT administered and the magnitude of the failure. Method: 261 adult examinees completed a battery of neuropsychological tests as part of their clinical or forensic evaluations. These batteries contained 4-12 PVTs (mean = 8.1) and always included both the Test of Memory Malingering (TOMM) and Reliable Digit Span (RDS). Analyses were performed to assess associations between PVT failures. Results: 16.5% of examinees failed the TOMM at conventional cutoffs; 97.7% of these individuals failed at least one other PVT. RDS was failed by 14.2% of examinees; 75.7% of whom failed at least one other PVT. The TOMM was significantly more strongly associated than RDS with at least one additional PVT failure with a medium effect size. At a TOMM Trial 2 or Retention score of <43, 100% of examinees failed at least one other PVT. At an RDS cutoff of <4, 100% of individuals failed at least one additional PVT; this was not useful, because only one individual produced that score. Conclusions: While use of multiple PVTs is recommended, the current results suggest that failure on the TOMM, especially with Trial 2 or Retention <43, is sufficient for determining that test data are invalid if multiple PVTs are not available for analysis. Further research is recommended to cross-validate these findings and generalize the results to other PVTs.