Clinical Neuropsychologist最新文献

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.

Objective: Disorders of motor agency and ownership following stroke represent a complex clinical spectrum, ranging from transient phenomena to chronic syndromes. However, the prognostic factors that govern symptom persistence remain poorly defined.

Methods: We conducted a systematic review of post-stroke cases with uncontrollable hand actions and structural imaging data. Eligible reports were screened for lesion sites, awareness of limb ownership, and clinical courses. The time to the last reported assessment was documented to distinguish acute/subacute from chronic trajectories. Additionally, we present a longitudinal case study of a patient with a lesion extending from the genu to the splenium of the corpus callosum and into the right medial frontal area cortex, with follow-up imaging at both acute and chronic stages. A lesion-based disconnectome analysis was performed to characterize network disconnection.

Results: Agency disruption was universal, whereas ownership loss occurred selectively, typically associated with parietal, parieto-occipital, fronto-parietal, or combined callosal and medial frontal lesions. Patients with isolated callosal, fronto-parietal, or callosal plus cingulate lesions often achieved complete resolution in the early stages. In contrast, chronic persistence of symptoms was almost invariably linked to combined damage of the corpus callosum and frontal or fronto-parietal cortices. The index case exemplified this pattern, with sustained grasping behavior at long-term follow-up and disconnection of callosal fibers, the superior longitudinal fasciculus, the frontal aslant tract, and cingulum bandle confirmed by tract-based modelling.

Conclusions: Chronic anarchic hand phenomena primarily result from the combined breakdown of interhemispheric and premotor networks. Early imaging of callosal and frontal pathways is essential for prognosis and therapeutic planning.

Objective: The goals of this project were to (1) provide demographically adjusted normative data for three performance-based tests of everyday cognition: The Everyday Problems Test, Observed Tasks of Daily Living-Revised, and Timed Instrumental Activities of Daily Living and (2) examine the relationships between test performance and traditional cognitive test scores and relevant self-report measures. Method: A sample of 2,767 Black (n = 726) and White (n = 2,041) older adults (aged 65-94) in the ACTIVE baseline sample were included in this study. Normed scores adjusting for age, education, gender, and race were created using multivariable fractional polynomial regressions. Adjusted scores were unrelated to age, education, gender, and race. A Poisson regression was performed to predict participants' number of demographically adjusted low (<16^th percentile) test scores. Results: Higher intellectual self-efficacy (coef = -0.20), immediate memory (-0.21), reasoning (-0.25), recognition vocabulary (-0.04), and digit-symbol substitution (-0.01) significantly predicted fewer low test scores while higher physical health related QOL (0.21) and daily activity limitations (0.10) significantly predicted more low test scores (p < .01). Conclusions: Generally, persons with more widespread impairment on the tests evinced more cognitive, emotional, and functional problems. The three demographically adjusted scores fit excellently on a single factor, which uniquely accounted for 19%-36% of variance in the three test scores, in excess of what was already explained by the covariates, indicating the presence of reliable shared variance among the three tests that was not attributable to demographics nor any of the other covariates.

Objective: To examine neuropsychology education and training in Puerto Rico (PR) and identify areas of growth within neuropsychology curricula in graduate programs. Method: A survey was conducted among 44 psychology graduate students, 21 psychologists, and 17 neuropsychologists in PR to assess interest in neuropsychology, education and training experiences, training barriers, professional affiliations, awareness of the Houston Conference Guidelines (HCG), knowledge of competitive neuropsychology internships in the United States (US), and attitudes toward neuropsychology training in PR. Comparisons were made to evaluate PR's alignment with the US HCG standards. Results: Participants were primarily Spanish-English bilinguals completing or with doctoral degrees in clinical psychology. While APA-approved programs in PR offer foundational neuropsychology courses, clinical training opportunities are limited, resulting in few individuals acquiring HCG competencies. Most neuropsychology training occurs in private practice settings. Barriers to HCG training standards include the scarcity of neuropsychology practicums, with students often seeking education and training outside their institutions. The top professional affiliation was with the National Academy of Neuropsychology. Strengths included the number of psychotherapy hours, while research skills and consultation need improvement. Most participants reported inadequate guidance on postdoctoral training and agreed with the recognition of clinical neuropsychology as a sub-specialty in PR, alongside the development of local training guidelines. Conclusions: PR is advancing neuropsychology for a bilingual and bicultural population, but addressing barriers in education and training is essential. Coordinated efforts among educational institutions, the government, and professionals are crucial to enhance neuropsychological practice on the island and contribute to the global neuropsychology community.

Objective: To produce regression-based norms for older adults on the revised Trail Making Test with alphabet support (TMT-NR3). By examining the potential modulating effects and putative interaction effects of age, education, and sex, we aim to gain insights into cognitive aging and the effects of education. Method: Altogether, 440 healthy participants with an age-span from 70 to 92 years from the NorFAST (n = 249) and the HUNT (n = 191) studies were included. Regression-based norms for TMT-A, TMT-B, and derived measures TMT B-A, TMT B/A, and TMT-β were produced. Models were assessed for pertinent linear, curvilinear, or interaction effects of age, education, and sex. We evaluated and compared our norms to published North American TMT norms. Results: Higher age was linearly associated with lower performance on all measures. No sex differences were found. We found a reduced positive association with education on test performance at higher age. However, this interaction effect was found to be driven by participants with low education. Our validated proposed norms showed a better fit to observed data than the existing norms. Conclusion: The norms were adjusted for age on all measures. Norms without age adjustment are made available for TMT B/A due to a slightly better fit of this model. The results indicate (i) that only processing speed and not set-shifting declines with age and (ii) that the selection process for education might be more important than actual education for older-age performance.

Objective: Suicide is a leading cause of death globally. Clinical neuropsychologists may see patients at increased risk of suicide who may have had no prior engagement with another mental health provider. Even if their role is limited to a single encounter, neuropsychologists can still incorporate specific practices (e.g. into their interview appointment) that help reduce a patient's suicide risk. Method: This review aims to highlight current best practices for suicide risk assessment and management, emphasizing the crucial role neuropsychologists can play in suicide prevention. Conclusions: Neuropsychologists' involvement in healthcare systems positions them to implement effective suicide prevention strategies, including the Zero Suicide (ZS) framework. The ZS framework is a systematic approach to improve suicide prevention through the implementation of evidence- based strategies including specific strategies to use when working with patients (i.e. identify, engage, treat, and transition). Effective screening tools for suicidal thoughts and behaviors include the Columbia-Suicide Severity Rating Scale (C-SSRS) and the Ask Suicide-Screening Questions (ASQ) Toolkit. Brief interventions that can be incorporated into an assessment appointment, such as safety planning and means safety interventions, demonstrate significant reductions in suicidal behavior and improved engagement with mental health treatment. Neuropsychologists can refer patients to evidence-based treatments that directly target suicide risk and support at-risk patients through transitions in care by employing strategies like Caring Contacts and structured follow-up calls. By integrating these best practices and engaging in continuous education, neuropsychologists can significantly contribute to reducing suicide risk among their patients.

Background: In the field of clinical neuropsychology, researchers and clinicians often use predefined criteria to determine whether there are indications of cognitive impairment. However, corrections and expected false-positive rates are typically available only for uncorrelated tests and simple consensus criteria. Objective: To present an easy-to-use and freely available online tool as a solution for scenarios involving correlated tests and composite consensus criteria, as frequently encountered in clinical neuropsychological research and practice. Method: Our tool employs Monte Carlo simulations to account for the number of participants, thus addressing the uncertainty in estimating false positive rates with small samples. We demonstrate the tool's utility through an example involving cognitive impairment assessment in cancer patients after chemotherapy. Results: The tool reveals considerable uncertainty in false positive rates, especially with small sample sizes, where rates may be higher than traditionally assumed. We found that correlations between tests affect impairment rates differently depending on whether single or multiple test criteria are used. For single-test criteria, lower correlations are associated with more false positives, while for multiple-test criteria, lower correlations lead to fewer false positives. Conclusions: This innovative tool enables more accurate estimation of false positive rates in various neuropsychological conditions. By providing a user-friendly interface and accounting for real-world complexities such as test correlations and composite criteria, our tool empowers clinicians and researchers to:Make informed decisions when interpreting neuropsychological test results.Design more robust research protocols for cognitive impairment studies.Better understand the implications of sample size on false positive rates.

Objective: Neurobehavioral disturbances often follow acquired brain injuries. Patients and family members may perceive these anomalies differently, and these discrepancies are difficult to interpret due to methodological constraints. We explored the differing perceptions of behavioral alterations in patients with severe acquired brain injury (sABI) and their caregivers using the Latent Difference Score (LDS) analysis. We also examined the relation between the behavioral ratings and demographic, injury, and functional variables. Method: Data from 154 patients with sABI in the post-acute phase and their caregivers were retrospectively analyzed. The BIRT Personality Questionnaire was used to assess behavioral disorders. Results: We examined four subscales: Lack of Motivation (LoM), Lack of Emotion Regulation (LoER), Negative Emotionality/Reactivity (NE), and Lack of Social Skills (LoSS). Patients generally tended to underestimate their problematic behaviors compared to their family members. Sex predicted patient/caregiver discrepancies in the LoM and LoER subscales, with male patients perceiving themselves as higher functioning than female patients. The scale measuring physical disability was not associated with patient/caregiver discrepancies, except for LoER, with family members' judgments of greater severity correlated with lower functional scores. Conclusions: Notable gaps emerged between subjective and family perceptions, particularly in motivation and social skills. The discrepancies were associated with sex differences. LDS is a promising tool for examining patient/caregiver discrepancies in patients with ABI.

Objective: The analysis of risk of bias in systematic reviews (SR) and meta-analyses (MA) is a fundamental task to ensure the correct synthesis of results. To carry out this task, specific tools must be used for each research design of the studies analyzed. The choice of an appropriate tool is currently a challenge for researchers developing SR and MA in the area of symptom and performance validity because the research designs used have been created specifically for this field. Although these designs can be integrated within the classic classifications, they present a number of particular characteristics that are not reflected in any of the current risk of bias analysis tools. The aim of this study is to design a checklist specifically for systematic review/meta-analysis focused on validity tests. Methods: The checklist was developed through objective review of the existing evidence, development of checklist items, and refinement by external feedback and performance analysis. Results: The checklist is composed of four sections: Clinical comparison group selection, sources of bias in either simulation or criterion group designs, and overall assessment of the study. Inter-rater reliability was assessed with a sample of 20 studies, resulting in good to excellent intraclass correlation coefficients for most items. Conclusions: The checklist seeks to fill an important gap in the literature by serving as an assessment tool that improves the reliability of evidence synthesis in symptom and performance validity studies. This instrument facilitates the development of SR and MA that meet international standards, improving methodological rigor and reliability in the forensic setting.

Objective: People with functional seizures (FS) have frequent and disabling cognitive dysfunction and mental health symptoms, with low quality of life. However, interrelationships among these constructs are poorly understood. In this meta-analysis, we examined associations between objective (i.e. performance-based) cognitive testing and self-reported (i) mental health, (ii) cognition, and (iii) quality of life in FS. Method: We searched MEDLINE, Embase, PsycINFO, and Web of Science, with the final search on June 10, 2024. Inclusion criteria were studies documenting relationships between objective cognitive test scores and self-reported (i.e. subjective) mental health, cognition, and/or quality of life in adults with FS. Exclusion criteria were mixed FS/epilepsy samples. A modified Newcastle-Ottawa Scale evaluated risk of bias. This project is registered as CRD42023392385 in PROSPERO. Results: Initially, 4,054 unique reports were identified, with the final sample including 24 articles of 1,173 people with FS. Mean age was 35.9 (SD = 3.9), mean education was 12.6 (SD = 1.3), and proportion of women was 73.9%. Risk of bias was moderate, due in part to inconsistent reporting of confounding demographic variables. Significant relationships were found between global objective cognition and global self-reported mental health (k = 21, Z = -0.23 [0.04], 95% CI = -0.30, -0.16), depression (k = 11, Z = -0.13 [0.05], 95% CI = -0.21, -0.04), cognition (k = 5, Z = -0.16 [0.05], 95% CI = -0.26, -0.06), and quality of life (k = 5, Z = -0.17 [0.05], 95% CI = -0.24, -0.10). Exploratory analyses showed associations between select cognitive and mental health constructs. Conclusions: Objective cognition is reliably associated with self-reported mental health, cognition, and quality of life in people with FS. Scientific and clinical implications are discussed.