Archives of Clinical Neuropsychology最新文献

Objective: Adverse childhood experiences (ACEs) are associated with a range of negative health outcomes, including attention-deficit/hyperactivity disorder (ADHD) and neurocognitive deficits. This study identified symptom profiles in adult patients undergoing neuropsychological evaluations for ADHD and examined the association between these profiles and ACEs.

Methods: Utilizing unsupervised machine learning models, the study analyzed data from 208 adult patients.

Results: The Gaussian Mixture Model revealed two distinct symptom profiles: "Severely Impaired" and "Moderately Impaired". The "Severely Impaired" profile, 23.6% of the sample, was characterized by more severe ADHD symptomatology in childhood and worse neurocognitive performance. The "Moderately Impaired" profile, 76.4% of the sample, had scores in the average range for self-reported internalizing and externalizing psychopathology and better neurocognitive performance. There was a greater number of ACEs reported by patients in the Severely Impaired profile than the Moderately Impaired profile (p = .022). Specifically, using an ACEs cutoff of ≥4, 53.1% of patients in the Severely Impaired profile reported four or more ACEs, compared with 34.6% in the Moderately Impaired profile (p = .020). Profiles were not related to clinician-ascribed diagnosis.

Conclusions: Findings underscore the association between ACEs and worse symptom profiles marked by impaired neurocognitive function, increased internalizing and externalizing psychopathology, and heightened perceived stress in adults with ADHD. Future research may explore the effect of ACEs on symptom profiles in diverse populations and potential moderators or mediators of these associations. Findings offers valuable insights for clinicians in their assessment and treatment planning.

High-quality and accessible education is crucial for advancing neuropsychology. A recent study identified key barriers to board certification in clinical neuropsychology, such as time constraints and insufficient specialized knowledge. To address these challenges, this study explored the capabilities of advanced Artificial Intelligence (AI) language models, GPT-3.5 (free-version) and GPT-4.0 (under-subscription version), by evaluating their performance on 300 American Board of Professional Psychology in Clinical Neuropsychology-like questions. The results indicate that GPT-4.0 achieved a higher accuracy rate of 80.0% compared to GPT-3.5's 65.7%. In the "Assessment" category, GPT-4.0 demonstrated a notable improvement with an accuracy rate of 73.4% compared to GPT-3.5's 58.6% (p = 0.012). The "Assessment" category, which comprised 128 questions and exhibited the highest error rate by both AI models, was analyzed. A thematic analysis of the 26 incorrectly answered questions revealed 8 main themes and 17 specific codes, highlighting significant gaps in areas such as "Neurodegenerative Diseases" and "Neuropsychological Testing and Interpretation."

Objective: Cognitive dysfunction has been observed consistently in a subset of breast cancer survivors. Yet the precise neurophysiological origins of cancer-related cognitive decline remain unknown. The current study assessed neural noise (1/f activity in electroencephalogram [EEG]) in breast cancer survivors as a potential contributor to observed cognitive dysfunction from pre- to post-treatment.

Methods: We measured EEG in a longitudinal design during performance of the paired-click task and the revised Attention Network Test (ANT-R) to investigate pre- versus post-treatment effects of neural noise in breast cancer patients (n = 20 in paired click; n = 19 in ANT-R) compared with healthy controls (n = 32 in paired click; n = 29 in ANT-R).

Results: In both paradigms, one sensory (paired click) and one cognitive (ANT-R), we found that neural noise was significantly elevated after treatment in patients, remaining constant from pretest to posttest in controls. In the ANT-R, patients responded more slowly than controls on invalid cuing trials. Increased neural noise was associated with poorer alerting and poorer inhibitory control of attention (as measured by behavioral network scores), particularly for patients after treatment.

Conclusions: The current study is the first to show a deleterious effect of breast cancer and/or cancer treatment on neural noise, pointing to alterations in the relative balance of excitatory and inhibitory synaptic inputs, while also suggesting promising approaches for cognitive rehabilitation.

Objective: The effects of stimulation frequency on verbal fluency (VF) following subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson's disease (PD) are not well understood. The present study examines the impact stimulation frequency has on VF following bilateral STN-DBS in PD.

Methods: Prospective study of 38 consecutive patients with PD with low frequency STN-DBS (LFS) (n = 10) and high frequency STN-DBS (HFS) (n = 14), and a non-operated PD control group consisting of patients with fluctuating response to dopaminergic medication (n = 14) homogeneous in age, education, disease duration, and global cognitive function. Patients were evaluated on VF tasks (letter, semantic, action verbs, alternating). A one-way analysis of variance (ANOVA) was conducted to assess distinctions between groups. Pre- and post-surgical comparisons of fluencies were performed for operated groups. A mixed ANOVA was applied to the data to evaluate the interaction between treatment (HFS vs. LFS) and time (pre- vs. post-surgery). Strategy use (clustering and switching) was evaluated.

Results: Semantic and letter fluency performance revealed significant differences between HFS and LFS groups. Pre- and post-surgical comparisons revealed HFS negatively affected letter, semantic, and action fluencies, but LFS had no effect on VF. No interaction effect or main effect of treatment was found. Main effect of time was significant for semantic and action fluencies indicating a decrease in postoperative fluency performance. Patients with LFS produced larger average cluster sizes than patients with HFS.

Conclusion: LFS may be less detrimental to VF, but these findings suggest that VF decline following STN-DBS is not caused by stimulation frequency alone.

Superagers are 80 to 89-year-olds with average or better cognition and memory equivalent to individuals 20 to 30 years younger. As sex and modifiable lifestyle/health factors influence cognitive aging and dementia risk, we examined their impact on superager status. Data from participants (n = 469; 67% female) aged 80-89 years old were analyzed from an online database that included demographic and dementia risk factors, and performance on tasks assessing working memory, cognitive inhibition, associative memory, and set shifting. Cross-sectional comparisons were made between superagers and those with typical-for-age cognitive abilities (typical-agers) to examine relationships between sex, superager status, and dementia risk factors. Females performed better than age-matched males on the associative memory task in the 50-69 years old group used for normative comparisons, and in the 80-89 years old group (ps < .001). More females than males were classified as superagers using non-sex-stratified normative comparisons (p = .009), and in sex-stratified normative comparisons (p = .022). Total weighted dementia risk reduced odds of superager status (OR = 0.199, 95% CI [0.046, 0.829]). Other lifestyle dementia risk factors were unrelated to superager status or could not be tested due to low endorsement. The findings support observations that superaging is more common in females, even when controlling for sex differences in memory performance. Future studies of superagers should account for sex differences. Results support being ambitious about dementia prevention, as having fewer modifiable dementia risk factors may be positively associated with superager status.

Objective: The Clock Drawing Test (CDT) is a widely used test for cognitive screening as its execution taps into a large number of cognitive functions. Because of the involvement of visuospatial abilities, the CDT is also commonly used to assess hemispatial neglect. In the present study, we introduce a new quantitative scoring method for the CDT that aims to measure the use of space for each half of the clock face and asymmetries of space use.

Method: Two measures are introduced: the explored space (ES) and used space (US) for each half of the clock, as well as two derived asymmetry indices. Such new measures were applied to CDTs of four groups of participants: right brain-damaged patients without visuospatial neglect, two groups of right brain-damaged patients with varying degrees of visuospatial neglect, and a group of neurologically healthy participants.

Results: Analyses showed that only neglect patients explored and used the left clock half significantly less than the right one. This result was also confirmed by the asymmetry indices, where neglect patients showed a stronger rightward bias. For neglect patients, the US asymmetry index correlated with the patients' scores on the neuropsychological tests. The analyses of receiver operating characteristic curves showed that left US and left ES scores had good accuracy in categorizing neglect patients.

Conclusions: The present work provides new quantitative indices of CDT space usage in hemispatial neglect. Cutoffs are provided for clinical practice.

Objective: Although Coronavirus disease 2019 (COVID-19) is primarily a respiratory infectious disease, it has also been associated with a wide range of other clinical manifestations. It is widely accepted in the scientific community that many patients after recovery continue to experience COVID-19-related symptoms, including cognitive impairment. The aim of this systematic review was to investigate the cognitive profile of patients with long-COVID syndrome.

Methods: A systematic search of empirical studies was conducted through the PubMed/Medline and Scopus electronic databases. Cross-sectional and longitudinal studies published between 2020 and 2023 were included.

Results: Of the 516 studies assessed for eligibility, 36 studies met the inclusion criteria. All included studies support the presence of persistent cognitive changes after COVID-19 disease. Executive function, memory, attention, and processing speed appear to be the cognitive domains that are predominantly associated with long-COVID syndrome, whereas language is an area that has not been sufficiently investigated.

Conclusions: In this review, the high frequency of cognitive impairment after COVID-19 is evident. If we consider that cognitive functioning affects our ability to live independently and is a key determinant of our quality of life, it is imperative to precisely define those factors that may induce cognitive impairment in COVID-19 survivors, with the ultimate goal of early diagnosis of cognitive changes and, consequently, the development of targeted rehabilitation interventions to address them.

Objective: Subjective cognitive symptoms are commonly reported after mild traumatic brain injury (mTBI) but are often not associated with objective cognitive performance. This may be due to limitations in traditional cognitive performance measures, which may not be sensitive to subtle variations in cognition in post-acute mTBI. This study explored associations between objective and subjective cognition using computer-based tasks of increasing cognitive load, proposed to be more sensitive to subtle differences in performance.

Method: Individuals with mTBI (n = 68) and trauma controls (n = 40) were prospectively recruited and assessed approximately 8 weeks post-injury. Participants completed measures of subjective symptom reporting, objective cognitive performance (including two computer-based tasks of increasing cognitive load), and psychological distress.

Results: There were no significant associations between subjective and objective cognition reporting in the mTBI group, both in bivariate correlations (|r| = 0.01-0.20, p > .05) and when controlling for psychological distress (|r| = 0.00-0.17, p > .05). A similar pattern of results was observed in trauma controls, suggesting that the limited relationships between objective and subjective cognition in mTBI may not be specific to this population.

Conclusions: Despite employing measures of cognitive performance proposed to be more sensitive than traditional tasks, no significant relationships were observed between objective and subjective cognition in post-acute mTBI, and estimated effect sizes were small to negligible. This provides further evidence that at a group level 8 weeks after mTBI subjective cognitive symptoms primarily reflect factors aside from objective cognition.

Objectives: To examine the performance reliability of the Oral Trail Making Test (OTMT) in face-to-face (FTF) and teleneuropsychology (TeleNP) conditions among older individuals with and without cognitive impairment.

Methods: Two hundred participants (with [n = 81], and without cognitive impairment [n = 119]) completed the OTMT in both conditions, in a counterbalanced design. Paired sample t-tests compared OTMT scores and intra-class correlation coefficients examined the degree of agreement between the two testing conditions for both diagnostic groups.

Results: For both groups, mean scores were similar across test conditions, with small yet statistically significant differences for OTMT-A (p < .001), though OTMT-B scores did not significantly differ (p-values: .702-.749). Despite substantial variability in OTMT scores, there was a strong agreement between testing formats for OTMT-A (α values = 0.845-0.939) and moderate to strong agreement for OTMT-B scores (α-values = 0.657-0.837).

Conclusions: OTMT administration may be feasible and reliable for TeleNP, though caution is advised for clinicians when interpreting overall test performances given large score variability.