Archives of Clinical Neuropsychology最新文献

Objective: There is a concerning lack of systematic understanding regarding the availability and validity of neuropsychological assessment tools for children in Southeast Asia. This issue is further complicated by the unclear landscape for test development, adaptations, and translations in these countries. The purpose of this paper is twofold. First, we offer insights into the broader practice of pediatric neuropsychology within Southeast Asia communities based on their current medical infrastructural standings. Then, we provide a specific case study by examining the current status of pediatric neuropsychology for Vietnamese children.

Method: A brief overview of the status of pediatric neuropsychology in Southeast Asia groups is provided, followed by a scoping review examining performance-based and objective rating inventories for the Vietnamese pediatric population.

Results: 42 studies were included in the Vietnamese review spanning several cognitive and socioemotional domains. Adaptation and translation protocols were significantly variable. Figures and tables summarizing the identified questionnaires and test measures are included.

Conclusions: Vietnam, with its moderately developed medical infrastructure and shared cultural, economic, and sociopolitical traits with other Southeast Asian countries, provides a compelling case study for the growth, challenges, and gaps in neuropsychology. While the field continues to develop in this country, ongoing opportunities and the need for guidelines on test development and adaptation are critically needed to advance the field further. Implications for more and less developed Southeast Asia countries are provided based on our scoping review.

Objective: There is a dearth of research on neuropsychological functioning and the validity of assessment measures in American Indian (AI) older adults. The present study sought to comprehensively examine neuropsychological functioning in cognitively normal AI older adults in the southwestern USA (i.e., Arizona).

Participants and methods: Ninety predominantly female participants (45 AIs and 45 non-Hispanic Whites) aged 44 years and older (mean age of mid-60s) were matched on age, decade, gender, and assessment battery. Participants were enrolled in the Arizona Alzheimer's Disease Center database. Data obtained included demographics, medical history, psychiatric variables, and raw neuropsychological scores. Analyses included ANCOVAs, chi-square, and stepwise multiple regression.

Results: AIs generally had lower performance across all neuropsychological measures compared with matched Whites, even after controlling for demographic variables. Performance between groups was most discrepant on several measures of global cognition, attention, executive functioning, and language, while performance was statistically comparable on measures of memory and visuospatial abilities. The AI group had higher proportions of diabetes and obesity, but results showed that higher cardiovascular risk was not predictive of lower cognitive performance with the exception of the Clinical Dementia Rating Scale-Sum of Boxes.

Conclusions: Findings suggest that older AIs perform lower on many neuropsychological measures compared with non-Hispanic Whites, even after controlling for demographic variables. This suggests that other factors, including language, culture, educational quality, overall health, socioeconomic status, and level of acculturation may be impacting test scores and need to be considered when assessing and diagnosing older AIs.

Objective: The goal of this study is to understand the evolution of cognitive phenotypes in a clinical cohort of adult patients with relapsing-remitting multiple sclerosis (RRMS) over time and to assess whether demographic and clinical features of MS have any effect on the progression of cognitive decline in MS.

Methods: One hundred twenty-five patients with RRMS underwent annually neuropsychological assessment along 3 to 5 consecutive years with the brief repeatable battery of neuropsychological tests (BRBN-T) and the brief international cognitive multiple sclerosis (BICAMS). The international classification of cognitive disorders in multiple sclerosis (IC-CoDiMS) was used to define the cognitive phenotypes.

Results: In our cohort the mean age was 41.81 years and 88 patients (70.4%) were female. The prevalence of cognitive impairment decreased over the 3-year assessments, both in BRBN-T (29.6% vs. 25.0% vs. 18.5%) and BICAMS (33.6% vs. 30.4% vs. 19.2%). Longitudinal differences were observed for all the applied tests, except for verbal fluency, with the results pointing to an improvement in performance over time. At the first and the 3rd assessment, we observed four cognitive phenotypes: intact, uni-domain, bi-domain, and multidomain. At the 4th and 5th assessments, no patients presented multi-domain impairments. MS patients with optic neuritis (ON) as onset syndrome, showed the highest percentage of cognitive impairment on both BRBN-T and BICAMS.

Conclusions: This study corroborates the importance of knowing the evolution of cognitive performance over time to better determine the best cognitive intervention programs in order to prevent cognitive decline and promote quality of life.

Objective: Although Huntington's disease is characterized by motor onset, psychiatric disturbances may present years prior and affect functioning. However, there is inter-individual variability in psychiatric expression and progression. This study therefore strives to stratify longitudinal psychiatric signatures that may inform Huntington's disease prognosis, with potential clinical applications.

Methods: Forty-six Huntington's disease gene carriers (21 premanifest, 25 manifest; 31 female; age range 25-69) underwent short-Problem Behavior Assessment for depression, irritability, apathy, and dysexecutive behaviors for up to six longitudinal visits. The Disease Trajectories software, a machine-learning approach, was employed to perform unsupervised clustering of psychiatric trajectories. Linear fits were calculated for each cluster. Lastly, the main clusters of shared trajectories were assessed for group differences in demographic and clinical characteristics.

Results: The Disease Trajectories analysis software identified two main psychiatric patterns comprising premanifest and manifest patients that explained 54% of the sample. These two clusters evinced a dissociation in the development of depression and irritability; the first cluster was defined by increasing irritability with no depression and the second by a rise-and-fall in depression with no irritability. Both clusters showed a longitudinal increase in clinically relevant apathy and dysexecutive behaviors.

Conclusions: Ultimately, through the detection of individual-level psychiatric trajectories with machine-learning, this exploratory study reveals that a dissociation of depression and irritability is apparent even in premanifest stages. These findings underscore individual differences in the severity of longitudinal multivariate clinical characteristics for real-world patient stratification, with implications for precision medicine.

Cognitive intra-individual variability (IIV) is a sensitive marker of neuropathology and is increased in people with HIV (PWH). In a sample of PWH from the United States Deep South, we examined the relationship of cognitive IIV with cognitive impairment and social determinants of health (SDoH). This secondary analysis included 131 PWH from a larger cognitive training protocol. Our primary outcome measure was the coefficient of variation (CoV). We also included the individual standard deviation (iSD), with both calculated from demographically adjusted T-scores and unadjusted sample-based scores. Mixed-effects models investigated the relationship between IIV and cognitive impairment severity (i.e., Global Rating Score), SDoH, and clinical variables. Bivariate correlations were used to further explore these relationships. Greater cognitive IIV was associated with greater cognitive impairment in PWH, when accounting for demographic factors. When IIV is calculated from the sample, then IIV is no longer associated with cognitive impairment, but is associated with race (>IIV in Black and African American participants). Demographically adjusted IIV is associated with global cognition, Wide Range Achievement Test-Fourth Edition reading score, and viral load (iSD only). No correlations were significant when using the unadjusted sample-based IIV metrics. In PWH from the Deep South, greater cognitive variability is seen in those with greater cognitive impairment, in Black participants, and in those with lower reading scores. Further research on the psychometric properties of IIV in HIV and other populations is needed, as results varied depending on the normative adjustments.

>objective: Cognitive dysfunction is a common symptom of post-COVID-19 condition (PCC). Few studies have examined rates and predictors of cognitive performance validity test (PVT) failure in patients seeking treatment for PCC.

>methods: We report the rates of PVT failure in 323 patients who received care in a long-COVID-19 clinic for any post-COVID-19 health concern and underwent routine telephone cognitive testing that included two embedded PVTs. Binary logistic regressions examined the demographic, illness, and psychological variables associated with PVT failure.

>results: The prevalence of single PVT failure ranged from 4.7% to 26.1% whereas failure on both PVTs occurred in just 6.3%. Illness characteristics, subjective cognitive dysfunction, and most demographic and psychological variables were unrelated to single PVT failure. Males and those with anxiety were more likely to fail both PVTs.

>conclusion: Failure across multiple PVTs was not common and was unrelated to COVID-19 severity or cognitive complaints.

There are no published guidelines regarding remotely training research assistants (RAs) to conduct neuropsychological tests. With technological advances allowing for increased international collaboration within the medical and research communities, challenges often arise from such partnerships, including linguistic, cultural, and physical barriers. A notable challenge for supervising neuropsychologists in international projects is the physical distance from RAs, sites, and materials, making training/supervision of RAs and monitoring test data quite challenging. In the context of a research collaboration between neuropsychologists based in New York and RAs based in Kerala, India, as part of the Kerala-Einstein Study, we explore the obstacles of remotely training RAs and maintaining neuropsychological data integrity. We share lessons learned and systems developed to optimize remote, multilingual, cross-cultural training of RAs in administration/scoring of neuropsychological tests. One-on-one video training sessions mitigated logistical problems (i.e., time differences, internet connection, language comfort). Individualized training in scoring and a centralized individual to double-score protocols addressed quality assurance of test data. Close collaboration between our teams was necessary for cultural competency, particularly when building an appropriate test battery, creating and translating manuals, and adapting protocols. Finally, frequent and ongoing communication channels ensured excellence in study design, information gathering, and data quality. Future studies should continue highlighting strategies for remotely training psychometrics/RAs in neuropsychological administration.

Objective: This study introduces the Montefiore Einstein Robust Geriatric Normative Project (MERGER-NP), which provides robust normative data for older adults on the Repeatable Battery for Neuropsychological Status (RBANS) and other select neuropsychological tests.

Method: Age-stratified and regression-based demographic norms were derived from a robust sample of older adults (n = 420, mean age = 75.55, 68% female). The study included assessments using the RBANS, Trail Making Test, Digit-Symbol Coding, a 15-item version of the Boston Naming Test, and verbal fluency tests, along with word reading measures. Regression-based norms were generated by analyzing predictors of test performance, integrating demographic variables and measurable social determinants of health (SDOH), specifically word reading ability and occupational attainment.

Results: Normative data include convenient look-up tables for the RBANS and other tests. Findings indicate that word reading measures significantly predict neuropsychological performance, accounting for up to 41% of the variance when included with demographic variables. Notably, our analyses revealed that race often did not contribute unique variance when controlling for reading ability. Additionally, occupation was identified as a significant predictor of test performance, with Job Zone scores retained in approximately 60% of regression models.

Conclusions: The MERGER-NP enhances existing normative data by integrating robust norms with regression-based methods, facilitating more precise assessments for older adults. The findings underscore the utility of including SDOH such as reading ability and occupation into normative approaches, with important implications for improving diagnostic accuracy and patient care in clinical settings. Future research should explore the generalizability of these norms to more diverse populations.

Objective: The Beck Anxiety Inventory (BAI) is a commonly used anxiety measure, but it was not specifically designed for use among older adults. Previous research has raised concern that it may inflate anxiety ratings among older adults because of its emphasis on physical symptoms. The Geriatric Anxiety Scale (GAS) is designed for older adults but has not been examined in a neurology clinic setting. This study sought to compare the psychometric properties of the BAI and the GAS in an older adult neurology clinic sample. An exploratory aim was to determine the influence of motor symptoms on anxiety scores.

Method: Participants included 68 adults age 60+ referred for a neuropsychological evaluation in an outpatient neurology clinic. Measures included the BAI, GAS, and the Montreal Cognitive Assessment (MoCA). Psychometric properties were determined. A McNemar test compared the proportion of anxiety classifications between the BAI and GAS. Referral source (cognitive disorder versus movement-oriented teams) was used as a proxy for grouping patients who were likely to have prominent motor symptoms versus those who were not. An independent t-test compared scale performance between these groups to examine the influence of motor symptoms on anxiety ratings.

Results: Both scales had good internal consistency (GAS α = 0.93; BAI α = 0.88). Convergent validity (GAS and BAI: r = 0.81, p < .001) and discriminant validity (GAS and MoCA, r = 0.18, p = .20) were supported. The BAI detected anxiety among 40% of participants, while the GAS detected anxiety among 56%, which was a statistically significant difference (p = .002). Anxiety ratings did not differ based on referral source (t(66) = -1.59, p = .12).

Conclusion: Both scales had good psychometric properties, though the GAS detected a higher rate of anxiety compared to the BAI despite having less focus on motor symptoms that could be attributed to age-related physical changes or movement disorders. The GAS may capture aspects of anxiety not assessed by the BAI among older adults.

Objective: The COVID-19 pandemic highlighted the need to build an evidence base to support teletesting as an equivalent modality for standardized neuropsychological assessment. As such, the purpose of this study was twofold. First, this study evaluated teletesting equivalency of standardized reading achievement measures during COVID-19 in children ages 6-16. Further, to examine the impact of COVID-19 on reading, achievement scores were compared in two samples of children assessed before and during COVID-19.

Methods: Participants were referred for testing at an outpatient neuropsychology clinic at an urban, academic medical center. Aim one compared assessments administered in-person (n = 1039) versus teletesting (n = 283). A two one-sided test (TOST) was used to determine equivalency. Aim two compared children seen pre-COVID-19 (n = 2125) and during COVID-19 (n = 1322) including a subsample of elementary school-aged children. One-way analyses of covariance were employed, with insurance type and Wechsler Intelligence Scale for Children, Fifth Edition Matrix Reasoning (as a proxy for nonverbal IQ) included as covariates.

Results: Results showed equivalence in reading achievement scores administered via teletesting compared to in-person during COVID-19. For aim two, Nonsense Word Decoding scores were significantly higher for the COVID-19 group compared to the pre-COVID-19 group (p = 0.03). No other significant differences in reading scores were found between groups, including no differences among a subsample of elementary school-aged children (ages 6-10; all ps > 0.05).

Conclusions: This provides additional support for teletesting equivalency and suggests the negative impact of COVID-19 on foundational reading skills is less than predicted in a clinically referred sample.