Archives of Clinical Neuropsychology最新文献

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.

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 relationship between perseveration and switching in semantic verbal fluency tasks and the possible role of self-generated interference one must overcome before switching back to a previously visited subcategory has not been explored.

Participants & method: We studied the performance on semantic verbal fluency in 60 cognitively unimpaired subjects, 30 patients with amnestic mild cognitive impairment (aMCI) and 30 patients with Alzheimer's Clinical Syndrome-dementia (ACS-Dementia). Our primary analysis focused on the association of switching and switchback with the first perseverative error.

Results: Perseveration was significantly associated with switchback in all three groups (χ2 = 24.88, p < .001). Within-cluster perseverations were few. The number of switchbacks was the only significant variable to predict perseverative responses (p < .01). Moving from cognitively unimpaired to aMCI to ACS-Dementia, progressively fewer switches and switchbacks were needed to trigger perseveration. In over half of the perseverations after a switchback in the cognitively unimpaired and aMCI groups and in over a third in the ACS-Dementia group, the subjects had already activated a new word in the switched back subcategory.

Conclusion: Switching between subcategories and subsequent switchback play an important role in triggering perseverations in semantic verbal fluency tasks in the cognitively unimpaired as well as in aMCI and ACS-Dementia. Self-generated interference caused by repeated switching may overwhelm the working memory capacity enough to reactivate a previously suppressed response when revisiting an earlier subcategory. Our findings may facilitate a deeper understanding of the cognitive mechanisms underlying perseveration in semantic fluency tests.

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: This study aims to establish normative data for the modified Location Learning Test (m-LLT), considering sociodemographic characteristics such as age, sex, and educational level.

Materials and methods: One hundred eighty-nine middle-aged and elderly people aged 50 years and older were recruited from the French-speaking population in Quebec (Canada). The m-LLT procedure described by Kessels et al. (2006) was used. Percentiles were derived for performance scores (Trial 1, Total Displacement Score, Learning Index, Delayed Recall Displacements), stratified by sociodemographic characteristics where appropriate.

Results: Regarding the sex variable, the number of displacements in Trial 1 and for the Total Displacement Score were higher in men than in women. Age was positively associated with the Total Displacement Score and Delayed Recall Displacements and negatively associated with the Learning Index. Education was positively associated with the Learning Index and Delayed Recall Displacements. Two-thirds of the normative sample achieved a perfect score on the fifth and final learning trial.

Conclusions: Learning was better in women than in men, which may be explained by the use of verbal and nonverbal strategies and environmental awareness favoring women. The decline in learning and retrieval with age can be explained, among other reasons, by a less strategic approach during the encoding phase, a decline in other cognitive domains, or poorer imagery-based representations of the stimuli. The associations between education, strategic retrieval, and cognitive reserve are discussed. Overall, these normative data will enhance the detection of cognitive decline in geriatric clinical or research settings.

Objective: Context-dependent effect (CDE) is a process by which reinstating at test the original learning context enhances the recall ability of the material being studied. Although recognition by people with traumatic brain injury (TBI) is poorer than that of healthy controls, both groups show CDE equally. In the current study, we seek to test the effect of body emotional expressions as contextual information, on facial recognition, and eye movements.

Method: Twenty-four healthy individuals and 27 patients with moderate-to-severe TBI participated in the study. Participants were exposed to photos of people with neutral facial and body expressions and were asked to remember the people for a subsequent memory test. In the testing session, they were asked to determine whether the person presented to them had appeared before, under two conditions: (1) where the context remains constant (facial and body expressions remained neutral-Repeat condition) and (2) where the context changes (facial expression remained neutral but the body expression changed to angry or happy-Re-pair condition).

Results: While the memory of the individuals with TBI was poorer than that of the controls, both groups exhibited equal CDE. We found that both groups, controls more than TBI, spent most of their time looking at the head. Furthermore, longer dwell time was associated with better recognition in the study phase.

Conclusions: These findings are consistent with previous studies showing that despite impaired memory following TBI compared to a control group, CDE was preserved. The current study extends the context effect to body postures that express emotion.

Objective: Anomia is defined by difficulty in retrieving content words like nouns and verbs from long-term memory, independent of any impairments related to articulatory movements or motor speech execution. The tools for measuring picture naming, the conventional method for assessing anomia, are very limited in Turkey. The aim of this study was to adapt the Test de Dénomination de Québec-60 images/Quebec picture-naming test-60 pictures (TDQ-60), a color picture-naming test for adults and the elderly into Turkish, establish its validity, and develop normative data adapted to the Turkish population to address this gap.

Method: We conducted three separate studies. The objective of Study 1 was to culturally adapt the Test de Dénomination de Québec-60 images. In Study 2, we developed normative data for the TDQ-60 Tr adapted to the adult and elderly population in Turkey based on the performance of 414 community residents aged 18 years and older. In Study 3, the known-group validity, the convergent validity, and the test-retest validity of the TDQ-60 Tr were determined.

Results: The results show that the TDQ-60 Tr is reliable in distinguishing participants with Alzheimer's disease and mild cognitive impairment from healthy participants. The TDQ-60 Tr measures the same cognitive construct as the Boston Naming Test and also has a high test-retest reliability.

Conclusions: In summary, the TDQ-60 Tr is a valid and reliable instrument for assessing naming abilities in adults and the elderly. The results of this study have significant implications for the assessment of naming ability in Turkish-speaking patients. Our work serves as a crucial connection to address the lack of tools for diagnosing anomia in Turkey.

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.