Archives of Clinical Neuropsychology最新文献

Background: Multiple sclerosis (MS) is a potentially disabling disease of the brain and spinal cord. This cross-sectional study aimed to validate the Arabic version of the Multiple Sclerosis Impact Scale-29 (MSIS-29) using Rasch analysis to assess quality of life in Jordanian MS patients.

Method: Rasch analysis was conducted to evaluate the suitability of the model for the present study. Model fit was assessed by computing item/person separation reliability, infit and outfit mean square (MSQ) values, Cronbach's alpha, and the Akaike Information Criterion.

Results: A total of 301 MS patients were enrolled in the study. Significant likelihood ratios for all three scales (MSIS-29-PHYSICAL, MSIS-29-PSYCHOLOGICAL, and MSIS-29-TOTAL) supported the use of a partial credit Rasch model. An issue with disordered thresholds was resolved by collapsing adjacent response categories. Item reliability scores for MSIS-29-PHYS and MSIS-29-PSYCH were 0.95 and 0.89, respectively, while person reliability scores were 0.92 and 0.84, respectively. Infit and outfit MSQ were within the acceptable range for all items on the MSIS-29-PSYCH scale. However, for the MSIS-29-PHYS scale, item MSIS-29_17 exceeded the acceptable range in both infit (1.93) and outfit (1.82) MSQs, and item MSIS-29_20 exceeded the acceptable range in infit (1.81). The Wright map also indicated that most items were considered relatively easy by the respondents, exhibiting various difficulty levels on the latent scale.

Conclusion: The Arabic version of the MSIS-29 is a valid and reliable tool for evaluating quality of life in Jordanian MS patients.

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: This study aims to adapt and provide psychometric support for the validation of version B of the Edinburgh Cognitive and Behavioural ALS Screen (ECAS) for the Portuguese population, addressing the need for consistent cognitive evaluations in amyotrophic lateral sclerosis (ALS). A second culturally adapted ECAS screen facilitates the accurate characterization of ALS progression, mitigates learning effects, and supports tailored care management.

Methods: The adaptation process included forward-backward translation, cultural adaptation, and cognitive debriefing on a prospective sample of 193 ALS patients and 106 controls. A multiple regression analysis identified predictors relevant for establishing ECAS cut-off scores. Psychometric evaluations, including reliability assessments and tests of convergent, construct, and criterion validity, were conducted. Additionally, version A's psychometric properties were reevaluated with complementary analyses and a larger sample.

Results: Version B demonstrated good internal consistency with Cronbach's alpha of 0.802, comparable to the previously established version A. Moderate inter-item correlations further supported reliability, reflecting internal coherence. Equivalence testing between the Portuguese versions supported convergent validity, confirming version B's alignment with version A's theoretical framework. Exploratory factor analysis provided preliminary support for construct validity, and receiver operating characteristic analyses established cut-off values for both versions, revealing moderate sensitivity with a tendency toward false negatives, and higher specificity.

Conclusions: This study provided evidence for the cultural suitability, reliability, and validity of the Portuguese ECAS B. As evidence supports the equivalence of the Portuguese ECAS versions, they can be used for flexible screenings and applied with the calculated cut-off values to enhance diagnostic accuracy.

Objective: Explore the tip-of-the-tongue (TOT) scores from the Children's Auditory and Visual Naming Tests (cANT, cVNT) as embedded validity indicators (EVIs).

Method: A retrospective design of 98 consecutively referred youth aged 6-15 years (M = 11.28, SD = 2.80) that completed neuropsychological evaluation at a tertiary-care academic medical center.

Results: Invalid performance (i.e., ≥2 failed PVTs) occurred in 12.2% of the sample, with base rates of failure on individual PVTs ranging from 1.0% to 30.6%. Area under the curve (AUC) showed statistical significance for the auditory (AUC = 0.811, p = .004) but not the visual TOT. Logistic regression indicated the combination of both TOT scores with other PVTs increased correct identification of invalid performance to 85.7% versus 75% without TOT scores.

Conclusion: The utility of the TOT as a language-based EVI is one of many potential advantages of the cANT and cVNT compared to other confrontation naming tests. To confirm this, future studies with more diverse populations are warranted.

Objective: Technology can be combined with psychological interventions to support older adults with memory concerns. Using a bi-phasic design, cognitive rehabilitation (CR) was integrated with off-the-shelf technology and delivered to two people with cognitive impairment, and one care partner.

Method: Pre- and post-intervention assessments were completed for all participants. Individuals with memory problems received pre- and post-intervention remote neuropsychological assessment (i.e., Rey auditory verbal learning test; mental alternations test; animal fluency), and the hospital anxiety and depression scale (HADS). The care partner completed the HADS, Zarit burden interview, and neuropsychiatric inventory questionnaire. Change metrics incorporated reliable change indices where possible. Goals were tracked using the Canadian occupation performance measure; these data were analyzed through visual inspection. A research journal (used to document intervention process) was analyzed thematically.

Results: Results cautiously suggested our integration was feasible and acceptable across several technologies and varying goals. Across participants, significant changes in goal progress suggested the integration of technology with CR successfully facilitated goal performance and satisfaction. The research journal underscored the importance of a visual component, intervention flexibility, and a strong therapeutic alliance in integrating technology and CR.

Conclusions: CR and technology present a promising avenue for supporting people living with cognitive impairment. Further exploration of technology and CR with a range of etiologies and target goals is warranted.

Objective: To examine correlates of the discrepancy between subjective cognitive complaints and processing speed performance in a sample of military personnel with and without traumatic brain injury (TBI).

Method: About 235 U.S. military service members (31 noninjured controls [NIC], 69 injured controls [IC], 70 uncomplicated mild TBI [mTBI], and 65 complicated mild/moderate/severe TBI [sTBI]) prospectively enrolled in a longitudinal TBI study completed neuropsychological testing, performance validity tests, and self-report measures of cognitive complaints and psychological symptoms. Service members were categorized as "Accurate Estimators," "Underestimators," and "Overestimators" based on discrepancies between their subjective cognition and processing speed performance.

Results: The NIC group was less likely to underestimate their cognitive abilities than the mTBI group (p < .05). Discrepancy groups significantly differed in processing speed scores (p < .001), with underestimators demonstrating the best objective cognitive performance. Spearman correlations revealed significant positive correlations between unadjusted discrepancy scores and psychological symptoms in the NIC, IC, and sTBI groups (ps < 0.05) but not the mTBI group (ps > 0.05). In contrast, discrepancy scores adjusted for premorbid intelligence were consistently and positively correlated with psychological symptoms across all injury groups (ps < 0.05).

Conclusions: Findings suggest that mTBI injuries may increase the likelihood of a patient underestimating their cognitive performance. Further, premorbid cognitive functioning is an important factor in evaluating discrepancies in self-reported cognitive complaints and processing speed performance.

Objective: Deficits in online self-awareness (SA) are common after acquired brain injury (ABI), leading to safety concerns and impacting daily activities and rehabilitation outcomes. Early identification is recommended as a critical first step in cognitive rehabilitation following ABI. The aim of this observational study was to examine differences in online SA and strategy use between individuals with ABI and healthy controls. It also investigated whether online SA moderates the relationship between strategy use and performance accuracy on a test designed to assess cognitive-functional deficits.

Method: 80 individuals with ABI and 76 controls completed the Spanish Weekly Calendar Planning Activity-10. Measures of online SA included strategy use and self-recognized errors assessed during task. An after-task interview assessed individuals' self-evaluation of task difficulty and accuracy of performance.

Results: Individuals with ABI performed worse than controls on most measures of online SA. They were less likely to self-recognize errors and use self-monitoring strategies. They also tended to overestimate their performance and showed greater discrepancy between self-rated and actual performance. Moderation analyses show that better performance was significantly associated with greater strategy use among ABI individuals who were aware of their performance.

Conclusions: Online SA appears to moderate the use of cognitive strategies during functional cognitive performance after ABI. Therefore, it is important to include assessments of online SA and strategy use for individuals with ABI. Furthermore, these findings highlight the importance of focusing on SA and self-generated strategies as key goals of cognitive rehabilitation aimed at improving daily functioning after ABI.

Objective: Cognitive dysfunction occurs in many neurological, psychiatric, and other health conditions. This review aimed to characterize the breadth and degree of cognitive morbidity associated with varied health conditions.

Method: We systematically reviewed Medline, EMBASE, and Cochrane databases for meta-analyses of cognitive dysfunction associated with any health condition. Meta-analyses were eligible if they reviewed studies that compared patients with health conditions to healthy controls on cognitive testing and provided effect sizes.

Results: We found 91 meta-analyses for 94 health conditions. Among >800,297 participants, healthy controls out-performed clinical participants in every condition on cognitive testing. Mean effect sizes ranged from -2.02 to -0.00 across conditions and were ≤ -0.5 on average, denoting moderate to very severe dysfunction for 41% of them.

Conclusions: Cognitive dysfunction is ubiquitous in medicine. Both primary care and specialist physicians likely treat patients with cognitive dysfunction. Depending on its severity, cognitive dysfunction can affect treatment adherence, everyday functioning, quality of life, and the capacity to provide informed consent for treatment. These findings highlight the transdiagnostic nature of cognitive symptoms and the potential value of establishing collaborations between physicians and clinical neuropsychologists to integrate cognitive assessment into patient care. Even brief assessments can identify cognitive deficits that likely affect treatment adherence and functional outcomes.

Objective: Conflicting evidence has arisen from the few studies that have examined the role of the prefrontal cortex and executive control functions in theory of mind (ToM). Moreover, the involvement of other cognitive domains in the ability to infer mental states is still under debate. This study aims to examine, in addition to the potential contribution of executive functions, the role of cognitive estimation in ToM abilities, given that cognitive estimation processes are strongly associated with some aspects of executive control functions.

Method: The cognitive estimation task, along with a set of neuropsychological tasks assessing executive functions, was administered to 30 patients with prefrontal cortex damage and 30 control subjects matched by gender, age, and education level.

Results: Patients with prefrontal cortex damage were impaired in all measures of executive functions, cognitive estimation, and theory of mind compared with control subjects. Regression analysis showed a significant interaction between executive measures and cognitive estimation in predicting ToM performance for patients with prefrontal cortex damage. Additionally, voxel-based lesion analysis identified a partially common bilaterally distributed prefrontal network involved in all three domains, centered within the ventral and dorsomedial areas with extension to the dorsolateral prefrontal cortex.

Conclusion: Our findings highlight that, apart from executive functions, cognitive estimation plays a crucial role in the ability to interpret others' cognitive and emotional states in both patients with prefrontal cortex damage and control subjects.

Objective: To meet the growing demand for timely diagnosis in the new era of disease-modifying medications for Alzheimer's disease (AD), the present study aimed to reduce clinic wait times by developing and refining an abbreviated neuropsychological battery to assess individuals with a suspected amnestic process (i.e., Early-Stage AD Pathway).

Method: Early-Stage AD Pathway patients were referred by an internal neurology provider who determined that the patient had: (1) an amnestic clinical presentation, (2) a normal neurological examination, and (3) a Montreal Cognitive Assessment total score between 18 and 25. These patients were scheduled for a 2-h neuropsychological evaluation, including a brief clinical interview and an abbreviated testing battery. We evaluated n = 19 patients in the Early-Stage AD Pathway and compared them to 114 older adults referred via traditional clinic procedures (i.e., General Clinic).

Results: Most individuals evaluated via the Early-Stage AD Pathway were diagnosed with mild cognitive impairment (MCI; 68.4%) or mild dementia (21.1%) through the neuropsychological evaluation. Rate of diagnosis of MCI/dementia was comparable between groups. The average number of days between initial referral and completion of the neuropsychological evaluation was significantly lower (Mdiff = 145.8 days, U = 1867.500, p < 0.001) for the Early-Stage AD Pathway group than for the General Clinic group, as the former could be scheduled more flexibly.

Conclusions: Implementing an abbreviated neuropsychological assessment process significantly reduced the time between referral and evaluation to identify individuals who may be eligible for emerging pharmacological treatments for AD and/or non-pharmacological interventions in a timely manner.