CLINICAL NEUROPSYCHOLOGIST

Right temporal variant frontotemporal dementia initially presenting with gradually progressing heading disorientation: A case report
Komori Y, Kurihara M, Goto R, Obata M, Ishibashi K, Ishii K, Tokumaru AM, Kanemaru K, Takeda K and Iwata A
: Previous studies of topographical disorientation have focused on cerebrovascular diseases. However, a detailed assessment of patients with neurodegenerative diseases may aid our understanding of spatial navigation. We report the case of a patient with right temporal variant frontotemporal dementia (rtvFTD) initially presenting with heading disorientation, a distinct category of topographical disorientation. : The patient was a 71-year-old woman with gradually increasing episodes of getting lost in a familiar environment. Detailed neuropsychological assessment, magnetic resonance imaging (MRI), and positron emission tomography (PET) studies were performed. : Topographical disorientation was conspicuous in the patients' cognitive dysfunction despite preserved general cognition. She could not dictate a route or draw a map from her nearest train station to her home, although she recognized environmental landmarks relatively well. Neuropsychological assessments, including the card-placing test, suggested heading disorientation. The MRI and PET abnormalities were large but confined to the right hemisphere and involved the retrosplenial region, an area associated with heading disorientation in cerebrovascular diseases, and the cortical areas that comprise a network together with the retrosplenial region. Amyloid PET was negative, ruling out Alzheimer's disease. Her topographical symptoms gradually worsened. Behavioral symptoms and loss of empathy gradually became apparent fulfilling the criteria for rtvFTD. : Neuropsychological assessment revealed heading disorientation in the initial stage of rtvFTD. Based on previous studies, heading disorientation was likely attributed to neurodegeneration in the right hemispheric network centered in the retrosplenial region. The gradual progression of topographical symptoms contrasted with previous reports of heading disorientation due to cerebrovascular diseases.
Foundational skills in the assessment and management of suicide risk in neuropsychological practice
Calamia M, Tucker R and Hill R
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. This review aims to highlight current best practices for suicide risk assessment and management, emphasizing the crucial role neuropsychologists can play in suicide prevention. 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. and ). 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.
Enhanced detection of suboptimal effort in psychoeducational assessments for dyslexia
Harrison AG, Davin N and Pollock B
: Although performance validity tests (PVTs) are routinely administered in neuropsychological evaluations, they are employed less frequently in assessments for specific learning disabilities such as dyslexia, likely due, at least in part, to the limited availability of PVTs to evaluate effort on measures of academic achievement. This is troubling, as previous research suggests that up to 24% of postsecondary students undergoing learning disability assessments produce noncredible test scores indicative of symptom exaggeration or low effort. This paper discusses normative data collected for the revised Dyslexia Assessment of Simulation or Honesty- Revised (DASH-R), a PVT developed specifically to identify symptom exaggeration or magnification during dyslexia testing. We administered the DASH-R to three groups of students: honest responding controls ( = 48), students with documented dyslexia ( = 232), and students coached to simulate dyslexia ( = 42). Students were also administered measures of reading and processing speed. DASH-R scores differentiated simulators from both honest responding controls and those with dyslexia. Further, ROC curve analysis showed that a composite feigning index score derived from the DASH-R could be used diagnostically to detect low effort; an optimal cut score of ≥4 on a seven-variable index yielded high specificity (≥98%) and good sensitivity (71%), with positive predictive accuracy of 86%. Creation of a 9-variable index that included errors on an additional reading test produced improved positive predictive accuracy to 96% while retaining excellent specificity (99%). The DASH-R appears to be a promising disability-specific measure for detecting feigned reading problems in young adults undergoing evaluations for dyslexia.
Interpreting the direct- and derived-Trail Making Test scores in Argentinian children: regression-based norms, convergent validity, test-retest reliability, and practice effects
Arán Filippetti V and Gutierrez M
We carried out two research studies (using a cross-sectional and a longitudinal design) to establish regression-based normative data, and to examine the convergent validity, the test-retest reliability, and the changes in performance with practice (1-month and 1-year interval) of the direct- and derived- (B-A, B + A, and B/A ratio) Trail Making Test (TMT) scores in Spanish-speaking children. In S1 ( = 413 6- to 15-year-old children and adolescents), regression-based norming procedure and partial correlations were employed. In S2 ( = 110 6- to 12-year-old children), intraclass correlation coefficient (ICC), Pearson's r-product-moment correlations, and paired t-tests were used. S1 demonstrated that age was associated with better performance on both TMT-A and TMT-B. This improvement was more strongly related to direct scores than derived measures B-A and B/A. Additionally, TMT-B was found to be more related to other executive functions (EF) compared to the performance of TMT-A. Among the derived scores, only the B-A was related primarily to cognitive flexibility, while the B + A index was associated with most EF, suggesting a general measure of cognitive functioning. In S2, fair to good test-retest reliability coefficients were found at Time 2 for TMT-A and TMT-B, as well as the B + A index, both in 6 to 8-year-olds (ICCs .61 to .74) and 9 to 12-year-olds (ICCs .53 to .65). There was a significant increase in performance on TMT-A and TMT-B from the first assessment (Time 1) to the follow-up testing at Time 2 in older children. However, this significant improvement was not observed for TMT-B in the younger group. Test scores on the TMT direct measures improved significantly across 1-year. The B-A and B/A ratio scores did not change across examinations. These findings have important implications for assessing EF and developing interventions that target cognitive flexibility in pediatric populations.
Development of a Symptom Validity Index for the Beck Anxiety Inventory
Snodgrass MA, Bieu RK and Schroeder RW
Anxiety disorders are the most prevalent psychiatric disorders experienced by individuals in the United States, and anxiety is often assessed with anxiety symptom inventories. At present, though, there are no anxiety symptom inventories that include symptom validity indices. The present study sought to develop a symptom validity index for the most commonly used anxiety symptom inventory in neuropsychological practice, the Beck Anxiety Inventory (BAI). A sample of 244 veterans seeking outpatient neuropsychological assessments were included in the study. Participants were divided into valid and invalid groups based on external criterion symptom validity tests. The valid participants were then divided into clinical subgroups (Current Anxiety, Lifetime Anxiety, and No Anxiety). A validity index derived from the BAI total score was examined for the total sample and all subgroups. A cutoff of ≥ 29 was identified when utilizing the Valid Full Sample, which resulted in a 0.91 specificity rate and 0.54 sensitivity rate. However, cutoffs had to be adjusted when applied to the clinical subgroups. The Valid Current Anxiety subgroup required the largest cutoff increase (i.e. ≥ 36), which resulted in a 0.91 specificity rate and a 0.42 sensitivity rate. This is the first published article to develop a symptom validity index for the BAI. To minimize false positive errors, a BAI total score of ≥ 36 is recommended.
Symptom validity indices for the Beck Depression Inventory-II: development and cross-validation in research and clinical samples
Shura RD, Schroeder RW, Ord AS, Bieu RK, O'Connor VL, Magnante AT, Snodgrass M, Miskey HM, Martindale SL and Rowland JA
The present study sought to cross validate the recently developed total score cut-off for the Beck Depression Inventory-II (BDI-II) and identify additional embedded symptom validity indices within this commonly used self-report depression measure. Study 1 included a research sample of 379 veterans with diagnostic subgroups of Current and Lifetime Depression and Current and Lifetime Posttraumatic Stress Disorder (PTSD). Study 2 included a clinical sample of 224 veterans with diagnostic subgroups of Current Depression, Lifetime Depression, and No Depression. Three embedded BDI-II symptom validity indices were examined in the total samples and subgroups: the BDI-II Symptom Severity Scale (total raw score), BDI-II Extreme Symptom Scale (summed frequency of extreme responses), and the BDI-II Rare Items Scale (summed frequency of rarely endorsed items). Validity indices from the Personality Assessment Inventory were utilized in both studies, with the Miller Forensic Assessment of Symptoms Test also used in Study 1. In Study 1, BDI-II validity index cut-off scores had to be adjusted the highest for the Current Depression or Current PTSD subgroups. The cut-offs were associated with sensitivity rates ranging from 0.12 to 0.53 and specificity rates ranging from 0.90 to 0.96. In Study 2, cut-offs had to be adjusted, the highest for the Current Depression subgroup. Identified cut-offs had sensitivity rates ranging from 0.22 to 0.65 and specificity rates ranging from 0.89 to 0.95. This study supports the use of all three proposed BDI-II embedded symptom validity indices.
Perceptions in neuropsychology about non-inclusivity in testing materials: Preliminary results from a small-scale survey
Burton CZ, Katz LA, Schmitt TR, Trittschuh EH, Correro AN, Rahman-Filipiak A and Richard AE
: While some recommendations for neuropsychologists have been established regarding best practices when working with gender and sexual minorities, there are many assessment practices that could contribute to disparities for LGBTQ+ patients. The purpose of the current preliminary study is to collect initial information on practitioner perceptions of non-inclusivity in our instruments, allow neuropsychologists who attempt to increase inclusivity to share their approaches with others, and use the information to guide future, larger-scale studies and advocacy efforts. : Forty-six participants (mostly doctoral level neuropsychologists) completed a survey related to their experiences with inclusive and non-inclusive language in test materials. : The majority of respondents reported encountering non-inclusive language, with many having made changes in their practices as a result. Respondents highlighted concerns specific to neuropsychological instruments and questionnaires as well as normative data specific to the LGBTQ+ population. Respondents provided several examples for improvements. : Based on these initial findings, several suggestions and future directions are highlighted.
Determining whether false positive rates increase with performance validity test battery expansion
Kanser RJ, Rohling ML and Davis JJ
Performance validity test (PVT) misclassification is an important concern for neuropsychologists. The present study determined whether expanding PVT analysis from 4-PVTs to 8-PVTs could lead to elevated rates of false positive performance validity misclassifications.
Effects of an individual cognitive stimulation intervention on global cognition, memory, and executive function in older adults with mild to moderate Alzheimer's disease
Justo-Henriques SI, Pérez-Sáez E, Carvalho JO, Lemos R and Ribeiro Ó
To determine the efficacy of a 12-week individual cognitive stimulation (iCS) intervention on global cognition, memory, and executive function of older adults with mild to moderate Alzheimer's disease (AD).
New2Neuropsychology (N2N): An organization to promote diversity, equity, and inclusion in neuropsychology
Schmitt TR, Van Patten R, DesRuisseaux LA, Gotra MY, Hewitt KC, Peraza J, Tan A, Votruba KL, Bellone JA, Block C, Talbert LD, Ray C, Kaseda ET, Owens R, Martinez MN, Persad CC and Stringer AY
To introduce New2Neuropsychology (N2N), an organization that seeks to increase recruitment of historically underrepresented minoritized (URM) students, and to examine preliminary data on N2N's impact and effectiveness in increasing knowledge about neuropsychology for URM students.
Machine learning-based screening for outpatients with dementia using drawing features from the clock drawing test
Masuo A, Kubota J, Yokoyama K, Karaki K, Yuasa H, Ito Y, Takeo J, Sakuma T and Kato S
In geriatrics and dementia care, early diagnosis is crucial. We developed a dementia screening model using drawing features from clock drawing tests (CDT) and investigated the features contributing to the discrimination of dementia and its screening performance. This study included 129 older adults attending a dementia outpatient clinic. We obtained information on the diagnosis of dementia and CDT data from medical records and quantified 12 types of drawing features according to the Freedman scoring system. Based on the dementia diagnosis information, participants were assigned to two groups: 58 in the dementia diagnosis group and 71 in the non-diagnosis group. Using Boruta, an iterative feature selection algorithm, and a support vector machine, a machine learning method, we analyzed the drawing features contributing to dementia discrimination and evaluated discrimination performance. Five types of drawing features were selected as contributors to discrimination, including "numbers in the correct position," "minute target number indicated," and "hand in correct proportion." These features exhibited a discriminating sensitivity of 0.74 ± 0.16 and specificity of 0.74 ± 0.18 for detecting dementia. This study demonstrated a method for identifying individuals likely to be diagnosed with dementia among patients attending a dementia outpatient clinic using drawing features. The knowledge of drawing features contributing to dementia differentiation may assist healthcare practitioners in clinical reasoning and provide novel insights for clinical practice. In the future, we plan to develop a primary screening for dementia based on machine learning using CDT.
Relationship of subjective and objective cognition with post-stroke mood differs between early and long-term stroke
Kusec A and Demeyere N
Depression and anxiety affects approximately 1 in 3 stroke survivors. Performance on standardized objective cognitive tests and self-reported subjective cognitive symptoms are associated with concurrent depression and anxiety, but longitudinal data on whether and how objective and subjective cognition relate to emotional outcomes are lacking.  99 stroke survivors ( age = 68.9,  = 13.1; Median NIH Stroke Severity = 5) completed measures of depression and anxiety (Hospital Anxiety and Depression Scale; HADS), objective cognition (Oxford Cognitive Screen) and subjective cognitive symptoms (Cognitive Failures Questionnaire) at 6-months, 4.5, and 5.5 years post-stroke. The contribution of objective and subjective cognition to depression and anxiety was determined mixed-effects models. We found no evidence that age, stroke severity, years of education, and participant sex related to changes in HADS-Depression or HADS-Anxiety scores (Marginal =0.03 and 0.05, respectively). Objective cognitive impairments at 6-months and increases in subjective cognitive symptoms at 5.5 years significantly related to increased HADS-Depression scores (Marginal =0.22). Only increases in subjective cognitive symptoms at 5.5 years significantly related to increased HADS-Anxiety scores (Marginal =0.20). When conducting models in reverse, HADS-Depression and HADS-Anxiety scores did not reciprocally explain changes in subjective cognitive symptoms. Objective cognitive abilities are more strongly associated with depression at 6-months post-stroke, while subjective cognitive symptoms are more relevant to both long-term post-stroke depression and anxiety. There may be a unique unidirectional influence of subjective cognitive symptoms to post-stroke depression and anxiety.
Semantic memory navigation in HIV: Conceptual associations and word selection patterns
Gattei CA, Ferrante FJ, Sampedro B, Sterpin L, Abusamra V, Abusamra L, Cañataro PA and García AM
This proof-of-concept study aimed to characterize semantic memory profiles in individuals with human immunodeficiency virus (HIV) and mild neurocognitive impairment. Using a semantic relatedness task, we explored conceptual association and word selection patterns in people living with HIV (PLWH;  = 50) relative to people living without HIV ( = 46). We also studied whether word selection patterns in the PLWH group were associated with working memory capacity, cognitive flexibility and inhibitory control. While accuracy did not differ between groups, PLWH produced significantly longer responses than controls ( = .32), with fewer hypernyms ( = .47), more troponyms ( = .37), and words that were more frequent ( = .39) and had more phonological neighbors ( = .22). These patterns survived covariation with participants' cognitive status. None of these patterns correlated with measures of working memory, cognitive flexibility, inhibitory control or viral load (all correlation coefficients .36). Together, these results suggest that PLWH might use alternative word finding strategies during semantic memory navigation, irrespective of the severity of other cognitive symptoms. Such findings contribute to the characterization of cognitive deficits in HIV and to the search for novel markers of the condition.
Examining the utility of the BAARS-IV scales as embedded symptom validity indicators for adult attention-deficit/hyperactivity disorder evaluations
Finley JA, Robinson AD, Cerny BM, Ovsiew GP, Pliskin NH, Calamia M, Ulrich DM, Phillips MS and Soble JR
This study investigated whether extreme cut-scores on the Barkley Adult Attention-Deficit/Hyperactivity Disorder (ADHD) Rating Scale-Fourth Edition (BAARS-IV) self-report scales could serve as symptom overreporting indicators in adult ADHD evaluations. The sample consisted of 162 adults who underwent a neuropsychological evaluation for ADHD. Patients were classified into valid ( = 115) and invalid ( = 47) groups based on multiple criterion symptom validity tests. Overreporting cut-scores identified for each of the BAARS-IV scales demonstrated acceptable classification accuracy or better. The Current Total scale yielded the highest classification accuracy (area under the curve of .83). An optimal raw cut-score of ≥56 for this scale yielded 47% sensitivity when upholding ≥90% specificity. A cut-score of ≥31 for the Current Inattention scale (90% specificity; 47% sensitivity) and ≥29 for the Current Sluggish Cognitive Tempo scale (88% specificity; 46% sensitivity) were also relatively strong indicators of overreporting. The Current Total and Current Sluggish Cognitive Tempo scales captured nonredundant aspects of symptom validity, and using them together increased sensitivity to 57% while maintaining ≥90% specificity. Findings provide preliminary support for the criterion and construct validity of extreme cut-scores on the BAARS-IV Current Sluggish Cognitive Tempo, Current Inattention, and Current Total scales as indicators of ADHD symptom overreporting. However, employing the cut-scores from the Current Sluggish Cognitive Tempo (≥29) and Current Total (≥56) together may be the most promising way to detect overreporting. Scores above both of these cut-points should, at a minimum, prompt further investigation into the validity of a patient's reported symptoms.
A survey of practicum training practices in clinical neuropsychology
Towns SJ, Jaffe SN, Butts AM, Penna S and Whiteside DM
: While previous survey research has focused on various training constituencies such as trainees, and postdoctoral/internship supervisors, no previous survey research has examined the needs and perspectives of practicum level supervisors and training programs. This study was designed to address this limitation. These results were used in forming the North American Association of Practicum Sites in Neuropsychology (NAPSN). A 41-item survey was developed and distributed to practicum supervisors across the United States and Canada listserv. A total of 142 supervisors completed the survey; the majority were employed at academic medical centers (62%) and located in the U.S. (93%). Most participants evaluated adults (61%), while a minority evaluated children (27%), or patients across the lifespan (12%). Most respondents supervise one (44%) or two (26%) students per year and prefer advanced trainees (>90%). The majority (78%) indicated students see one case per week. The number of clinical contact hours and reports varied based on location (U.S. vs. Canada) and population (adult vs. pediatric). Supervisors found professional papers and publicly available didactics to be the most helpful resources. Commonly endorsed needs included help with policies and procedures (53%), supervising trainees from underrepresented groups (49%) and nontraditional backgrounds (44%), and access to didactics (49%). The survey provided insights into current practices and the needs of practicum supervisors. These findings will inform NAPSN's development of materials and policies to support trainees and supervisors and can guide other professionals in supporting their practicum trainees as they navigate training in neuropsychology.
Distortion errors characterise visuo-constructive performance in Huntington's disease
Di Cecca A, Ilardi CR, Della Pia F, Criscuolo C, Della Sala S and Salvatore E
Visuospatial deficits have been extensively studied in Huntington's disease (HD), particularly in relation to visuomotor integration, with less emphasis on visuo-constructive abilities. Quantitative analyses have demonstrated that individuals with HD perform worse than healthy controls (HC) but similarly to people with Alzheimer's disease (AD). The aim of the present study was to conduct a qualitative investigation of visuo-constructive abilities in both HD and AD. By employing both simple and complex tasks, we hypothesized that a qualitative analysis of performance would reveal a distinct pattern of errors specific to HD. Participants for this study were identified retrospectively. The sample included 41 individuals with HD, 25 with AD, and 35 HC. All participants underwent a neuropsychological battery, which included the Constructional Apraxia Test (CAT) and the Rey-Osterrieth Complex Figure (ROCF) test. Our results showed no significant quantitative difference in visuo-constructive performance between the two patient groups. However, distinct qualitative patterns of drawing errors emerged. Simplifications were more frequent in the AD group, while distortions were distinctive errors in the HD group. These qualitative error patterns were consistent across both the CAT and ROCF. Our study emphasises the value of qualitative analysis in interpreting visuo-constructive performance, shifting the focus from "how much" a participant achieves to "how" they perform a neuropsychological task. This qualitative approach is useful to capture the complexity and variability of individual performance, providing deeper insight into the cognitive processes affected by different neurological conditions.
Correction
Exploring the relationship between cognition and mental health in intersex participants in the UK Biobank study
Reineberg AE, Eckstrand KL and Flatt JD
The physical and mental health of intersex individuals is woefully understudied. A recent survey of intersex individuals found high rates of self-reported cognitive issues such as difficulty remembering and concentrating as well as high rates of mental health issues, such as depression and anxiety. The current study explores whether cognitive differences are observed between 353 intersex and over 400,000 non-intersex people using a latent model of cognitive tasks derived from measures in the UK (United Kingdom) Biobank study. There were no differences in intelligence between intersex people and non-intersex people. We found significantly lower executive function and processing speed in intersex individuals versus non-intersex individuals. However, after accounting for mental health differences regression and case-control matching, there were no significant differences in executive function or processing speed between intersex individuals and non-intersex individuals. Mental health differences between intersex and non-intersex individuals may account for differences in cognitive factor scores.
A clinical evaluation program to monitor neurocognitive risk in children and adolescents with sickle cell disease
Longoria JN, Schreiber JE, Potter B, Raches D, MacArthur E, Cohen D, Brazley-Rodgers M, Hankins JS and Heitzer AM
Sickle cell disease (SCD) is an inherited hematologic disorder that impacts approximately 100,000 Americans. This disease is associated with progressive organ damage, cerebral vascular accident, and neurocognitive deficits. Recent guidelines from the American Society of Hematology (ASH) recommend cognitive screening with a psychologist to help manage cerebrovascular risk and cognitive impairment in this population. SCD patients benefit from neuropsychology services and several institutions already have programs in place to monitor cognitive risk. We describe a longitudinal neurocognitive evaluation program at our institution that serves all patients with SCD, regardless of disease severity or referral question. The Sickle Cell Assessment of Neurocognitive Skills (SCANS) program was established in 2012. We outline the program's theoretical framework, timepoints for evaluation, test battery, logistics, patient demographics, integration with research programming, and multidisciplinary collaboration to support optimal outcomes. Our program has provided 716 targeted neuropsychological evaluations for patients over the last decade. Nearly 26% of patients in the program have been followed longitudinally. The most common diagnoses generated across cross-sectional and longitudinal evaluations include cognitive disorder ( = 191), attention-deficit/hyperactivity disorder ( = 75), and specific learning disorder ( = 75). Approximately 87% of patients who participated in SCANS during late adolescence successfully transitioned from pediatric to adult care. We discuss considerations for developing programming to meet the needs of this population, including tiered assessment models, timing of evaluations, scope, and reimbursement. Program models that utilize prevention-based tiered models or targeted evaluations can assist with serving large volumes of patients.
Visual tests, touch responses: Computer-based neuropsychological tools
Chervinsky AB, Barr WB, Millis SR, Veksler B, Yu M and Christiano OR
Investigate three new computer tests of visual abilities relative to traditional paper-and-pencil (P&P) tests on groups with and without cerebral neurological impairment (CNI, Non-CNI) based on MRI and EEG criteria. The new tests employ an intuitive interface with audio instructions, touch responses, non-response prompts, and videography of test behavior. The Presidents Test was designed as an achievement-related measure of visual knowledge; the Railroad Test - visual perception and delayed recognition; and the Swamp Test - visual attention. Attitudes toward testing were assessed with an original Testing Experience Questionnaire (TEQ). Of the 129 participants, 84 were women, 73 identified as non-White, average age 45.5 and education 14.3 years. Procedures included the new computer tests and a selection of standard neuropsychological measures including performance validity tests (PVT). Participants who failed two or three PVTs or had missing PVT data were excluded from main analyses, resulting in  = 115. The new computer tests demonstrated adequate reliability. Correlations and factor analyses confirmed the computer tests as functioning in accordance with design. The Presidents Test was associated with academic achievement. The Railroad and Swamp Tests were linked to visual perception and visual attention. Correlations between computer total test duration time and traditional speed of processing tasks were modest. Computer and traditional tests demonstrated similar discriminability between CNI and Non-CNI groups. TEQ indicated positive attitudes toward testing in general, and computer testing in particular. The new computer tests evaluated in this study were found to be reliable, functioned to assess the designed cognitive domains, and discriminated between CNI and Non-CNI participants similarly to the traditional neuropsychological measures. Attitudes toward computer testing were favorable.
Large-scale evidence for the validity of remote MoCA administration among people with cerebellar ataxia
Picciotto Y, Lithwick Algon A, Amit I, Vakil E and Saban W
: For over half a century, studies of rare diseases using in-person cognitive tools have faced challenges, such as long study periods and small sample sizes (e.g.  = 10). The Montreal Cognitive Assessment (MoCA) was widely employed to assess mild cognitive impairment (MCI). We aimed to validate a modified online version of the MoCA in a large sample of a rare disease (population prevalence < .01%). : First, we analyzed 20 previous findings ( = 1,377), comparing the MoCA scores between large groups of neurotypically healthy (NH;  = 837) and cerebellar ataxia (CA;  = 540), where studies were conducted in-person. Second, we administered the MoCA in-person to a group of NH ( = 41) and a large group of CA ( = 103). Third, we administered a video conferencing version of the MoCA to NH ( = 38) and a large group of CA ( = 83). : We observed no performance differences between online and in-person MoCA administration in the NH and CA groups ( > .05, = 0.001), supporting reliability. Additionally, our online CA group had lower MoCA scores than the NH group ( < .001, Hedges'  = 0.68). This result is consistent with previous studies, as demonstrated by our forest plot across 20 previous in-person findings, supporting construct validity. : The results indicate that an online screening tool is valid in a large sample of individuals with CA. Online testing is not only time and cost-effective, but facilitates disease management and monitoring, ultimately enabling early detection of MCI.
The impact of MIND diet consumption and physical activity on cognitive functioning in healthy aging older adults
Hollander M, Jariwala N, Sotelo L, Kiefer J and Gomez R
Modifiable lifestyle factors evidence great promise in reducing cognitive decline in older adults. Greater consumption to the MIND diet (Morris et al.) and increased daily physical activity (Buchman et al.) are associated with higher cognitive functioning. The interactive effects of lifestyle factors on cognition in older adults has not been investigated extensively. The present study examined the interaction between MIND diet consumption and intensity of physical activity on cognition in community-dwelling older adults. The sample included 215 older adults (159 female, 79.8; =15.5) from the Memory and Aging Project (Bennet et al.). The measures included the food frequency questionnaire (FFQ, MIND diet consumption), a portable actigraph worn 24 h a day for ten days (activity intensity), and a neuropsychological battery (cognitive variables). Controlling for age and education, multiple regression analyses revealed that MIND diet consumption significantly predicted global cognition (< .05). Physical activity significantly predicted global cognition (< .05), and processing speed (< .01). Interaction effects were significant in global cognition (< .05), and episodic memory (< .01) revealing a pattern that those with the lowest MIND diet consumption may experience greater cognitive benefits from physical activity in than those with higher diet consumption. Findings suggest that older adults who do not consume the MIND diet closely may experience greater benefit in cognitive functioning from exercise than individuals who more greatly consume the diet.
Base rates of healthy community-dwelling adults meeting criteria for traumatic encephalopathy syndrome and levels of chronic traumatic encephalopathy certainty
Karr JE and Ingram EO
The National Institute of Neurological Disorders and Stroke (NINDS) recently revised criteria for Traumatic Encephalopathy Syndrome (TES) (Katz et al.), aiming to improve the specificity of former TES criteria (Montenigro et al.) and adding methods to gauge certainty of underlying Chronic Traumatic Encephalopathy (CTE). This study examined base rates of Montenigro et al. and Katz et al. TES criteria in healthy community-dwelling adults. Participants consisted of healthy adults ( = 835;  = 48.1 ± 18.2 years-old, range = 18-85; 37.1% male; 64.1% White) without known history of neurotrauma or psychiatric or neurological conditions. The former and current TES criteria were operationalized using the NIH Toolbox Cognition, Motor, and Emotion batteries and PROMIS-29. Per Katz et al. criteria, 36.9% had symptoms Suggestive of CTE (i.e. either cognitive impairment or neurobehavioral dysregulation), 4.1% had Possible CTE (i.e. requiring cognitive impairment and two additional criteria), and 0.8% had Probable CTE (i.e. requiring cognitive impairment and three additional criteria). The requirement of cognitive impairment for Possible CTE certainty decreased the base rate of Possible CTE tenfold from Montenigro et al. criteria (40.1%). The Katz et al. criteria were met less frequently by healthy adults than the Montenigro et al. criteria. Requiring cognitive impairment and more supportive TES features when gauging CTE certainty may reduce false-positive diagnoses. This finding supports the role of neuropsychologists in the diagnosis and monitoring of patients in TES research studies. To assess specificity, future research should examine base rates of Katz et al. criteria in other psychiatric and neurological conditions.
Identifying culturally insensitive tests, stimuli, and assessment practices in neuropsychology: A survey of professionals and trainees
Wong CG, Arastu SF and Ng R
Identify culturally insensitive tests and assessment practices based on a survey of neuropsychologists and neuropsychology trainees.
Neighborhood resources are associated with neuropsychological outcomes among pediatric brain tumor survivors
Peterson RK, Choi JHS, Jacobson LA, Acharya S and King TZ
Cancer-related cognitive impairment in survivors of pediatric brain tumors is a public health concern, yet studies seldom explore the role of social determinants of health beyond treatment effects. We investigated the influence of neighborhood resources using the Child Opportunity Index (COI) on neuropsychological functioning in survivors. Intelligence (IQ) and untimed reading and math proficiency were assessed retrospectively in 190 survivors. Multiple regression analyses explored associations among the COI composite and indices (Education, Health-Environment, Social-Economic) and neuropsychological outcomes, controlling for cumulative neurological risk and treatment exposures (Neurological Predictor Scale; NPS) and parental education. Performance was on average within normal limits: IQ ( = 94.08, SD = 15.85, =.37) with 13.4% of scores below impairment thresholds; reading ( = 95.08, SD = 17.36, =.28) and math calculation ( = 91.84, SD = 18.82, =.43) with 16.92% and 20.63% of scores below impairment thresholds, respectively. Each COI domain predicted reading and IQ after controlling for NPS, parental education, and age at diagnosis; however, the Education domain was the only significant predictor of math outcomes. The COI domains significantly predicted IQ and untimed academic skills in survivors, revealing the critical role of neighborhood resources on cognition above and beyond parental education and treatment factors. This is among the first studies to illuminate the influence of neighborhood resources on cognition in survivors. Future research should examine neighborhood context, an understudied construct, with importance in the move toward precision medicine.
Neuropsychological performance labels: do patients understand?
Smetana RM, Picard EH, Parker AN, Bajo SD and Broshek DK
 Descriptive labels to communicate performance are integral in neuropsychological reports. Although the American Academy of Clinical Neuropsychology (AACN) reached consensus on standardizing uniform labels of performance, consumer understanding of these labels is unclear. This pilot prospective cohort study evaluated patient, family member, and medical provider understanding of neuropsychological performance labels.
Comparing in-home telehealth and in-person administration of neuropsychological measures in an outpatient pediatric sample during the COVID-19 pandemic
Manning MC, Vuijk PJ, Laurent E, Cook E, Braaten EB, Doyle AE and Colvin MK
Research establishing the validity of neuropsychological assessment using telehealth (teleNP) is much needed in pediatric populations. Current analyses compared performances on twelve common neuropsychological measures completed at home teleNP or in-person during the COVID-19 pandemic in 476 youth (ages 6 to 17, M 11.4 ± 3.0). No differences were found on nine measures. In-person performances on three verbal tests were ∼1 scaled score point lower (all p <.05). Post-hoc analyses showed that the in-person pandemic performances were comparable to an in-person pre-pandemic cohort (unmasked). Overall, teleNP was comparable to in-person assessment. Results indicate that teleNP administration does not result in substantially different performance in pediatric patients undergoing clinical evaluations.
Cognitive reserve in the recovery and rehabilitation of stroke and traumatic brain injury: A systematic review
Oliva G, Masina F, Hosseinkhani N, Montemurro S and Arcara G
Cognitive reserve (CR) is the brain's ability to cope with changes related to aging and/or disease. Originally introduced to explain individual differences in the clinical manifestations of dementia, CR has recently emerged as a relevant construct in stroke and traumatic brain injury (TBI). This systematic review aims to investigate whether CR could predict post-stroke and TBI clinical recovery and rehabilitation outcomes, and how different variables used to estimate CR (i.e., proxies) are related to the prognosis and effectiveness of rehabilitation in these clinical populations. A search was made in Pubmed, Embase, and PsycInfo for articles published until 12 January 2023, following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) protocol guidelines. 31 studies were included after completing all screening stages. Overall, results show that a higher CR was associated with a better prognosis and a more effective rehabilitation in most of the clinical aspects considered: cognitive functioning, functional, occupational, and socio-emotional abilities, as well as psychiatric and neurological scales. A higher CR seems to be associated with a more favorable prognosis and a better rehabilitation outcome after stroke and TBI. Results suggest that CR should be taken into account in clinical practice to make more accurate predictions about recovery and effectiveness of rehabilitation. However, some inconsistencies suggest the need for further investigations, possibly using multiple proxies for CR.
Disinhibition, rather than moderate-to-severe traumatic brain injury, moderates the impact of anger provocation on subjective emotional experience
Mendez M, Logan J, Filipčíková M, McDonald S and Wearne T
Altered reactivity to emotional stimuli is common after traumatic brain injury (TBI), which is suggested to reflect difficulties with emotion regulation. While disinhibition is common after moderate-to-severe TBI, limited research has investigated the link between disinhibition and emotional reactivity in this clinical group. The aim of this research, therefore, was to investigate the relationship between disinhibition and TBI to anger provocation.
Atypical language organization in a Spanish-speaking adolescent with drug-resistant epilepsy: a multicultural case report
Chiang JA, Winstone-Weide LK, Clarke DF and DeLeon RC
: Epilepsy disproportionally affects children from Hispanic/Latino backgrounds, particularly among those born outside the U.S. Longstanding health-related disparities associated with ethnicity (e.g. language use) further contribute to gaps in care. Neuropsychologists are beginning to outline best practices when working with non-English speakers; however, the lack of appropriately normed/validated measures for pre-surgical language evaluation is a limiting factor. This report informs practices among neuropsychologists by discussing atypical language organization in a non-English speaker using a multicultural framework and collaborative therapeutic assessment process. : The current study presents a 16-year-old, right-handed, monolingual Spanish-speaking, Latina designated female with drug-resistant focal seizures with impaired awareness. Comprehensive presurgical epilepsy workup included: CBC, video EEG, brain MRI, functional MRI, PET, MEG, baseline neuropsychological evaluation by bilingual Spanish-English providers, and Wada testing. : Neuropsychological testing revealed the most pronounced deficits in language, working memory, and processing speed domains. Functional MRI showed bilateral language activation, which Wada testing confirmed along with bilateral memory representation. : Diagnosis, treatment, surgical intervention, and post-operative status are discussed. The clinical course is examined through a multicultural lens, highlighting limitations in international health services, barriers accessing health care in the U.S., and patient-specific factors that were considered as a part of the clinical decision-making process. Targeted recommendations related to culturally-informed care are offered.