There are few attention deficit/hyperactivity disorder (ADHD)-specific symptom validity tests (SVTs) available. The revised Dissimulation ADHD scale (Ds-ADHD-r) was developed to identify noncredible reporting on the Minnesota Multiphasic Personality Inventory (MMPI). The current study examines whether the Ds-ADHD-r can identify noncredible performance and reporting in a clinical sample. : Participants ( = 113) completed neuropsychological evaluations in an university clinic, including the Conners' Adult ADHD Rating Scale (CAARS), MMPI-2-RF or MMPI-3, at least one standalone performance validity test (PVT), and at least four embedded PVTs. Noncredible groups were created based on falling above or below the cutoff on at least one PVT or falling above or below the cutoff on one SVT. Those who scored above the SVT cutoffs scored higher on both the RBS and the Ds-ADHD-r compared to those who scored below the SVT cutoffs, while PVT performance groups did not differ on either the RBS or Ds-ADHD-r. The Ds-ADHD-r demonstrated greater utility in identifying symptom overreporting when compared to the MMPI RBS. The Ds-ADHD-r did not show utility in detecting noncredible performance. In correlation analyses, the Ds-ADHD-r was more strongly correlated to MMPI F and scales as compared to FBS and RBS. : Results support the utility of the Ds-ADHD-r to detect symptom overreporting in adults seeking evaluation for ADHD, though validation in additional, more diverse samples are needed.

The goals of this project were to (1) provide demographically adjusted normative data for three performance-based tests of everyday cognition: The Everyday Problems Test, Observed Tasks of Daily Living-Revised, and Timed Instrumental Activities of Daily Living and (2) examine the relationships between test performance and traditional cognitive test scores and relevant self-report measures. A sample of 2,767 Black ( = 726) and White ( = 2,041) older adults (aged 65-94) in the ACTIVE baseline sample were included in this study. Normed scores adjusting for age, education, gender, and race were created using multivariable fractional polynomial regressions. Adjusted scores were unrelated to age, education, gender, and race. A Poisson regression was performed to predict participants' number of demographically adjusted low (<16 percentile) test scores. Higher intellectual self-efficacy (coef = -0.20), immediate memory (-0.21), reasoning (-0.25), recognition vocabulary (-0.04), and digit-symbol substitution (-0.01) significantly predicted low test scores while higher physical health related QOL (0.21) and daily activity limitations (0.10) significantly predicted low test scores ( < .01). Generally, persons with more widespread impairment on the tests evinced more cognitive, emotional, and functional problems. The three demographically adjusted scores fit excellently on a single factor, which uniquely accounted for 19%-36% of variance in the three test scores, in excess of what was already explained by the covariates, indicating the presence of reliable shared variance among the three tests that was not attributable to demographics nor any of the other covariates.

: The COVID-19 pandemic necessitated a rapid transition to tele-neuropsychology (teleNP), fundamentally altering the delivery of neuropsychological services traditionally relying on face-to-face interactions. Research indicates that teleNP assessments can yield reliable diagnostic outcomes, yet existing literature has primarily focused on non-Hispanic White populations. This is particularly concerning given the increasing diversity of the U.S. population. There remains a notable gap in the evidence regarding the validity of teleNP assessments among historically underrepresented groups, compounded by linguistic heterogeneity and the scarcity of culturally congruent neuropsychologists. This manuscript addresses this disparity by providing a framework for incorporating cultural consultation and interpretation services in teleNP. : We provide a framework for cultural consultation and interpretation services in teleNP based on an examination of literature relevant to teleNP and its impact on service delivery and the authors' clinical experience. A case study highlights practical considerations for incorporating these services. Key measures include rapport-building techniques and assessments of cultural competency in neuropsychological evaluations. The findings indicate that teleNP assessments can yield reliable diagnostic outcomes; however, there remains a significant gap in evidence regarding their validity for historically underrepresented groups. The case study demonstrates effective collaboration with cultural consultants, emphasizing their role in enhancing cultural responsiveness. Enhancing cultural competence within teleNP frameworks is essential for addressing disparities in neuropsychological care. By leveraging teleNP to provide access to culturally appropriate services, neuropsychologists can better meet the needs of diverse patient populations, promoting equitable access to mental health services and improving clinical outcomes and patient satisfaction.

Blood-based biomarkers are valued for their lower cost and less invasive nature, though issues with widespread implementation and accessibility remain. Process-based scores from story recall have been shown to detect neuronal network disturbances typical of Alzheimer's disease (AD) pathology more effectively than traditional metrics. This study examined the associations between process-based scores and concurrent plasma AD biomarkers in older adults without dementia, while also comparing them to traditional metrics. Additionally, it also investigated the diagnostic utility of these metrics in detecting plasma p-tau217 positivity. Data from 416 participants (mean age = 66.6 ± 7) free of dementia were extracted from the Wisconsin Registry for Alzheimer's Prevention (WRAP). Logical Memory Test (LMT) and plasma p-tau217, p-tau181, p-tau231, Aβ42/Aβ40 ratio, GFAP and NfL levels were analyzed. Bayesian regression models assessed associations between plasma biomarkers and both process-based and traditional LMT scores, controlling for the covariates.  The best-fitting model for plasma p-tau217 included Total ratio (Tr) and Immediate recall (BF10=573), but Tr showed stronger evidence of association (mean coefficient = 0.208; BFinclusion=14.4) than Immediate recall (mean coefficient=-0.007; BFinclusion=1.7). Tr was also the best predictor of plasma p-tau181 (mean coefficient = 0.144; BF10=10.5) and GFAP (mean coefficient = 0.141; BF10=5.8), outperforming traditional LMT scores. No memory scores were associated with plasma p-tau231 or Aβ42/40 ratio levels. Tr score was the strongest single predictor of p-tau217 positivity (BF=38).  These findings suggest that process-based memory scores might be useful in enhancing the detection of neuronal network disturbances associated with AD pathology, especially in settings where biomarker testing is unavailable.

Some studies show using neuropsychological-actuarial mild cognitive impairment (MCI) criteria may produce lower reversion rates (i.e. reverting from a cognitive diagnosis to no diagnosis) and higher associations with Alzheimer's disease biomarkers compared to conventional methods, but this has not been evaluated in a Hispanic sample. This study evaluated neuropsychological-actuarial MCI criteria performance in the Texas Alzheimer's Research and Care Consortium (TARCC) cohort compared to clinical-consensus diagnosis. Data from 2,110 TARCC participants (47% Hispanic) were utilized. McNemar tests evaluated the performance of neuropsychological-actuarial versus clinical-consensus criteria in those who remained stable or converted to dementia over 3 annual visits, stratified by ethnicity (Hispanic vs. non-Hispanic). Chi-square analysis was used to compare frequencies of ε4 allele positivity by diagnostic method. Significantly more Hispanic participants were diagnosed with MCI using neuropsychological-actuarial criteria than were non-Hispanics, χ(1) = 195.3, < .001,  = 0.32. Hispanic participants meeting neuropsychological-actuarial MCI criteria at baseline were more likely to revert at follow-up, χ(1) = 10.04, < .01,  = 0.10. No differences in reversion rate were found between Hispanic and non-Hispanic individuals with clinical-consensus MCI diagnoses, χ(1) = 0.38,  = .60. There was no association between ε4 allele positivity and neuropsychological-actuarial diagnosis, while there was an association for clinical-consensus diagnoses (1) = 15.1,  < .001,  = 0.09. In TARCC, the clinical-consensus MCI diagnostic method produced fewer cases of reversion compared to the neuropsychological-actuarial method, particularly in Hispanic participants. This is consistent with recent research investigating the use of the neuropsychological-actuarial method in African American/Black individuals. Caution is warranted when using neuropsychological-actuarial criteria among individuals with diverse backgrounds.

The association between head injury history and subjective cognitive symptoms among contact sport athletes has been frequently reported, but links between head injury history and performance-based measures have been more variable. Dispersion-based intraindividual variability (IIV) may better align with subjective cognitive concerns and be a more sensitive measure of subtle head injury-related changes. This study investigated the associations among IIV, subjective cognitive symptoms, and head injury history. Former collegiate football players ( = 57 included in analyses; age = 38 ± 1.5 years) completed evaluations consisting of neuropsychological assessment, subjective rating of cognition (Neuro-QoL Cognitive Functioning-Short Form and Behavior Rating Inventory of Executive Function-Adult; BRIEF-A), and structured interviews of head impact history (i.e. HIEE). Three IIV indices were calculated reflecting degree of dispersion across cognitive domains: Memory-IIV, reaction time/processing speed-IIV (RT/PS-IIV), and attention/executive function-IIV. General linear models were fit to test associations among IIV, subjective measures, concussion history, and Head Impact Exposure Estimate (HIEE). Greater history of concussion and RHI exposure were not significantly associated with levels of cognitive dispersion (IIV indices, 's >.05). Worse general subjective cognition was associated with greater RT/PS-IIV, and worse BRIEF-A metacognition was associated with greater memory-IIV, even when controlling for psychological distress and sleep quality. Results support the assessment of dispersion in cognitive performance as a useful objective measure that complements subjective cognitive symptoms. While IIV is clinically relevant for detecting subtle cognitive difficulties not captured by central tendency methods, it may only indirectly, if at all, relate to changes associated specifically with head injury history.

The Trail Making Test (TMT) is a widely used neuropsychological tool for assessing executive functions. This study aimed to establish regression-based normative data for TMT performance in a Turkish population aged 18-80, accounting for the effects of age, education, and sex on both basic (TMT A and TMT B) and derived scores (TMT B-A and TMT B/A). A total of 462 participants were recruited, with 409 included in the final analysis after applying exclusion criteria. Participants completed the international version of the TMT. Pearson correlation analyses and multiple linear regression models assessed relationships between TMT scores and demographic variables. Education was treated as a continuous variable, and regression-based norms were developed for all TMT scores. Age and education were significant predictors of TMT performance. Age primarily affected TMT A scores, while education was the strongest predictor for TMT B, TMT B-A, and TMT B/A scores. The regression models explained 36-38% of the variance in basic scores and 6-24% in derived scores. Women performed better than men on the TMT B/A ratio score, but overall, sex had a less pronounced effect than age and education. This study provides the first regression-based normative data for the TMT in a Turkish population. These norms are crucial for improving the accuracy of neuropsychological assessments in Turkey and facilitating cross-cultural comparisons in cognitive research. The findings emphasize the importance of adjusting for demographic factors in clinical and research settings to ensure precise evaluations of cognitive functioning.

: To evaluate the accuracy and reliability of ChatGPT 4 Omni in diagnosing neurocognitive disorders using comprehensive clinical data and compare its performance to previous versions of ChatGPT. : This project utilized a two-part design: Study 1 examined diagnostic agreement between ChatGPT 4 Omni and clinicians using a few-shot prompt approach, and Study 2 compared the diagnostic performance of ChatGPT models using a zero-shot prompt approach using data from the National Alzheimer's Coordinating Center (NACC) Uniform Data Set 3. Study 1 included 12,922 older adults ( = 69.13,  = 9.87), predominantly female (57%) and White (80%). Study 2 involved 537 older adults ( = 67.88,  = 9.52), majority female (57%) and White (81%). Diagnoses included no cognitive impairment, amnestic mild cognitive impairment (MCI), nonamnestic MCI, and dementia. : In Study 1, ChatGPT 4 Omni showed fair association with clinician diagnoses (χ2 (9) = 6021.96, < .001; κ = .33). Notable predictive measures of agreement included the MoCA and memory recall tests. ChatGPT 4 Omni demonstrated high internal reliability (α = .96). In Study 2, no significant diagnostic agreement was found between ChatGPT versions and clinicians. : Although ChatGPT 4 Omni shows potential in aligning with clinician diagnoses, its diagnostic accuracy is insufficient for clinical application without human oversight. Continued refinement and comprehensive training of AI models are essential to enhance their utility in neuropsychological assessment. With rapidly developing technological innovations, integrating AI tools in clinical practice could soon improve diagnostic efficiency and accessibility to neuropsychological services.

Few normative data for unsupervised, remotely-administered computerized cognitive measures are available. We examined variables to include in normative models for Mayo Test Drive (MTD, a multi-device remote cognitive assessment platform) measures, developed normative data, and validated the norms. 1240 Cognitively Unimpaired (CU) adults ages 32-100 years (96% White) from the Mayo Clinic Study of Aging and Mayo Alzheimer's Disease Research Center with Clinical Dementia Rating of 0 were included. We converted raw scores to normalized scaled scores and derived regression-based normative data adjusting for age, age, sex, and education (base model); alternative norms are also provided (age + age + sex; age + age). We assessed additional terms using an cut-off of 1% variance improvement above the base model. We examined low test performance rates (< -1 ) in independent validation samples ( = 167 CU,  = 64 mild cognitive impairment (MCI),  = 14 dementia). Rates were significantly different when 95% confidence intervals (CI) did not include the expected 14.7% base rate. No model terms met the cut-off beyond the base model, including device type, response input source (e.g. mouse, etc.), or session interference. Norms showed expected low performance rates in CU and greater rates of low performance in MCI and dementia in independent validation samples. Typical normative models appear appropriate for remote self-administered MTD measures and are sensitive to cognitive impairment. Device type and response input source did not explain enough variance for inclusion in normative models but are important for individual-level interpretation. Future work will increase the inclusion of individuals from under-represented groups.

We assessed the reliability of home-based video teleneuropsychology (TeleNP) compared to face-to-face (FF) neuropsychological assessments in clinic-referred patients for whom a typical or atypical Alzheimer's disease (AD) syndrome was on the neurologist's differential diagnosis.

The Hopkins Verbal Learning Test-Revised (HVLT-R) is widely used for assessing episodic memory. In this study, we evaluated the HVLT-R with Semantic Cues (HVLT-R-SC), an adapted version incorporating semantic cues to improve diagnostic utility. The assessment was conducted in a Spanish cohort comprising cognitively unimpaired controls, individuals with multi-domain amnestic mild cognitive impairment (md-aMCI), and early Alzheimer's disease (AD). 684 participants (333 controls, 141 md-aMCI, and 210 early AD) completed the HVLT-R-SC. Effect sizes were calculated to quantify group differences, while Cronbach's alpha was used to assess the test's reliability. Receiver Operating Characteristic curve analysis was performed to assess discriminatory power, with the Area Under the Curve (AUC) summarizing classification accuracy. Sensitivity, specificity, and efficacy percentages were reported, with optimized cutoff points determined. Odds ratios quantified the association between HVLT-R-SC performance and diagnostic group classifications. Significant differences were observed across all HVLT-R-SC indices among the groups. Total Delayed Recall with and without Semantic Cues exhibited the largest effect size (η = 0.69), with Total Delayed Recall with Semantic Cues demonstrating the highest diagnostic accuracy (AUC = 0.90 for differentiating md-aMCI from controls and 0.99 for distinguishing early AD from controls). Optimal cutoffs for Total Delayed Recall with Semantic Cues were 5 words for md-aMCI (sensitivity = 74%, specificity = 90%, efficacy = 85.44%) and 4 words for early AD (sensitivity = 93%, specificity = 97%, efficacy = 95.21%). Significant associations were observed between HVLT-R-SC performance and diagnostic classification, with an odds ratio of 26.04 for md-aMCI and 362.50 for early AD. Internal consistency was excellent (Cronbach's alpha = 0.95), indicating strong reliability of the HVLT-R-SC. The HVLT-R-SC demonstrated strong reliability and excellent diagnostic performance in identifying memory impairments. The inclusion of semantic cues improved diagnostic accuracy, provided clinically actionable cutoff points, and enhanced the test's utility, particularly for detecting md-aMCI and early AD.

At times, patients with Long COVID fail performance validity tests (PVTs) for cognitive measures and symptom validity tests (SVTs) embedded in formal personality measures. This is the first study, to our knowledge, to examine whether self-reported symptoms on the Personality Assessment Inventory (PAI) and the Modified Fatigue Impact Scale (MFIS) were related to performance validity in Long COVID patients. Participants were 175 individuals diagnosed with Long COVID who completed four PVTs, the MFIS, and the PAI. There was evidence for nots based on medical records review for 25.71% of the patients. Based on PVT performances, patients were assigned to one of three groups: Pass group (no PVT failures), Intermediate group (1 PVT failure), or Fail group (2+ PVT failures). 84.57% of participants were in the Pass group, 9.14% in the Intermediate group, and 6.29% in the Fail group. There was a not a significant difference in external incentive frequency between groups. Only one significant group difference on the PAI scales and subscales was found, with slightly greater somatization symptoms (SOM-S) reported in the Fail group relative to the Pass group ( = .03). The MFIS was not significantly different between groups. These findings suggest that PVT failure is not associated with fatigue or PAI responses, except on the somatization subscale.

Use of teleneuropsychological services has greatly increased since the beginning of the COVID-19 pandemic. The present study aimed to create normative data for a neuropsychological test battery of diverse cognitive domains in a Canadian population.

In the field of clinical neuropsychology, researchers and clinicians often use predefined criteria to determine whether there are indications of cognitive impairment. However, corrections and expected false-positive rates are typically available only for uncorrelated tests and simple consensus criteria. To present an easy-to-use and freely available online tool as a solution for scenarios involving correlated tests and composite consensus criteria, as frequently encountered in clinical neuropsychological research and practice. Our tool employs Monte Carlo simulations to account for the number of participants, thus addressing the uncertainty in estimating false positive rates with small samples. We demonstrate the tool's utility through an example involving cognitive impairment assessment in cancer patients after chemotherapy. The tool reveals considerable uncertainty in false positive rates, especially with small sample sizes, where rates may be higher than traditionally assumed. We found that correlations between tests affect impairment rates differently depending on whether single or multiple test criteria are used. For single-test criteria, lower correlations are associated with more false positives, while for multiple-test criteria, lower correlations lead to fewer false positives. This innovative tool enables more accurate estimation of false positive rates in various neuropsychological conditions. By providing a user-friendly interface and accounting for real-world complexities such as test correlations and composite criteria, our tool empowers clinicians and researchers to: Make informed decisions when interpreting neuropsychological test results.Design more robust research protocols for cognitive impairment studies.Better understand the implications of sample size on false positive rates.

To examine neuropsychology education and training in Puerto Rico (PR) and identify areas of growth within neuropsychology curricula in graduate programs. A survey was conducted among 44 psychology graduate students, 21 psychologists, and 17 neuropsychologists in PR to assess interest in neuropsychology, education and training experiences, training barriers, professional affiliations, awareness of the Houston Conference Guidelines (HCG), knowledge of competitive neuropsychology internships in the United States (US), and attitudes toward neuropsychology training in PR. Comparisons were made to evaluate PR's alignment with the US HCG standards. Participants were primarily Spanish-English bilinguals completing or with doctoral degrees in clinical psychology. While APA-approved programs in PR offer foundational neuropsychology courses, clinical training opportunities are limited, resulting in few individuals acquiring HCG competencies. Most neuropsychology training occurs in private practice settings. Barriers to HCG training standards include the scarcity of neuropsychology practicums, with students often seeking education and training outside their institutions. The top professional affiliation was with the National Academy of Neuropsychology. Strengths included the number of psychotherapy hours, while research skills and consultation need improvement. Most participants reported inadequate guidance on postdoctoral training and agreed with the recognition of clinical neuropsychology as a sub-specialty in PR, alongside the development of local training guidelines. PR is advancing neuropsychology for a bilingual and bicultural population, but addressing barriers in education and training is essential. Coordinated efforts among educational institutions, the government, and professionals are crucial to enhance neuropsychological practice on the island and contribute to the global neuropsychology community.

During the COVID-19 pandemic, teleneuropsychology (teleNP) practice was quickly adopted to afford continuity of clinical care, however, the teleNP literature in children remains limited and focused on specific clinical populations and/or select test measures. Notably, attention and executive functioning are commonly assessed in neuropsychological assessments of patients with medical conditions, psychological, or educational concerns, yet few studies have offered support for teleNP administration of measures targeting these cognitive domains in children. This cross-sectional study involved a retrospective chart review of pediatric patients who underwent an in-person neuropsychological evaluation at an academic medical center before the pandemic ( = 287) or videoconference teleNP assessment during the pandemic ( = 277). The assessment battery included a test of intellectual functioning and measures indexing sustained attention or executive functioning (inhibition, set-shifting, concept formation). No effect of test modality was seen across measures of sustained attention, shifting, and abstract reasoning. TeleNP testing yielded lower inhibition, switching, and divided attention scores than in-person testing, a pattern that was observed among those with anxiety. In contrast, no effect of test modality was seen in those without anxiety. Although findings provide evidence of equivalence between remote and in-person testing for select auditory and executive functioning measures, results highlight the importance of considering anxiety. TeleNP can be an important assessment modality to expand accessibility for youth with medical and psychological concerns, however, more research is necessary to determine specific tools that are diagnostically sensitive across test modalities.

Processing speed is an important neuropsychological construct, with weaknesses evident across many pediatric medical conditions. During the COVID-19 pandemic, tele-neuropsychological evaluations were widely utilized in children with various health conditions to examine cognitive functioning as part of standard care or disease surveillance. Although remote testing afforded better access to neuropsychological care for many families, psychometric properties of tele-neuropsychological assessments, and particularly the equivalence of processing speed measures across in-person versus telehealth test modality, remain underexamined. Pediatric patients with a medical condition completed a measure of intellectual functioning and oral processing speed (verbal fluency, speeded object naming, speeded word reading) either in-person prior to the pandemic or telehealth during the pandemic. -tests or chi-squared tests examined differences in processing speed outcomes in patients by testing modality. Additionally, the impact of test modality on processing speed performance was examined across individual medical conditions to determine if remote testing may be more appropriate in the monitoring of cognition for select diagnoses. As a whole, patients performed similarly on oral processing speed measures regardless of testing modality. By medical diagnosis, pediatric oncology patients' performance was higher on a measure of speeded color naming but lower on a measure of speeded object naming when administered tele-testing. Findings suggest that oral processing speed can be assessed remotely in pediatric patients with medical conditions, though assessment in pediatric oncology patients should be further examined. Limitations and implications for practice are discussed.

The aim of this study was to create demographically-adjusted norms for Rey-Osterrieth Complex Figure Test (RCFT) for Sri Lankan adults. Four-hundred and twenty-two healthy, adult participants (age: 19-83 years, education: 5-23 years, 202 men) underwent the RCFT copy, 3-min and 30-minute-recall trials. Age- and education-stratified percentile-based norms and demographically-adjusted regression-based norms were created for copy-trial scores and recall trial scores, respectively. There was a ceiling effect of the copy scores where the maximum possible score (i.e. 36) reached between 25th and 90th percentile depending of the age and the education band. Age, years of education and sex accounted for 25.0% of the variance of the RCFT 3-min-recall scores (adjusted = 0.25,  < .0001). The age and years of education explained 25.1% of the variance of the 30-minute recall score (adjusted = 0.251,  < .0001). Age accounted for 7%-8% and years of education accounted for 10%-11% of the variances of the recall trial scores. Sex only affected the 3-min recall scores and accounted for only about 1% of the variance. No significant differences in RCFT scores were observed among different ethnic groups. These RCFT norms for Sri Lankan adults fill a hiatus in neuropsychological assessment of visuospatial construction and visual memory. The percentile tables and accompanying software-based calculator with embedded regression equations help clinicians more readily interpret individual test results and account for the RCFT performance variability introduced by demographic variables.

The analysis of risk of bias in systematic reviews (SR) and meta-analyses (MA) is a fundamental task to ensure the correct synthesis of results. To carry out this task, specific tools must be used for each research design of the studies analyzed. The choice of an appropriate tool is currently a challenge for researchers developing SR and MA in the area of symptom and performance validity because the research designs used have been created specifically for this field. Although these designs can be integrated within the classic classifications, they present a number of particular characteristics that are not reflected in any of the current risk of bias analysis tools. The aim of this study is to design a checklist specifically for systematic review/meta-analysis focused on validity tests. The checklist was developed through objective review of the existing evidence, development of checklist items, and refinement by external feedback and performance analysis. The checklist is composed of four sections: Clinical comparison group selection, sources of bias in either simulation or criterion group designs, and overall assessment of the study. Inter-rater reliability was assessed with a sample of 20 studies, resulting in good to excellent intraclass correlation coefficients for most items. The checklist seeks to fill an important gap in the literature by serving as an assessment tool that improves the reliability of evidence synthesis in symptom and performance validity studies. This instrument facilitates the development of SR and MA that meet international standards, improving methodological rigor and reliability in the forensic setting.

To investigate the ability of the Color-Word Interference Test (CWIT) from the Delis-Kaplan Executive Function System (D-KEFS) to predict noncredible neurocognitive dysfunction in a large mixed sample of personal injury litigants. Participants included 100 adults who underwent a comprehensive neuropsychological examination. Criterion groups were formed based upon their performance on stand-alone measures of cognitive performance validity (PVT). Participants failing the Word Memory Test and trial one of the Test of Memory Malingering performed significantly worse across all four CWIT trials compared to participants who passed both. Receiver operating curve characteristic analysis revealed that a Total ACSS ≤ 34 (sum total of age-corrected scaled scores across all four trials) was the best predictor of PVT status at .90 specificity and .65 sensitivity. Multivariate logistic regression did not add to classification accuracy. Noncredible executive functioning should be a consideration in personal injury litigants who score ≤ 34 across all four trials of the CWIT.

: The purpose of this American Academy of Clinical Neuropsychology (AACN) paper is to provide the neuropsychological community with the fundamentals of a competent forensic review of records. : Narrative review addressing fundamental factors related to review of records. Examples highlighted information necessary for a forensic determination of traumatic brain injury (TBI), and the data from records that can be used to address questions regarding validity of presentation. International and intra-jurisdictional perspectives within the US were used to illustrate the necessity of adhering the review to the rules. : Factors identified involve ethical responsibilities, completeness in obtaining and reviewing relevant records, evaluation of credibility of the records, considerations regarding examinee self-reporting, grounding of opinions within peer-reviewed science, determination of causation in the context of litigation, and avoiding bias in reporting, as well as consideration of cultural and language factors. Different jurisdictional rules require close attention. : Neuropsychologists need to be aware of the need for a competent review of records to obtain basic facts, maintain objectivity, and provide a context for conclusions in a neuropsychological examination report. In litigation cases, opinions based solely on review of records may be challenged for reasons that might include not having personally evaluated the plaintiff, and whether opinions meet criteria pertaining to sufficient scientific bases and facts. A thorough review in the context of examination helps deal with litigant/claimant subjectivity and malleability of self-report, and it can provide critical reasoning about other factors relevant to causation.

To produce regression-based norms for older adults on the revised Trail Making Test with alphabet support (TMT-NR3). By examining the potential modulating effects and putative interaction effects of age, education, and sex, we aim to gain insights into cognitive aging and the effects of education. Altogether, 440 healthy participants with an age-span from 70 to 92 years from the NorFAST ( = 249) and the HUNT ( = 191) studies were included. Regression-based norms for TMT-A, TMT-B, and derived measures TMT B-A, TMT B/A, and TMT-β were produced. Models were assessed for pertinent linear, curvilinear, or interaction effects of age, education, and sex. We evaluated and compared our norms to published North American TMT norms. Higher age was linearly associated with lower performance on all measures. No sex differences were found. We found a reduced positive association with education on test performance at higher age. However, this interaction effect was found to be driven by participants with low education. Our validated proposed norms showed a better fit to observed data than the existing norms. The norms were adjusted for age on all measures. Norms without age adjustment are made available for TMT B/A due to a slightly better fit of this model. The results indicate (i) that only processing speed and not set-shifting declines with age and (ii) that the selection process for education might be more important than actual education for older-age performance.

Despite significant progress in understanding the factors influencing cognitive function in Parkinson's disease (PD), there is a notable gap in data representation for the Latinx population. This study aims to evaluate the contributors to and disparities in cognitive performance among Latinx patients with PD. A retrospective analysis was conducted based on cross-sectional data encompassing demographic, environmental, motor, and non-motor disease characteristics from the Latin American Research Consortium on the Genetics of PD (LARGE-PD) and the Parkinson's Progression Markers Initiative (PPMI) cohorts. Linear regression multivariable models were applied to identify variables affecting Montreal Cognitive Assessment (MoCA) scores, accounting for age, sex, and years of education. The analysis comprised of 3,054 PD patients (2,041 from LARGE-PD and 1,013 from PPMI) and 1,303 Latinx-controls. Latinx-PD patients (mean age 63.0 ± 11.8, 56.8% male) exhibited a significantly lower average MoCA score ( < .001) compared to white Non-Hispanic PD patients from PPMI (mean age 67.5 ± 9.9, 61.7% male). This difference persisted when comparing the Latinx-PD to the Latinx-controls (mean age 58.7 ± 9.3, 33.2% male;  < .001). Factors significantly associated with better MoCA scores in Latinx-PD included unilateral symptom onset ( = .009), and higher educational attainment ( < .001). Conversely, those associated with worse scores included the use of dopamine agonists ( = .01), previous tobacco use ( = .01), older age ( < .001), and a higher Hoehn and Yahr scale score ( < .001). Latinx-PD patients demonstrated significantly lower cognitive scores compared to their white non-Hispanic PD counterparts and Latinx-controls. These results highlight the importance of interpreting MoCA scores in a nuanced manner within diverse populations.

 Cognitive impairment is a core feature of traumatic encephalopathy syndrome (TES), the putative clinical syndrome of chronic traumatic encephalopathy-a neuropathological disease associated with repetitive head impacts (RHI). Careful operationalization of cognitive impairment is essential to improving the diagnostic specificity and accuracy of TES criteria. We compared single- versus two-test criteria for cognitive impairment in their associations with CSF and imaging biomarkers in male former American football players.  169 participants from the DIAGNOSE CTE Research Project completed neuropsychological tests of memory and executive functioning. Cognitive impairment was identified by single-test criteria (≤-1.5 on one test) and two-test criteria (<-1 on two tests within a domain). ANCOVAs adjusting for age, race, education, body mass index, word-reading score, and APOE ε4 status assessed whether single- or two-test criteria predicted CSF markers (Aβ, p-tau, p-tau/Aβ, total tau, neurofilament light [NfL], glial fibrillary acidic protein [GFAP]) and MRI markers (hippocampal volume, cortical thickness, white matter hyperintensities). Ninety-nine participants met single-test criteria for cognitive impairment. Sixty-six met two-test criteria. Participants who met two-test criteria had greater exposure to RHI than those who did not (=.04). Two-test criteria were -associated with higher CSF p-tau/Aβ (=.02) and CSF NfL (=.02). The association between two-test criteria and CSF NfL remained after excluding amyloid-positive participants (=.04). Single-test criteria were not associated with any biomarkers ('s>.05).  Two-test but not single-test criteria for cognitive impairment were associated with markers of neurodegeneration. Future clinical research in TES may benefit from applying two-test criteria to operationalize cognitive impairment.

The long-recognized association of brain injury with increased risk of dementia has undergone significant refinement and more detailed study in recent decades. Chronic traumatic encephalopathy (CTE) is a specific neurodegenerative tauopathy related to prior exposure to repetitive head impacts (RHI). We aim to contextualize CTE within a historical perspective and among emerging data which highlights the scientific and conceptual evolution of CTE-related research in parallel with the broader field of neurodegenerative disease and dementia.

: We conducted a project to manage a high volume of referrals to pediatric neuropsychology. We aimed to manage referrals for children and adolescents without known medical risk factors. We proposed that a clinical neurodevelopmental interview conducted telehealth would reduce the number of patients on the waitlist and identify those who do not need neuropsychological evaluation. : We conducted clinical neurodevelopmental interviews telehealth to assess patients' need and urgency for neuropsychological testing. These patients had no or unclear risk factors and non-specific concerns with learning, attention, and/or behavior. We monitored our waitlist over a 2-year period to determine if this service could reduce our waitlist. We measured the time to initial consultation before and after this new service. We surveyed referring providers to assess their satisfaction of this service. : Using this new triage consultation service, we found that 1 in 4 children did not require a neuropsychological evaluation. This reduced our waitlist by about 5 months, even while we had an increase in referrals during the same period. After implementation, patients were seen for consultation within a month of the referral. Referring providers were generally satisfied with this service. : Implementing telehealth clinical interviews was effective in triaging healthy children with non-specific learning, attention, and/or behavior concerns. This new service effectively reduced our waitlist and offered quick access to neuropsychological consultation and recommendations. Referring providers appreciated efforts to increase access to pediatric neuropsychology services for those who were anticipated to benefit the most from such services.

Few performance validity tests exist for youth undergoing baseline testing for the management of sport-related concussion. This study provides an initial validation of a reliable span calculation from the Wechsler Intelligence Scale for Children-Fourth Edition Letter-Number Sequencing (LNS) subtest as a performance validity indicator for youth baseline testing (Reliable Letter-Number Span; RLNS). Youth athletes ( = 173) underwent baseline concussion testing for the management of sport-related concussion. We classified participants as valid ( = 153) or invalid performance ( = 20) based on several well-established performance validity tests. We calculated RLNS by summing the spans of alphanumeric characters across two items within the Letter-Number Sequencing subtest, similar to the Reliable Digit Span. To better determine the utility of RLNS, we also examined other novel reliable span metrics and established summary scores from the Letter-Number Sequencing as potential validity indicators. Analyses revealed excellent classification accuracy for RLNS, with an area under the curve of .88 (95% CI [.81, .96]). The optimal cutoff for RLNS (≤6) yielded .55 sensitivity and .95 specificity. Results showed similar but slightly lower classification accuracy statistics (areas under the curve of .77-.86) for the other LNS validity indicators. Initial findings support the criterion validity of RLNS as an embedded validity indicator. This measure is among the few extant performance validity tests that may be appropriate for youth baseline concussion testing. RLNS may also be appropriate for other types of pediatric evaluations. However, additional support is necessary before neuropsychologists can use RLNS clinically.

Exposure to repetitive head impacts (RHI), such as those experienced in American football, is linked to cognitive dysfunction later in life. Traumatic encephalopathy syndrome (TES) is a proposed clinical syndrome thought to be linked to neuropath-ology of chronic traumatic encephalopathy (CTE), a condition associated with RHI from football. Cognitive intra-individual variability (d-CIIV) measures test-score dispersion, indicating cognitive dysfunction. This study examined d-CIIV in former football players and its associations with TES diagnosis, RHI exposure, and DTI and CSF biomarkers. Data included 237 males (45-74 years) from DIAGNOSE CTE Research Project, including former professional and college football players (COL) ( = 173) and asymptomatic men without RHI or TBI ( = 55). Participants completed neuropsychological tests. TES diagnosis was based on 2021 NINDS TES criteria. Years of football play and a cumulative head impact index (CHII) measured RHI exposure. Lumipulse technology was used for CSF assays. DTI fractional anisotropy assessed white matter integrity. Coefficient of variation (CoV) measured d-CIIV. ANCOVA compared d-CIIV among groups (football versus control; TES-status). Pearson correlations and linear regressions tested associations between d-CIIV, RHI exposure, and CSF and DTI biomarkers. Former professional players had higher d-CIIV than controls (F(7, 194) = 2.87,  = .007). d-CIIV was associated with TES diagnosis (F(8, 146) = 9.063,  < .001), with highest d-CIIV in TES Possible/Probable-CTE. Higher d-CIIV correlated with higher CHII scores ( = 0.19), reduced CSF Aβ ( = -0.302), increased p-tau (= 0.374), and reduced DTI FA ( = -0.202). d-CIIV is linked to RHI exposure and TES diagnosis in former football players, with associated changes in CSF biomarkers and white matter integrity.