Practice Of Clinical Neuropsychology Research Articles

Constitutional and Judicial Foundations for Competency-Related Assessment in Criminal Forensic Neuropsychology.

Clinical neuropsychologists wishing to consult in criminal cases have ethical requirements to familiarize themselves with this specialty prior to initiating services. This paper presents foundational knowledge for professional neuropsychological consulting in cases where competence to proceed through the criminal adjudication process is in question. Reviewed are key foundations of knowledge for practice of clinical neuropsychology in relation to competency to stand trial or to proceed examinations. These foundations include a review of the criminal judicial system, relevant US Constitutional Amendments, and select mental health case law. First, Fifth, Sixth, and Fourteenth Amendments to the US Constitution establish the rights of freedom of thought, due process, freedom from self-incrimination, assistance of counsel, and equal protection. As used in criminal legal proceedings, capacity generally refers to abilities (i.e., functional capabilities), while competency is a legal determination based on a set of capacities. Although competency to proceed is assumed, Dusky v United States (1960) establishes that defendants are not competent if they lack sufficient present ability to consult with their lawyers using a reasonable degree of rational and factual understanding. Case law and statutory law establish that the loss must be due to mental disease or defect. Clinical neuropsychologists wishing to consult in criminal forensic cases have ethical requirements to become familiar with this unique consultative arena before choosing to enter. The foundational knowledge for clinical consulting within the criminal forensic context is presented to help clinical neuropsychologists begin developing authentic professional competence in the criminal forensic arena.

Humanizing neuropsychological assessment: The role of empathy

Context Recent research and the majority of neuropsychological testing manuals emphasize the importance of establishing a proper relationship between the evaluator and the evaluatee. However, there is relatively little empirical research on this point. Objectives The objective of this study was to operationalize empathy in the evaluator/evaluatee relationship during neuropsychological assessment. The subsequent aim was to determine the impact of this empathy on the evaluator/evaluatee relationship and cognitive performance. Methods The participants, designated as “evaluatees”, were randomly assigned to complete a brief neuropsychological test in either an empathic (N = 47) or neutral condition (N = 47). The neuropsychological tests included the Stroop task from the GREFEX battery, the Letter-Number Sequencing from the WAIS-IV, and the d2 test of attention. Following the tests, participants completed scales indicating perceived relationship with the evaluator, lived experience of the test, and sociodemographic information. Results The manipulation check indicated that it was possible to manipulate empathy. Evaluators demonstrating empathy led to a better evaluator/evaluatee relationship. However, the results regarding cognitive performance were less consistent. Conclusions In conclusion, there is a need for improvement in clinical neuropsychological practice with regard to relational competencies during testing. This study proposes benchmarks to make the evaluator’s empathy perceptible. This technique has not been shown to have a consistent effect on cognitive performance.

Altered Trajectories: Considering the Long-Term Impact of Educational Disruption during the COVID-19 Pandemic on Neurodevelopment and a Call to Action for Neuropsychology.

The COVID-19 pandemic resulted in educational disruption of historic breadth and duration. The impact of school closures and remote learning have been evaluated in recent studies and reflect critical data for neuropsychologists who routinely assess brain development as it relates to diagnosis, recommendations, and informing public policy. Pre-pandemic and contemporaneous literature was summarized, including data on educational disruption and child and adolescent mental health challenges reported during the pandemic, and research on the impact of stress, social isolation, educational achievement, and other factors on brain development during critical developmental windows. Studies indicate that prolonged educational disruption has resulted in attenuated learning gains, most remarkably for those already at risk for educational disparities. Studies have shown increased mental health challenges for youth during the pandemic, with higher rates of mood and eating disorders, and suicidal ideation. Given that some skills develop optimally within specific time periods, pandemic-related disruption has likely contributed to altered developmental trajectories. Trajectory of neuropsychological development of children and adolescents, especially marginalized students, may be affected by effects on learning and mental health due to prolonged educational disruption and psychological stressors. Evaluation and treatment may be delayed due to backlog and increased demand. Clinical neuropsychological practice recommendations are presented with a call to action for the field in moving forward flexibly to increase access to evaluation services.

Factor analysis of neuropsychological domains in a preschool clinic

ABSTRACT Introduction The clinical practice of preschool neuropsychology assumes that our assessment tools are measuring underlying neuropsychological functions, and that these functions are negatively impacted by early life neurological injury, disease, and disorder. This study hypothesized that general intellectual capacity and specific cognitive skills, both “broad” neuropsychological domains and “specific” subdomains within those broader clusters, would be differentiable in a preschool-age clinical population. Methods Using neuropsychological data from 580 children (6 and 71 months) seen for a clinical neuropsychological evaluation in the Preschool and Infant Neuropsychological Testing (PINT) Clinic, exploratory factor analyses (EFA) were conducted. Results: A one-factor model provided a good fit when considering verbal, nonverbal, and adaptive functions. Consideration of one- versus two-factor solutions for broad neuropsychological domains indicated that a 2-factor solution provided a significantly better fit for the data. Factor 1 was defined by motor, language, and nonverbal reasoning abilities; Factor 2 was defined by inhibitory control and attention. Further consideration of specific neuropsychological functions also supported a 2-factor solution. Factor 1 (“thinking”) was defined by nonverbal reasoning, receptive language, and expressive language; Factor 2 (“processing”) was defined by impulse control, inhibitory control, inattention, visual-motor integration, and visuo-constructional abilities. Motor skills cross-loaded onto both factors. Secondary analyses suggest these models provide the best fit for preschool-aged children with > 70 overall intellectual functioning and no comorbid medical diagnosis. Conclusions In a clinical sample of preschool-age children, neuropsychological assessment data appears to assess a general level of intellectual capacity or functioning. Further differentiation between assessing “thinking” (knowledge and reasoning skills) and “processing” (cognitive attention and processing of information) can be considered clinically. Next steps include more recent clinical sample replication, consideration of whether neuropsychological profiles are detectable in the preschool-age range and whether the results of early life assessment are predictive of future functioning.

Ethical issues in clinical neuropsychology: International diversity perspectives

Objective Much of the information about the ethical practice of clinical neuropsychology has focused on North America. Additionally, of the scholarly publications on the intersection of ethical issues and cultural diversity practices in neuropsychology, most have focused on North America. The extent to which practitioners in other parts of the world are aware of, and find useful, such information is largely unknown. Similarly, the extent to which North American neuropsychologists are familiar with ethical issues and challenges encountered around the world is unknown. The purpose of this article is to advance the discussion of ethical issues in clinical neuropsychology from an international diversity perspective. Method The article presents, via a panel interview format, the thoughts and experiences of a small sample of neuropsychologists who represent all continents except North America (and Antarctica). Results Neuropsychologists across continents share an ethical commitment to providing services that are beneficial, and not harmful, to the recipients of the services. Professional competence is at the heart of such services. Conclusions Through continued and expanded dialogue about ethical issues with neuropsychology colleagues around the world, the potential exists for improvement in the provision of effective and compassionate care in our own towns.

13 Investigating the Influence of Educational Attainment and Crystalized Verbal Skills on Verbal Fluency Performance Among Patients from a Community-Based Outpatient Neurology Clinic

Objective:Neuropsychological measures of verbal fluency help detect cognitive decline and neuropathology. The discrepancy between semantic verbal fluency and phonemic verbal fluency is commonly utilized to differentiate between cortical and subcortical processes. Understanding how other factors influence a patient’s verbal fluency scores is vital in informing clinical interpretation of neuropsychological test data. This study aimed to investigate how educational attainment and crystalized verbal skills (i.e., word reading and vocabulary) influence verbal fluency performance among a clinical sample of patients seen for neuropsychological evaluation services at a community-based outpatient neurology clinic.Participants and Methods:We utilized data from N=26 patients [mean age = 50.5 (SD = 22.0), 31% female, mean education = 13.5 (SD = 2.3)] who completed neuropsychological evaluations as part of their clinical care at an outpatient neurology clinic. Participants were included in this study if they had complete data for all variables of interest. We used Pearson correlation analyses to investigate associations between each predictor variable of interest (years of education, WRAT-5 Reading, WASI-2 Vocabulary) and age-norm corrected D-KEFS Verbal Fluency scores. Prior to analysis, all variables were converted to z-scores.Results:We found that years of education (r = 0.49, p = 0.01) and vocabulary (r = 0.41, p = 0.04) were significantly positively correlated with category fluency performance. Reading was also positively correlated with category fluency at trend level, but this association was not statistically significant (r = 0.36, p = 0.07). We found that vocabulary (r = 0.47, p = 0.02) and reading (r = 0.51, p = 0.007) were significantly positively correlated with phonemic fluency performance, while the association between education and phonemic verbal fluency performance was not significant (r = 0.27, p = 0.18).Conclusions:Our results suggest that educational attainment and crystalized verbal skills are positively associated with verbal fluency performance, though the degree of influence of these individual factors may differ for category fluency vs phonemic fluency performance. Our results have implications for the clinical practice of neuropsychology. Namely, appreciating a patient’s educational attainment and crystalized verbal skills can help guide clinical interpretation of whether or not a patient’s verbal fluency test scores reflect a decline from their baseline. This may be particularly important to consider among patients with high educational attainment or high premorbid verbal skills, as a subtle decline in their verbal fluency abilities may not be appreciated if relying only on age-based norms for interpretation. This is clinically relevant including when assessing for the early stages of neurodegenerative disorders (e.g., Alzheimer’s disease, Primary Progressive Aphasia) or for subtle changes associated with stroke or brain injury.

H - 62 Current State of the Practice of Clinical Neuropsychology in Bolivia.

The present study aimed to determine the current state of the practice of clinical neuropsychology in Bolivia. This is a descriptive and cross-sectional study. The sample consisted of 72 professionals working in the field of neuropsychology in Bolivia. The information was collected through an online questionnaire that included 70 questions about the participants' professional training, professional practice, research, teaching, and perceived barriers to the profession's development, among other factors. Approximately 76% of participants reported receiving postgraduate neuropsychology training. Their training was rated as very good (34.8%) and good (23.9%). Conversely, their clinical supervision was rated very good (24.3%) and good (33.3%). The participants indicated that their professional practice is conducted mainly in private settings (72.2%). Also, they mentioned that the most assessed disorders were learning disabilities (93.5%), intellectual disabilities (90%), and ADHD (87.5%). Similarly, the more frequent conditions rehabilitated were learning disabilities (23.6%), ADHD (20%), and depression (20.85%). Only 41.5% of the participants reported conducting research. A smaller proportion of professionals (31.5%) taught neuropsychology courses. Neuropsychology is a relatively new field of work in Bolivia. For this reason, the participants considered that to enhance the quality of this specialty in Bolivia, new graduate programs in neuropsychology must be developed, more standardized tests validated, and more job positions created, especially in public institutions. Additionally, a professional organization that regulates the standards of this field needs to be established.

Examination of the relationship between symptom and performance validity measures across referral subtypes

ABSTRACT Introduction The extent to which performance validity (PVT) and symptom validity (SVT) tests measure separate constructs is unclear. Prior research using the Minnesota Multiphasic Personality Inventory (MMPI-2 & RF) suggested that PVTs and SVTs are separate but related constructs. However, the relationship between Personality Assessment Inventory (PAI) SVTs and PVTs has not been explored. This study aimed to replicate previous MMPI research using the PAI, exploring the relationship between PVTs and overreporting SVTs across three subsamples, neurodevelopmental (attention deficit-hyperactivity disorder (ADHD)/learning disorder), psychiatric, and mild traumatic brain injury (mTBI). Methods Participants included 561 consecutive referrals who completed the Test of Memory Malingering (TOMM) and the PAI. Three subgroups were created based on referral question. The relationship between PAI SVTs and the PVT was evaluated through multiple regression analysis. Results The results demonstrated the relationship between PAI symptom overreporting SVTs, including Negative Impression Management (NIM), Malingering Index (MAL), and Cognitive Bias Scale (CBS), and PVTs varied by referral subgroup. Specifically, overreporting on CBS but not NIM and MAL significantly predicted poorer PVT performance in the full sample and the mTBI sample. In contrast, none of the overreporting SVTs significantly predicted PVT performance in the ADHD/learning disorder sample but conversely, all SVTs predicted PVT performance in the psychiatric sample. Conclusions The results partially replicated prior research comparing SVTs and PVTs and suggested that constructs measured by SVTs and PVTs vary depending upon population. The results support the necessity of both PVTs and SVTs in clinical neuropsychological practice.

Remote Neuropscyhological Assessment: Teleneuropsychology.

Teleneuropsychology, which includes the remote application of neuropsychological tests to patients via telephone or videoconferencing, can expand access to health services for patients who reside in distant areas or have mobility restrictions. With the emergence of the COVID-19 pandemic, there has been a significant increase in the use of teleneuropsychology in cognitive assessment. In this review, the aim was to critically review the results of studies conducted in the field of teleneuropsychology and the fundamental principles related to tele-neuropsychological assessment. Additionally, the "guideline for home-based teleneuropsychology" developed for Türkiye's practices is outlined in this review. A literature search was conducted using the Web of Science and PubMed databases to include all types of articles related to the subject. The results of studies on in-clinic and home-based teleneuropsychological assessment indicate that tests that assess cognitive functions such as attention, memory, executive functions, and language, particularly those based on verbal administration, can be reliably applied through teleneuropsychological assessment. However, there are factors to consider when referring patients for teleneuropsychological assessment, selecting tests for assessment, and making ethical considerations. Additionally, it is important to follow recommended steps for both the clinician and the patient and/or their caregiver before and during the interview in order for the assessment to be carried out effectively. Although direct contact with the patient is an essential element in clinical neuropsychology practice, when necessary, teleneuropsychological assessment performed by trained experts following appropriate application procedures can be a good alternative to face-to-face evaluations.

Continuing education in diversity and multicultural factors: Current state psychology board requirements and a call to action

Objective: A growing body of literature shows the unequivocal importance of incorporating diversity-related factors into the practice of clinical neuropsychology. Thus, it is imperative that we continue to seek and obtain updated training and knowledge on how culture and diversity intersect with our clinical roles throughout our careers, not merely to satisfy initial coursework requirements. Although most professional organizations pertaining to clinical psychology – and thereby neuropsychology – strongly encourage the pursuit of training in diversity-related factors, explicit requirements for such training across one’s career are minimal. Method: The Asian Neuropsychological Association Advocacy Committee reviewed continuing education (CE) requirements for all US states. Results: We found that only 8 states mandated CE credits pertaining to diversity-related factors for the renewal of licensure. Discussion: Given how inseparable cultural competence is from any aspect of clinical work (and the harm that can be done if culture is not considered), it is essential that our field shift from aspirational guidance to firm requirements with regard to cultural competence and diversity-related training in psychology. Requiring CE units devoted to diversity-related factors represents one avenue to pursue this goal. This commentary outlines the current status of diversity-related CE for psychology licensure renewal and offers future directions for incorporating such training as a part of continuing professional development and education.

Pacient se získanou poruchou řečových schopností v praxi klinického neuropsychologa, kazuistika

Poruchy řečových funkcí u dospělých pacientů jsou doprovodným symptomem u celé řady diagnostických kategorií, zejména neurologických (například neurodegenerativní onemocnění, cévní mozkové příhody). V rámci své klinické praxe se s řečovými poruchami setkává naprostá většina neuropsychologů. V našem příspěvku předkládáme kazuistiku pacienta, kde se prolínají poruchy řeči s dalšími kognitivními a behaviorálními symptomy.

REMOTE COGNITIVE STIMULATION THERAPY: CONTINUITY IN THE CONTEXT OF COVID-19 PANDEMIC IN BUENOS AIRES, ARGENTINA.

Due to the COVID-19 pandemic, clinical practice of neuropsychology has been substantially modified keeping the remote attention since then. In this work our experience in remote cognitive stimulation (RCS) for the past fifteen months and the user satisfaction during the second year of the pandemic is described. Surveys were conducted using Google Forms sent via email to patients, relatives or caregivers of patients who agreed to the RCS practice. The degree of difficulty to handle virtual platforms, and the level of satisfaction with the RCS practice were assessed through subjective report of the respondents. The survey was completed by 121 individuals (67.8% patients and 32.2% relatives). The mean age of the patients who accessed RCS was 75.3, 66.9% were women, 2.6% had incomplete primary school, 34.2% had completed primary school, 42.6% had completed secondary school, 20.6% had completed university and higher degrees. Regarding the ease of accessing the platform, 56.2.3% referred that it was easy for them. About the degree of satisfaction with the RCS, 65.3% conveyed being very pleased, and 33.1% pleased. 96.7% of those surveyed held that the practice was in accordance with their expectations and 94.2% stated that they would carry out RCS again in the future. Regarding the advantages identified, 52.1.6% recognized as an advantage avoiding the transfer, and 42.1.9% referred a greater use of time. During the second year of the pandemic we have observed that the satisfaction level regarding remote practice held the same. Patients stood out as principal benefits of it avoiding traveling and the better use of time preferring to continue with this modality. This data allows us to take a glimpse at the benefits of this modality to continue using it in the future regardless of the epidemiological situation.

A-149 Being Othered: Associations between Discrimination and Perceived Stroke Risk in Biracial persons

Abstract Objective: Separate lines of research show that biracial people experience unique racial microaggressions (Johnston & Nadal, 2010), while also having elevated stroke risk (Kissela et al., 2021). However, research is lacking on the exact quantitative relationship between discrimination and perceived stroke risk in biracial individuals. Method: Biracial people (N = 421) completed the Brief Perceived Ethnic Discrimination Questionnaire (PEDQ), the Intersectional Discrimination Index (InDI), and the Perceived Stroke Risk subscale of the ABCD Risk Questionnaire. Depression was measured via the Patient Health Questionnaire-9 (PHQ-9) as a covariate. One hierarchical linear regression was used, with depression in block 1, brief PEDQ in block 2, and the subscales of the InDI in block 3 to predict perceived stroke risk. Results: All participants were Biracial, ranging from 18-76 of age (M = 34.9, SD = 10.4). The sample was 62% non-Hispanic Biracial and 38% Hispanic Biracial. For block 1, depression was significantly and positively associated with stroke risk (β= .51, p < .001). In block 2, the Threat Harassment subscale of the PEDQ was positively and significantly associated with stroke risk (β= .42, p = .002). In block 3, anticipated (β= .168, p <.001) and major intersectional discrimination (β = .120, p = .039) were positively and significantly associated with perceived stroke risk. Discussion: Findings suggest race-based and intersectional discrimination are associated with perceived stroke risk among Biracial persons. Implications for Clinical Neuropsychology practice with Biracial people who have elevated stroke risk are discussed.

Assessment of deep brain stimulation candidacy during the COVID-19 pandemic: Lessons learned and future directions for neuropsychologists

Objective Neuropsychological assessment is integral to the pre-surgical deep brain stimulation (DBS) workup for patients with movement disorders. The COVID-19 pandemic quickly affected care access and shifted healthcare delivery, and neuropsychology has adapted successfully to provide tele-neuropsychological (teleNP) DBS evaluations during this time, thus permanently changing the landscape of neuropsychological practice. Method: In this paper, we discuss the lessons learned from the pandemic and we offer care management guidelines for teleNP and in-person evaluations of pre-DBS populations, with exploration of the feasibility of the different approaches for uninterrupted care access. Results: We summarize the strengths and weaknesses of these care models and we provide future directions for the state of clinical neuropsychological practice for DBS programs, with implications for broader patient populations. Conclusions: A better understanding of these dynamics will inform and educate the DBS team and community regarding the complexities of performing DBS neuropsychological evaluations during COVID-19 and beyond.

Effects of Intermittent Theta Burst Stimulation on the Clock Drawing Test Performances in Patients with Alzheimer's Disease.

The clock drawing test (CDT) is widely used in clinical neuropsychological practice. However, its neuroanatomical correlates have not been well established. This study investigated the effects of theta burst stimulation (TBS) applied over different brain regions on CDT scores in patients with Alzheimer's disease (AD). The 10-20 positions F3, F4, T3, T4, TP3, TP4, P3, P4, as determined by a 10-20 positioning cap, were targeted. Excitatory intermittent TBS (iTBS) was given over the above-mentioned eight regions to ten AD patients and ten control subjects on separate days. CDT was administered at baseline (T0), during the 5min following the TBS (T1) and 60min after TBS (T2), with an inter-session interval of at least 4days. iTBS over TP4 and P4 transiently increased Rouleau CDT score in AD patients. When targeting TP4 and P4, mainly the area of the supramarginal/angular gyrus and the inferior parietal lobe, corresponding respectively to the Brodmann areas 40/39 and 7/40, are reached. iTBS thus seems able to modulate activity of the right posterior parietal cortex in AD patients performing the CDT. Our results provide physiological evidence that those parietal regions are functionally important for the execution of the Rouleau CDT. This finding suggests that CDT has reliable neuroanatomical correlates, and support the notion that this test can be used as a good marker of right parietal brain dysfunction. The present study also highlights the therapeutic potential of the induction of neuromodulatory effects using non-invasive brain stimulation techniques.

Normative data for Verbal Fluency and Object Naming Tests in a sample of European Portuguese adult population

The purpose of the present study was to calculate the construct validity, internal consistency and normative data of the Phonological Verbal Fluency Test (letters F, A, S, and M), Semantic Verbal Fluency Test (Animals, Fruits and Professions categories), and Boston Naming Test (short and standard version), and to generate normative data for these tests after adjusting for age, education, and sex. A sample of 293 European Portuguese adults participated in the study. Results showed adequate construct validity and internal consistency for all of the tests and the final multiple regression models found that age and education were significantly associated with P-VFT (letters F, A, S, and M), S-VFT (Animals, Fruits and Professions categories), and BNT performance. Sex was only found to have an effect on the fruit category, with women scoring higher than men. The normative data provided in this study will contribute to improving the clinical practice of neuropsychology in Portugal.

The use of videoconferencing in clinical neuropsychology practice: A mixed methods evaluation of neuropsychologists' experiences and views

ObjectiveVideoconference technology may be a means of improving access to neuropsychological services. We investigated the use of, and views on, videoconference for clinical purposes among neuropsychologists in Australia.MethodAn online survey was completed by a convenience sample of neuropsychologists (i.e., registered psychologists working in clinical neuropsychology roles) between March and June 2018, recruited through a profession‐based email group and word‐of‐mouth. Quantitative data were analysed descriptively and open‐ended responses summarised using thematic analysis.ResultsAmong 90 eligible respondents (77 female; Mage = 39.9-years, SD = 9.6, range: 25–69; Mexperience = 9.3-years, SD = 6.3, range: 1–26), only 25 (27.8%) had used videoconference in their clinical practice. The majority of these respondents had only used it once or less than monthly. Use was particularly scarce for history taking interviews (n = 6) and assessments (n = 6). Those who had not used videoconference were less willing to try it for clinical assessments in comparison to other areas of service delivery. Five themes characterised clinicians' views on videoconference in neuropsychology: tradition, practical and resource‐related considerations, quality of the clinical service, improved service resource use and clinician convenience, and client convenience, comfort and access.ConclusionsCurrently, few neuropsychologists use videoconferencing for client consultations. Positive and negative perceptions were reported. Education, training, and directions for future research were recommended to address barriers and increase uptake of the use of videoconference in clinical neuropsychology practice.

Recurrent intracerebral hemorrhages due to central nervous system vasculitis: A neuropsychological case report

Objective Primary angiitis of the central nervous system (PACNS) is a rare and devastating form of vasculitis that destroys the vessels of the brain and spinal cord, resulting in progressive and debilitating neurologic symptoms. The objective of the present study was to detail the diagnostic process of a case of a patient with PACNS who suffered from six intracerebral hemorrhages (ICHs). Method The patient was an African American woman with a history of recurrent ICHs of unclear etiology who received serial neuropsychological evaluations over the course of a 5-year period. Two comprehensive neuropsychological evaluations are included, as well as an overview of her clinical course, including differential diagnostic considerations and treatment planning. Results Neuropsychological assessment revealed marked deficits in visuospatial abilities and processing speed associated with her underlying neuropathology. Integrated review of her medical records indicated a probable diagnosis of PACNS as the likely etiology of her recurrent ICHs. Conclusions This study demonstrates the importance of differential diagnosis of low base-rate conditions, functional neuroanatomy and neurobehavioral phenomenology, serial assessment, and cognitive reserve in clinical neuropsychological practice.

Normative data of neuropsychological tests of attention and executive functions in Ecuadorian adult population

ABSTRACT Objective: The purpose of this study was to generate normative data for five tests of attention and executive functions (M-WCST, Stroop test, TMT, BTA, and SDMT), in a group of 322 Ecuadorian adults from Quito between the ages of 18 and 85. Method: Multiple regression analyzes taking into account age, education, and gender were used to generate the normative data. Results: Age and education were significantly related to test performance such that scores decreased with age and improved as a function of education. An online calculator is provided to generate normative test scores. Conclusions: This is the first study that presents normative data for tests of executive functions and attention in an Ecuadorian adult population. This data will improve the clinical practice of neuropsychology and help to develop the field in the country.

Normative data for test of learning and memory in an ecuadorian adult population

Objective The objective of this study was to develop norms for two neuropsychological tests of learning and memory in an Ecuadorian adult population. Method 322 healthy individuals, ages between 18 and 84, were enrolled in the Metropolitan District of Quito. Participants were administered a comprehensive neuropsychological evaluation that included tests of learning and memory (Rey-Osterrieth Complex Figure Test [ROCF] and Hopkins Verbal Learning Test-Revised [HVLT-R]). Backward stepwise multiple linear regression analyses were used to examine the influence of demographic variables age, education, and gender on test performance. Normative data were developed adjusting for demographic variables found to be significant in the final regression models. Results The final multiple linear models revealed performance on tests of learning and memory worsened with age and improved as a function of education. A user-friendly Excel-based calculator is presented to calculate the z score and percentile automatically based on raw score and sociodemographic information. Conclusion This is the first study that presents normative data for tests of learning and memory for an adult population in Ecuador. It is expected that these norms will help to improve the clinical practice of neuropsychology in Ecuador by limiting erroneous raw score interpretation and incrementing diagnostic accuracy.