Clinical Neuropsychology Research Articles

Klinikai neuropszichológiai tesztek magyarországi normatív adatai II.

One basis of clinical neuropsychology is the application of objective, standardized measurements. Several internationally widespread measurements of memory and learning do not have normative data of the Hungarian population, hence it is crucial to provide a basis for future reference. The purpose of this study was to provide normative data about neuropsychological instruments measuring executive functions, memory and verbal learning skills in relation to demographic factors. Rey Auditory Verbal Learning Test (RAVLT), Montreal Cognitive Assessment (MoCA) and Prospective and Retrospective Memory Questionnaire (PRMQ) were administered to an adult, Hungarian representative sample (age, sex, education). Higher educated participants performed better on PRMQ, MoCA and RAVLT. Participants with primary education were identified as a risk group for poor verbal learning skills, executive functions and they committed more memory errors. Age had no significant effect on the results of PRMQ, while on MoCA and RAVLT a significant decline in performance was observed with the passage of lifetime. Females performed better in immediate and delayed recall on RAVLT. Application of the presented neuropsychological tests is recommended in clinical practice and scientific research as well. The presented normative data could be a valuable reference point for future studies and practical application, furthermore a basis for early identification of neurocognitive deficits. Orv Hetil. 2023; 164(16) 618-629.

Competencies unique to clinical neuropsychology: A consensus statement of educators, practitioners, and professional leaders in Australia

Objective: To delineate the unique role of clinical neuropsychologists in contemporary Australian clinical practice and present a comprehensive consensus-based set of clinical neuropsychology competencies to guide and standardize the training of clinical neuropsychologists. Method: Twenty-four national representatives of the clinical neuropsychology profession (71% female, M = 20.1, SD = 8.1 years clinical practice), including tertiary-level educators, senior practitioners and members of the executive committee of the peak national neuropsychology body, formed the Australian Neuropsychology Alliance of Training and Practice Leaders (ANATPL). Informed by a review of existing international competency frameworks and Australian Indigenous psychology education frameworks, a provisional set of competencies for clinical neuropsychology training and practice were developed, followed by 11 rounds of feedback and revisions. Results: The final set of clinical neuropsychology competencies achieved full consensus and falls into three broad categories: generic foundational (i.e. general professional psychology competencies applied to clinical neuropsychology); specific functional (i.e. specific to clinical neuropsychology areas of practice) competencies relevant to all career stages; and functional competencies relevant to advanced career stages. Competencies span a number of knowledge and skill-based domains including neuropsychological models and syndromes, neuropsychological assessment, neuropsychological intervention, consultation, teaching/supervision and management/administration. Conclusion: The competencies reflect recent advances in the field of clinical neuropsychology, including expanded intervention competencies, culturally-informed neuropsychological practice and use of emerging technologies. They will be available as a resource to guide curriculum development for clinical training, as well as providing a useful framework for professional practice and advocacy more broadly within the discipline of clinical neuropsychology.

Commissioning NHS Clinical Neuropsychological Services

Commissioning NHS Clinical Neuropsychological Services

Centering Culture in Neuropsychological Training, Research, and Practice

During the past “long” decade, a confluence of events raised the consciousness within the discipline that neuropsychology has inadequately addressed the needs of minoritized patients. In 2010, Rivera Mindt, Byrd, Saez, and Manly (2010) challenged the discipline to improve access to competent neuropsychological services to minoritized patients by diversifying the workforce and increasing cultural competence through multicultural training, education, and research. This issue gained traction in 2014 with the projection that the United States will become a minority majority population in 2044 (Colby & Ortman, 2014). The American Academy of Clinical Neuropsychology (AACN) responded with the 2016 Relevance 2050 initiative which argued that neuropsychology must prepare itself for this demographic change, which is both a social justice and economic issue, as the discipline would become “increasingly irrelevant in the healthcare marketplace” if it were unable to provide competent neuropsychological services to its patient population (AACN, n.d.). Twin pivotal events in 2020 catalyzed the disciplines’ social consciousness at an emotional level. First, the morbidity and mortality of the COVID-19 pandemic illuminated the gravity of health disparities for Blacks, Hispanics, and Native Americans, and ingrained racist attitudes toward Asian Americans. Second, the world witnessed the inhumane murder of George Floyd, which was just one of a string of unarmed Black citizens killed by white police officers, most often with no legal repercussions. The profundity of institutional racism could no longer be ignored.

ANNOUNCEMENT: Winners of the Eighth Annual TCN/AACN Student Project Competition

"ANNOUNCEMENT: Winners of the Eighth Annual TCN/AACN Student Project Competition." The Clinical Neuropsychologist, ahead-of-print(ahead-of-print), pp. 1–2

Cognitive issues in patients with IDH mutant gliomas: from neuroscience to clinical neuropsychology.

The understanding of cognitive symptoms in patients with IDH-Mutant gliomas (IDH-Mut) is rapidly developing. In this article, we summarize the neuroscientific knowledge base regarding the influence of IDH-Mut tumors and their treatment on cognition and provide guidance regarding the management of these symptoms in patients. We performed a review of peer reviewed publications relevant to IDH-Mut glioma and cognitive outcomes and provide an overview of the literature as well as a case example to clarify management strategies. At the time of presentation, patients with IDH-Mut gliomas have a favorable cognitive profile as compared with those with IDH-wild type (WT) tumors. The relatively low cognitive burden may reflect the slower growth rate of IDH-Mut tumors, which is less disruptive to both local and widespread neural networks. Human connectomic research using a variety of modalities has demonstrated relatively preserved network efficiency in patients with IDH-Mut gliomas as compared with IDH-WT tumors. Risk of cognitive decline from surgery can potentially be mitigated by careful integration of intra-operative mapping. Longer term cognitive risks of tumor treatment, including chemotherapy and radiation, are best managed by instituting neuropsychological assessment as part of the long-term care of patients with IDH-Mutant glioma. A specific timeline for such integrative care is provided. Given the relative recency of the IDH-mutation based classification of gliomas, as well as the long time course of this disease, a thoughtful and comprehensive strategy to studying patient outcomes and devising methods of cognitive risk reduction is required.

National survey of telehealth neuropsychology practices: current attitudes, practices, and relevance of tele-neuropsychology three years after the onset of Covid-19

Objective: Examination of current tele-neuropsychology (teleNP) practices and attitudes within the clinical neuropsychology community, conducted September – November 2022. Method: Clinical neuropsychologists in U.S. and U.S. territories were invited to participate in an online survey of teleNP practices. The final sample consisted of 326 neuropsychologists. Results: Forty-six percent of the sample indicated they currently practice teleNP. Fourteen percent of the sample not currently practicing teleNP were considering practicing teleNP. The remainder was not practicing teleNP and had no plans to (41%). Most respondents agreed that teleNP where the patient is located in clinic is generally feasible and acceptable (71%); to a lesser extent, teleNP to home was viewed as feasible and acceptable (45% agreed, while 16% rated feasibility and acceptability as neutral). Only 11% agreed that teleNP is a feasible and acceptable part of forensic neuropsychology practice. Most respondents (74%) currently engaged in teleNP either agreed or strongly agreed that teleNP enabled them to provide similar quality of care as face-to-face neuropsychology. Current practice of teleNP was positively correlated with career phase, with greater adoption among early career neuropsychologists. Current teleNP providers anticipated teleNP to permanently comprise 31–40% of their overall practice on average. Conclusions: There is variability in teleNP acceptance by setting and career phase. While hesitancy around teleNP was expressed by some, results show that the adoption of teleNP has increased over time and remains a permanent feature of practice for a substantial number of respondents three years following onset of the Covid-19 pandemic.

Characteristics of and Professional Issues Experienced by Early Career Neuropsychologists in the United States - Findings from a Survey Study.

Multiple transitions occur during the early career stage of a psychologist, perhaps to a higher extent and with more potent ramifications than subsequent career stages. However, limited information exists on the various expectations, concerns, and challenges experienced by early career psychologists (ECPs) broadly, and more specifically in clinical neuropsychology. Therefore, the Society for Clinical Neuropsychology (SCN)/Division 40's Early Career Neuropsychologist Committee developed a Needs Assessment Survey with the primary goal of identifying various training and professional development issues encountered by ECPs in clinical neuropsychology. A comprehensive survey was distributed electronically via listserv announcements and SCN communication tools (Newsletters and Neuroblasts). Data collection occurred from 29 May, 2020 to 02 August, 2020. The total sample comprised of 89 respondents (85% aged 31-40years; 83% female; 82% Caucasian, followed by 18% Asian; 3% of Hispanic ethnicity). Majority of the respondents graduated from APA-accredited doctoral programs and from postdoctoral programs that adhered to Houston Conference Guidelines. About 7% took >2years to complete their residency and about 10%-15% of ECPs expressed clear dissatisfaction with at least some aspect of their residency training. Becoming board certified in neuropsychology was the highest ranked career goal for ECPs in neuropsychology (45%), whereas 72% indicated difficulty understanding billing and insurance-related issues as the most frequently encountered professional challenge. About 57% of ECPs were concerned about maintaining work/life balance. Specific ways to aid and strengthen trainees and ECPs' professional needs are discussed with a focus on activities that can be undertaken at individual-, department-, profession-, and higher legislative-specific levels. Question: Using survey data, this study aimed to characterize early career psychologists (ECPs) training history and their current work settings, identify their needs, and understand their perspectives about challenges and expectations. Findings: Results reveal that the workforce comprising of ECPs is getting increasingly diverse, and their needs are typically focused on obtaining board certification. ECPs identified areas for improvement in their training, such as increasing their knowledge of billing and insurance, and expressed concerns about maintaining work/life balance. Importance: The Minnesota 2022 Update Conference seems like a promising platform for addressing several of the needs identified by the survey and providing updated guidelines for ECPs. Next Steps: Based on the findings, general guidelines have been proposed for state and local level organizations along with call for action to higher-level legislation.

Using a virtual environment to assess moral cognition and underlying social-cognitive processes: Two case studies

IntroductionAlthough frequently observed in neurological disorders, social-cognitive deficits, which contribute to social behavior dysfunction, remain poorly assessed in clinical neuropsychology. A new task has been developed to better screen for these deficits. ObjectivesREALSoCog was used in two case studies (SL, 41-years-old, severe head injury; DP, 66-years-old, Alzheimer's disease) in order to pretest the task sensitivity to social-cognitive deficits due to neurological disorders. MethodParticipants encountered several social situations in a virtual city allowing the assessment of (i) moral cognition, (ii) theory of mind (TOM; cognitive and affective), (iii) emotional empathy, and (iv) inappropriate behavioral intentions. SL's performance was compared to 47 young adults and DP's performance was compared to 45 older adults. ResultsResults showed incongruence in patients’ felt emotions and a clear increase in inappropriate behavioral intentions despite relatively preserved transgression detection and TOM abilities in both patients. ConclusionREALSoCog may help detect social behavioral disorders related to socio-cognitive deficits. Future studies are required for further validation.

Historical trends in reporting effect sizes in clinical neuropsychology journals: A call to venture beyond the results section.

For decades, quantitative psychologists have recommended that authors report effect sizes to convey the magnitude and potential clinical relevance of statistical associations. However, fewer than one-third of neuropsychology articles published in the early 2000s reported effect sizes. This study re-examines the frequency and extent of effect size reporting in neuropsychology journal articles by manuscript section and over time. A sample of 326 empirical articles were drawn from 36 randomly selected issues of six neuropsychology journals at 5-year intervals between 1995 and 2020. Four raters used a novel, reliable coding system to quantify the extent to which effect sizes were included in the major sections of all 326 articles. Findings showed medium-to-large increases in effect size reporting in the Methods and Results sections of neuropsychology journal articles that plateaued in recent years; however, there were only very small and nonsignificant changes in effect size reporting in the Abstract, Introduction, and Discussion sections. Authors in neuropsychology journals have markedly improved their effect size reporting in the core Methods and Results sections, but are still unlikely to consider these valuable metrics when motivating their study hypotheses and interpreting the conceptual and clinical implications of their findings. Recommendations are provided to encourage more widespread integration of effect sizes in neuropsychological research.

Innovations in Neuropsychology: Future Applications in Neurosurgical Patient Care

Over the last century, collaboration between clinical neuropsychologists and neurosurgeons has advanced the state of the science in both disciplines. These advances have provided the field of neuropsychology with many opportunities for innovation in the care of patients prior to, during, and following neurosurgical intervention. Beyond giving a general overview of how present-day advances in technology are being applied in the practice of neuropsychology within a neurological surgery department, this article outlines new developments that are currently unfolding. Improvements in remote platform, computer interface, "real-time" analytics, mobile devices, and immersive virtual reality have the capacity to increase the customization, precision, and accessibility of neuropsychological services. In doing so, such innovations have the potential to improve outcomes and ameliorate health care disparities.

Foundations of Neuropsychology: Collaborative Care in Neurosurgery

The disciplines of neuropsychology and neurosurgery have a history of partnership that has improved prognoses for patients with neurologic diagnoses that once had poor outcomes. This article outlines the evolution of this relationship and describes the current role that clinical neuropsychology has within a department of neurological surgery across the preoperative, intraoperative, and postoperative stages of treatment. Understanding the foundations of collaboration between neuropsychology and neurosurgery contextualizes present challenges and future innovations for advancing excellence along the continuum of care for all neurosurgical patients.

The Evolving Need for Neuropsychology in Neurosurgical Settings: Challenges Facing Transformative Care

Clinical neuropsychology has been a valuable asset to neurologic surgery, contributing to lateralization and localization of pathologic brain tissue, identification of eloquent cortex, and evaluation of postoperative neuropsychological functioning. Moreover, neuropsychologists provide empirically driven interventions aimed at supporting preparation and/or recovery of neurosurgery patients. Nonetheless, several challenges may limit the reliability, validity, and generalizability of the assessment data obtained and reduce the usefulness of other neuropsychological services provided. Specifically, linguistic, cultural, educational, and other biases associated with demographic characteristics can lead to a narrowed view of an individual's life experiences, which must be confronted to fulfill the mission of ensuring that all patients have access to care that is appropriate to their needs. Instead of perceiving these challenges as insurmountable barriers, such issues can be viewed as opportunities to catalyze change and foster innovation for the future of neuropsychological care in neurosurgical settings. In addition to reviewing the possible mechanisms of these obstacles, the current article offers tangible solutions at both a macro level (e.g., discipline-wide transformations) and micro level (e.g., individualized patient-centric approaches). Outlined are practical techniques to potentially improve consensus and standardization of methods, advance and globalize research, expand representativeness of measures and practices to serve diverse individuals, and increase treatment adherence through engagement of patients and their families.

Teleneuropsychology during the COVID-19 pandemic in Mexico: the perspective from a middle-income country

ABSTRACT Introduction The use of teleneuropsychology (TeleNP) increased as a result of the COVID-19 pandemic; however, there have been no studies of the benefits and difficulties with this modality in middle-income countries. This study aimed to assess the current use of TeleNP in Mexico. Method Mexican neuropsychologists were invited to participate in an online survey regarding the use of TeleNP during the COVID-19 pandemic. The survey was based on issues from a literature review and consisted of 36 questions requiring yes/no, multiple choice, or ordinal answers. The survey was created using Google Forms and asked respondents to provide informed consent. A total of 107 clinical neuropsychologists completed the survey. Results 82% of participants currently use TeleNP, and most reported learning about TeleNP through personal experience, literature research, and colleagues. Brief evaluations, delivery of results, and intervention were the principal services provided, most frequently on a home-to-home basis. Almost 30% of clinicians reported not requiring informed consent for use of the modality. Consultations included children, adolescents, and adults in similar numbers; older adults were less frequent. Technological limitations were the most frequent reason for ruling out the modality with particular patients. Perceived benefits included the ability to continue consultations despite social distancing measures, lesser risk of COVID-19 infection, and the possibility of seeing patients with limited access to neuropsychological services. Reasons for not using TeleNP included a lack of standardized instruments, not feeling comfortable with the modality, and lack of technological resources and skills. Conclusions Despite the socioeconomic differences between Mexico and high-income countries, most of our findings were similar to reports from those countries. However, technological limitations were common, and smartphones were commonly used, contrary to recommendations in the literature. The future use of TeleNP in Mexico should include formal training and ethical guidelines.

History and State of Neuropsychology in Japan: A Modest Proposal from a Clinical Psychological Perspective

Introduction: Neuropsychology is a branch of clinical psychology that specializes in brain-behavior relationships by assessing cognition, behavior, and emotion. Neuropsychology was initially developed in the United States and Europe, and their practices have shaped other countries’ practices such as Japan. However, neuropsychology in Japan also has its own unique history. Aims: The present paper aims to discuss the history, work environment and licensure, and prospects of Japanese neuropsychology by comparing them to those in the United States. Methods: Information on four topics, including 1) the history and development of neuropsychology and the license of a clinical neuropsychologist in the United States, 2) the history and current situation of neuropsychology in Japan, 3) the background and process of the licensure in clinical psychology and neuropsychology in Japan, and 4) future directions and recommendations, were gathered through literature searches, official organization websites, and personal communication with clinical psychologists and other professionals in Japan. Results: While clinical neuropsychologists in the United States have a background in clinical psychology, most of the people conducting neuropsychological assessments and research in Japan are physicians, occupational therapists, and speech-language-hearing therapists. This is believed to be due to differences in the system of health insurance, education and training, cultural factors shaping psychology practice in Japan, funding opportunities, and the research environment. Conclusion: The care of patients who have neurological injuries and illnesses is one of the most crucial tasks for clinical neuropsychologists. It is important for clinical neuropsychologists in Japan to improve their knowledge and skills in clinical psychology to match global standards.

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.

THE IMPACT OF SELECTED NEUROPSYCHOLOGICAL BRAIN DYSFUNCTIONS ON THE CRIMINAL RESPONSIBILITY OF THE PERPETRATOR

Knowledge of clinical neuropsychology is of great importance in determining the possibility of holding the perpetrator criminally responsible and determining the scope of that responsibility. In the case of head injuries, the age of the brain, neurobiological and functional plasticity, brain resources, types and depth of dysfunction, as well as the assessment of the effects of current and planned therapy are important when assessing effects of determining responsibility. Findings in the field of clinical neuropsychology may be helpful especially in determining the subjective side (intention) of the perpetrator of the prohibited act, but above all – sanity (capacity). One of the grounds for declaring lack of criminal responsibility is “another disturbance of mental functions” (Article 31(1) Polish Criminal Code (CrC), which may include many neuropsychological conditions, such as frontal lobe syndromes, temporal lobe syndromes, frontotemporal disorders, temporal lobe epilepsy, limbic thalamus disorder, or cerebellar cognitive-affective syndrome. They cause cognitive or emotional deficits that may result in abolishing or limiting to a large extent the ability to recognize the meaning of an act or to control one’s own behavior. Certain neuropsychological findings may be important in determining that an act was committed under the influence of error, for example, in the case of agnosia – that is, the inability to recognize or interpret stimuli regardless of the channel. This text will mainly present selected neuropsychological deficits and their impact on the criminal responsibility of the perpetrator in the context of Article 31 Polish Criminal Code.

2023 Meeting Schedule Society for Clinical Neuropsychology Meeting at the 131st Annual Convention of the American Psychological Association

2023 Meeting Schedule Society for Clinical Neuropsychology Meeting at the 131st Annual Convention of the American Psychological Association

Preliminary Validity of a Telephone-Based Neuropsychological Battery in a Consecutive Series of Persons with HIV Disease Referred for Clinical Evaluation.

The COVID-19 pandemic necessitated use of remote assessments by clinical neuropsychologists. Telehealth was particularly important for vulnerable groups, including persons living with HIV (PLWH); however, limited internet access can be a serious barrier to care. This study examined the preliminary validity of a telephone-based neuropsychological assessment in a clinical sample of PLWH. A consecutive series of 59 PLWH were assessed via telephone at an HIV clinic in the southern U.S. between April 2020 and July 2022. The battery included auditory-verbal neuropsychological tests of memory, attention, and executive functions, and questionnaires assessing self-reported mood and activities of daily living (ADL). Study measures demonstrated acceptable internal consistency. PLWH demonstrated worse neuropsychological performance compared with expectations derived from the normal curve and an HIV-seronegative adult sample (N = 44). PLWH assessed via telephone demonstrated similar impairment rates to that of a consecutive series of PLWH (N = 41) assessed in-person immediately prior to the pandemic. Higher telephone-based global neuropsychological scores were related to younger age, more education, better fund of knowledge, White race/ethnicity, fewer medical conditions, and fewer depression symptoms. Global neuropsychological impairment was strongly and independently associated with greater dependence in ADL domains, particularly for instrumental activities. Although telephone-based approaches to neuropsychological assessment are not ideal, these data provide support for the feasibility, internal consistency, and preliminary validity of this method in a consecutive clinical series of PLWH. The direct comparability of telephone-based and in-person neuropsychological assessments remains to be determined by prospective, counterbalanced study designs examining both PLWH and seronegative individuals.

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.