Computerized Neuropsychological Tests Research Articles

70 Neuropsychological Consulting in Concussion Management: Remote Models Increase Access to Care

Objective:Neuropsychological assessment is the cornerstone of concussion management, and the nature of its delivery can vary widely. While literature concerning post-concussion care typically revolves around in-person evaluation, the proliferation of computerized neuropsychological tests (CNTs) has allowed for some distance between concussion patients and the neuropsychologist. In the wake of a global pandemic, several papers describing the use of telehealth for concussion care have emerged; however, the small samples found in these studies may suggest that access to care remains an issue. Additionally, telehealth may not be a sustainable fee-for-service approach as CMS aims to curtail telehealth reimbursement for behavioral health clinicians. The objective of the present study is to describe a remote neuropsychological consultation model of concussion management and evaluate its productivity and impact in a rural setting.Participants and Methods:In this model, a neuropsychologist based at an academic medical center in the northeastern United States consulted to middle school, high school, and collegiate concussion management programs. Students typically were administered baseline ImPACT tests prior to participation in sports, and all students in the current sample completed post-injury ImPACT tests as part of return to play protocols. The neuropsychologist read test results through the test’s online portal, then communicated interpretation and recommendations via email or phone to the school’s representative (e.g., athletic trainer, athletic director, or school nurse). 837 unique concussions were recorded between 2019 and 2022. After removing abnormal cases (e.g., COVID-19 school closures, extended college breaks, non-concussions, and non-return to play decisions), 790 unique concussions (51.4% male) were included for analysis, with a mean age of 16.84 years (SD=2.17). Descriptive statistics were used to characterize the sample.Results:Across 790 unique concussions, 7 were middle school, 571 were high school, and 212 were college students. 1,750 total postinjury ImPACT tests were administered over the three-year period. Per concussion, an average of 2.22 (SD=0.90) tests were used. Average time to the last ImPACT given was 18.47 days (SD=16.59), with a median of 15 days. Ten concussions (1.27% of total concussions) occurred within 3 months of a previous injury. The distance between schools and the medical center ranged from 2.4 to 102 miles (M=60.29; SD=34.34).Conclusions:The current study suggests that there is value in a remote model of neuropsychological consultation for concussion management. While telehealth offers a promising method of evaluation for concussion, it may be inaccessible and present reimbursement challenges. The remote consultation model described here increases access to care by eliminating in-person visits, which decreases demand for physical space at medical centers and increases access to rural populations with seemingly no negative effect on care. This consultation model also allows neuropsychologists working in concussion management more flexibility, potentially increasing the volume of cases they can assess. This program evaluation suggests remote models have merit, but replication studies in different regions of the country are needed.

Neurocognitive Functioning in Adolescents at Risk for Mental Health Problems.

The main goal of the study was to assess the neurocognitive performance in adolescents at high psychometric risk for mental health problems. A sample of 48 participants at high risk for mental disorders and an age-gender matched healthy comparison group of 48 adolescents were identified from a community-derived sample of 1,509 adolescents. The Strengths and Difficulties Questionnaire problems and the University of Pennsylvania Computerized Neuropsychological Test Battery for children (included 14 tasks assessing five neurobehavioral domains: executive functions, episodic memory, complex cognition, social cognition, and sensorimotor speed) were used. Relative to healthy comparison participants, individuals at high risk showed significant impairments across almost all neurocognitive domains (executive functions, episodic memory, complex cognition, social cognition, and sensorimotor speed). These findings demonstrate that neurocognitive impairments can be shown in adolescents at high psychometric risk for mental health problems before the onset of more severe psychological problems.

Effects of an Eye-Tracking Linkage Attention Training System on Cognitive Function Compared to Conventional Computerized Cognitive Training System in Patients with Stroke.

Objective: The purpose of the study was to investigate the effects of an eye-tracking linkage attention training system on cognitive function compared to a conventional computerized cognitive training system in stroke patients with cognitive impairment. Methods: This retrospective study was enrolled 40 stroke patients who received cognitive rehabilitation. The intervention consisted of 30 sessions and 30 min per session. Before and after the intervention, we assessed cognitive functions by Mini-Mental State Examination (MMSE-K) and activities of daily living by Modified Barthel Index (K-MBI) and administered a computerized neuropsychological test (CNT). Results: In both groups, there were significant improvements in MMSE-K and K-MBI (p < 0.05). In the visual and auditory attention test of the CNT, the eye-tracking linkage attention training group was significantly improved after intervention (p < 0.05). However, there were no significant differences in the conventional computerized cognitive training group. In addition, there were significant improvements in all memory tests of the CNT in the eye-tracking linkage attention training group. However, in the conventional computerized cognitive training group, there were significant improvements in some memory tests of the CNT. Conclusions: The training of poststroke cognitive impairment patients using an eye-tracking linkage attention training system may improve visuospatial attention and may be helpful for the improvement of short-term memory and independent performances in daily life activities.

The Effectiveness of Computer-Assisted Cognitive Rehabilitation and the Degree of Recovery in Patients with Traumatic Brain Injury and Stroke.

Objectives: To determine the effectiveness of computer-assisted cognitive rehabilitation and compare the patterns of cognitive function recovery occurring in both traumatic brain injury (TBI) and stroke. Methods: A total of 62 patients were finally enrolled, consisting of 30 with TBI and 32 with stroke. The patients received 30 sessions of computer-assisted cognitive rehabilitation (Comcog) five times per week. Each session lasted for 30 min. Before and immediately after cognitive rehabilitation, all patients were evaluated by computerized neuropsychological test (CNT), Mini-Mental State Examination (MMSE), and modified Barthel index (MBI). Results: We analyzed the differences between pre- and post-cognitive rehabilitation in each TBI and stroke group. Significant differences were observed in MMSE, MBI, and some CNT contents, including digit span forward, verbal learning, verbal learning delayed recall, visual span forward, visual span backward, visual learning, trail making test A and B, and intelligence quotient (IQ) in the TBI group (p < 0.05). In the stroke group, in addition to significant differences that appeared in the TBI group, additional significant differences in the digit span backward, visual learning delayed recall, auditory continuous performance test (CPT), visual CPT, and card sorting test. We compared the difference values at pre- and post-cognitive rehabilitation for cognitive recovery between the TBI and stroke groups. All contents, except the digital span forward, visual learning, word-color test, and MMSE, had greater mean values in the stroke group; and thus, statistically significant higher values were observed in the visual span forward and card sorting test (p < 0.05). Conclusion: Most evaluation results showed improvement and the evaluation between the TBI and stroke groups also showed significant differences in cognitive functions in addition to more CNT contents, which significantly change in the stroke group. The stroke group showed a high difference value in most CNT contents. Therefore, those with stroke in the focal brain region tend to have better cognitive function recovery after a computer-assisted cognitive rehabilitation than those with TBI, which could cause diffuse brain damage and post-injury inflammation.

Neurocognitive Dysfunction According to Hypoperfusion Territory in Patients With Moyamoya Disease.

ObjectiveTo demonstrate the prevalence of cerebral hypoperfusion without focal cerebral lesions in patients with Moyamoya disease (MMD), and the relationship between areas of hypoperfusion and cognitive impairment.MethodsTwenty-six MMD patients were included. Patients were categorized according to the presence/absence of hypoperfusion in the frontal, parietal, temporal, and occipital lobes on brain single-photon-emission computed tomography (SPECT) after acetazolamide challenge. Computerized neuropsychological test (CNT) results were compared between groups.ResultsOnly 3 patients showed normal cerebral perfusion. Baseline characteristics were similar between groups. Patients with frontal lobe hypoperfusion showed lower scores in visual continuous performance test (CPT), auditory CPT, forward digit span test, backward digit span test, verbal learning test, and trail-making test. Patients with parietal lobe hypoperfusion showed lower backward digit span test, visual learning test, and trail-making test scores. Related to temporal and occipital lobes, there were no significant differences in CNT results between the hypoperfusion and normal groups.ConclusionMMD patients without focal cerebral lesion frequently exhibit cerebral hypoperfusion. MMD patients with frontal and parietal hypoperfusion had abnormal CNT profiles, similar to those with frontal and parietal lesions. It is suggested that the hypoperfusion territory on brain SPECT without focal lesion may affect the characteristics of neurocognitive dysfunction in MMD patients.

The Effects of Transcranial Direct-Current Stimulation on Cognition in Stroke Patients.

Background and PurposeTo investigate whether transcranial direct-current stimulation (tDCS) can improve cognition in stroke patients.MethodsForty-five stroke patients (20 males and 25 females, average age: 62.7 years) with cognitive dysfunction were included in this prospective, double-blinded, randomized case–control study. All patients were right-handed and the mean elapsed time after stroke was 39.3 days. Three different treatments groups were used: (1) anodal stimulation of the left anterior temporal lobe, (2) anodal stimulation of the right anterior temporal lobe, and (3) sham stimulation. tDCS was delivered for 30 minutes at 2 mA with 25 cm2 electrodes, five times/week, for a total of 3 weeks, using a Phoresor II Auto Model PM 850 (IOMED®). The evaluation of cognitive impairment was based on a Computerized Neuropsychological Test (CNT), Korean Mini-Mental State Examination (K-MMSE). The Korean version of the Modified Barthel Index (K-MBI) was used to assess activities of daily living functionality. These evaluations were conducted in all patients before and after treatment.ResultsEach group included 15 patients. Pre-treatment evaluation showed no significant differences between the three groups for any of the parameters. There was significant improvement in the verbal learning test on the CNT in the left anodal stimulation group (P < 0.05). There were, however, no significant differences in the K-MMSE or K-MBI scores among the three groups.ConclusionsThese results demonstrated the beneficial effects of anodal tDCS on memory function. Thus, tDCS can successfully be used as a treatment modality for patients with cognitive dysfunction after stroke.

FMRI and brain activation after sport concussion: a tale of two cases.

Sport-related concussions are now recognized as a major public health concern: the number of participants in sport and recreation is growing, possibly playing their games faster, and there is heightened public awareness of injuries to some high-profile athletes. However, many clinicians still rely on subjective symptom reports for the clinical determination of recovery. Relying on subjective symptom reports can be problematic, as it has been shown that some concussed athletes may downplay their symptoms. The use of neuropsychological (NP) testing has enabled clinicians to measure the effects and extent of impairment following concussion more precisely, providing more objective metrics for determining recovery. Nevertheless, there is a remaining concern that brain abnormalities may exist beyond the point at which individuals achieve recovery in self-reported symptoms and cognition measured by NP testing. Our understanding of brain recovery after concussion is important, not only from a neuroscience perspective, but also from the perspective of clinical decision-making for safe return-to-play. A number of advanced neuroimaging tools, including blood oxygen level dependent functional magnetic resonance imaging (fMRI), have independently yielded early information on abnormal brain functioning. In the two cases presented in this article, we report contrasting brain activation patterns and recovery profiles using fMRI. Importantly, fMRI was conducted using adapted versions of the most sensitive computerized NP tests administered in our current clinical practice to determine impairments and recovery after sport-related concussion. One of the cases is consistent with the concept of lagging brain recovery.

A preliminary validity study of the cambridge neuropsychological test automated battery for the assessment of executive function in schizophrenia and bipolar disorder.

ObjectiveAlthough the executive function subtests of the Cambridge Neuropsychological Test Automated Battery (CANTAB) have been used to assess cognitive function in diverse psychiatric illnesses, few studies have verified the validity of this battery for Korean psychiatric patients. Therefore, this preliminary study evaluated the construct and concurrent validity of the executive function subtests of the CANTAB for Korean psychiatric patients by comparing it with subtests of the Computerized Neuropsychological Test (CNT).MethodsThree subtests of the CANTAB and three subtests of the CNT were administered to 36 patients diagnosed with either schizophrenia or bipolar disorder. Subtests of the CANTAB included the Intra/Extra-Dimensional Set Shift (IED), Stockings of Cambridge (SOC), and Spatial Working Memory (SWM). Differences between groups on each subtest as well as correlations between the subtests of the CANTAB and the CNT were assessed.ResultsThe schizophrenia group performed significantly more poorly on the IED and the Wisconsin Card Sorting Test (WCST) compared with the bipolar disorder group. Additionally, correlation analyses revealed a significant correlation between the IED and the WCST; a positive correlation between the SOC and the Trail Making Test, Part B and the Stroop test; and a significant correlation between the SWM and the Stroop test.ConclusionThis study verified the construct and concurrent validity of the executive function subtests of the CANTAB for Korean psychiatric patients and suggests that the subtests of this battery would be useful and appropriate for assessing deficits in executive function in Korean clinical settings.

Effect of virtual reality on cognitive dysfunction in patients with brain tumor.

ObjectiveTo investigate whether virtual reality (VR) training will help the recovery of cognitive function in brain tumor patients.MethodsThirty-eight brain tumor patients (19 men and 19 women) with cognitive impairment recruited for this study were assigned to either VR group (n=19, IREX system) or control group (n=19). Both VR training (30 minutes a day for 3 times a week) and computer-based cognitive rehabilitation program (30 minutes a day for 2 times) for 4 weeks were given to the VR group. The control group was given only the computer-based cognitive rehabilitation program (30 minutes a day for 5 days a week) for 4 weeks. Computerized neuropsychological tests (CNTs), Korean version of Mini-Mental Status Examination (K-MMSE), and Korean version of Modified Barthel Index (K-MBI) were used to evaluate cognitive function and functional status.ResultsThe VR group showed improvements in the K-MMSE, visual and auditory continuous performance tests (CPTs), forward and backward digit span tests (DSTs), forward and backward visual span test (VSTs), visual and verbal learning tests, Trail Making Test type A (TMT-A), and K-MBI. The VR group showed significantly (p<0.05) better improvements than the control group in visual and auditory CPTs, backward DST and VST, and TMT-A after treatment.ConclusionVR training can have beneficial effects on cognitive improvement when it is combined with computer-assisted cognitive rehabilitation. Further randomized controlled studies with large samples according to brain tumor type and location are needed to investigate how VR training improves cognitive impairment.

Conflicts of Interest in Recommendations to Use Computerized Neuropsychological Tests to Manage Concussion in Professional Football Codes

Neuroscience research has improved our understanding of the long term consequences of sports-related concussion, but ethical issues related to the prevention and management of concussion are an underdeveloped area of inquiry. This article exposes several examples of conflicts of interest that have arisen and been tolerated in the management of concussion in sport (particularly professional football codes) regarding the use of computerized neuropsychological (NP) tests for diagnosing concussion. Part 1 outlines how the recommendations of a series of global protocols for dealing with sports-related concussions (the 1st, 2nd and 3rd Consensus Statements on Concussion in Sport) have endorsed the use of NP testing. The development of these protocols has involved experts who have links with companies that sell computerised NP tests for concussion management. Part 2 describes how some professional football leagues—in particular the National Football League (NFL), the Australian Football League (AFL) and the National Rugby League (NRL)—have mandated specific NP testing products. They have done so on the basis of these international guidelines and by engaging experts who have conflicts of interest with NP testing companies. These decisions have also been taken despite evidence that casts doubt on the reliability and validity of NP tests when used in these ways.

Normative Data in a Sample of Canadian University Athletes Using ANAM Tests

The baseline / postconcussion neuropsychological (NP) assessment model has been shown to be of clinical value and currently contributes significant information in sport concussion evaluation. Computerized NP batteries are now widely used in elite sport environments and are rapidly becoming more commonly utilized at the community level. With the growth of computerized NP testing, it is important to identify and understand unique characteristics with respect to baseline NP performance. The Automated Neuropsychological Assessment Metrics (ANAM) is a library of computerized NP tests designed to detect speed and accuracy of attention, memory, and thinking ability. This article describes baseline ANAM test scores in a sample of Canadian university athletes and explores the following two factors: (a) performance differences between male and female student-athletes using ANAM tests and (b) the relationship between self-reported history of concussion and baseline NP performance.

Characteristics of Computerized Neuropsychologic Test According to the Location of Aneurysmal Subarachnoid Hemorrhage

ObjectiveTo evaluate characteristics of cognitive impairments according to the location of aneurysmal subarachnoid hemorrhage (SAH) using a computerized neuropsychological test (CNT).MethodA total of 211 patients were transferred to our rehabilitation department after becoming neurologically stable following aneurysmal SAH. Twenty four of the 211 patients met the inclusion criteria and participated in a screening test using the mini-mental state examination (MMSE). Twenty patients with a MMSE score <26 were followed prospectively with a CNT and Beck depression inventory (BDI). Eleven patients had anterior communicating artery (ACoA) aneurysms and the other 9 had middle cerebral, internal carotid or posterior communicating artery aneurysms.ResultsThere were no differences in age, education, Hunt and Hess grade, or Fisher grade between the patients with ACoA aneurysmal SAH compared to patients with other aneurysmal SAH. In patients with ACoA aneurysmal SAH, scores of BDI (p=0.020), verbal learning test were lower than those of other aneurysmal SAH patients. In contrast, patients with non-ACoA aneurysmal SAH took significantly more time in auditory (p=0.025) and visual continuous performance tests (p=0.028). The cognitive deficit following aneurysmal SAH could be characterized by its location using CNT.ConclusionUsing CNT in aneurysmal SAH patients could be a useful tool for evaluating the characteristics of cognitive impairment and planning rehabilitation programs according to each characteristic.

Influence of Socio-Demographic Factors on SRAVEN Performance

This exploratory study aimed to investigate the influence of specific socio-demographic variables on a computerized test of non-verbal neuropsychological performance. Six hundred and thirty South African first year students were assessed using the University of Pennsylvania Computerized Neuropsychological Test Battery (PennCNP). Fluid intelligence was measured by a computerized version of the Raven's Progressive Matrices (SRAVENS). Analysis of variance indicated that gender, home language, quality of schooling, language of schooling and paternal education influenced performance on the SRAVEN. Stepwise multiple regression evidenced the importance of language, paternal education and high school language on SRAVENS responses. The assumption of non-verbal test scores as being independent of socio-demographic factors needs to be revisited as such independence cannot be maintained in light of such evidence.

Examining the stability of Automated Neuropsychological Assessment Metric (ANAM) baseline test scores

Computerized neuropsychological (NP) testing has evolved into an important tool for clinicians in the assessment of sport-related concussions. The importance of having a reliable baseline test score for comparison post concussion is critical; yet, the stability of these baseline measurements has not been well established. The purpose of this study was to examine the consistency of the measurements derived from the Automated Neuropsychological Assessment Metric (ANAM) test battery over a series of repeated trials, in an attempt to determine at what point the test scores stabilized. A cohort of 25 recreationally active collegiate students, free from mild head injury, volunteered for the study. Throughput score (measures of performance efficiency) stability was assessed for the computerized NP tests using intraclass correlation coefficients (ICCs). Average throughput scores for all five test trials were simple reaction time (SRT) = 235, matching to sample (MSP) = 41, continuous performance test (CPT) = 108, math processing (MTH) = 24, and Sternberg memory (STN) = 89, and these are within the range of those previously reported. Results show that all four of the ICCs were in the excellent range of agreement (i.e., ≥ .75), and more importantly, the statistical comparisons of the ICCs show that there was no significant difference between the ICCs. Consequently, results serve to show that two time periods are sufficient to obtain stable NP results, and thus clinicians can feel comfortable relying on a two-score baseline test for follow-up comparison.

Cytokine levels in patients (pts) with localized colorectal cancer (CRC) after surgery and their relationship to fatigue and cognitive function

3623 Background: Cytokines have been associated with fatigue and cognitive dysfunction. Here we evaluate cytokine levels in pts with CRC as part of a longitudinal study evaluating these symptoms. Methods: Serum levels of 12 cytokines were measured using a LiquiChip assay on pts with localized CRC at baseline (mean 7 weeks post-surgery or before neoadjuvant therapy), 6 and 12 months. Group A (Stage III/high risk II) received chemotherapy (CT) and group B (Stage I/II) received no CT. Pts completed concurrent questionnaires for fatigue &amp; QOL (FACT-F), anxiety/depression (GHQ), and perception of cognitive function (FACT-COG); they had neuropsychological (NP) assessment with traditional tests and CANTAB, a computerized NP battery. Associations between cytokine levels, test results, demographic and disease-related factors were sought. Results: Baseline data are available for 82 pts: 65 group A and 17 group B, with follow-up at 6 and 12 months for 32 and 15 pts. Mean age was 58 years and 68% were male. Cytokine levels were elevated in all groups with larger ranges after surgery (selected data in table ); in healthy people they are generally undetectable. There was cognitive impairment at baseline in 28% on traditional NP tests. At 6 months CT pts had more fatigue (median FACT-F 43 vs 47), perceived more cognitive impairment (median FACT-COG 127 vs 138), and had more cognitive impairment on CANTAB (42% vs 17%), but not on traditional NP tests (32% vs 33%). At 6 months, elevated cytokines (IL-1,-6,-8,-12, TNF, IFN) were associated with greater deficit on CANTAB (p&lt;0.06); there was no association of cytokines with time from surgery, traditional NP test score, FACT-COG, fatigue, QOL or anxiety &amp; depression. Conclusions: Cytokine levels were elevated in most pts. Cognitive impairment is present in some pts prior to chemotherapy and CT pts have worse impairment on computerized NP tests than non-CT pts. Elevated cytokines may be associated with worse cognitive function. [Table: see text] No significant financial relationships to disclose.