Practice Of Clinical Neuropsychology Research Articles

A Review of the Neuropsychological Effects of Commonly Used Prescription Medications

The practice of clinical neuropsychology has traditionally accorded limited attention to the impact of prescription medications on cognitive functioning. Though neuropsychologists see a wide array of patients with cerebropathologic and other organ system disease that are under pharmacotherapy, systematic attention to how these compounds potentially affect neuropsychological functioning has lagged. Psychomotor functioning, concentration, and memory are the most common cognitive domains negatively affected by such medications. In general sedative, psychomotor, and, to a lesser extent, attention/concentration effects covary and typically show tolerance with sustained drug administration. Memory effects are more resistant probably due to ongoing anticholinergic effects and the established link between the cholinergic system and memory functioning. This review covers the basic science and clinical literature addressing neuropsychological functioning both in healthy nonpatients and in patients treated with antidepressants, anxiolytics, stimulants, antihypertensives, antiepileptics and antihistamines. Critical to the understanding of the effects of these agents is the integration of multiple factors that modulate medication-induced neurocognitive effects, such as chronicity of treatment, tolerance, age, ethnicity, metabolic capacity, psychological, and neurological disorders in the patient, and the benefits of successful treatment of these disorders.

Editorial Introduction to Wilson/Prigatano Dialogue

For too many members of our discipline, the practice of clinical neuropsychology is synonymous with the administration and interpretation of specialized tests of brain functioning. We have, in fact, become quite sophisticated in the assessment of brain-disordered patients. But the development of effective programs of neuropsychological treatment (which includes, but is not limited to, “cognitive rehabilitation”) remains one of the most pressing needs and awesome challenges for clinical and research neuropsychology.

The importance of demographic adjustments on neuropsychological test performance: A response to reitan and wolf son (1995)

Recently, Reitan and Wolfson (1995) questioned the validity of using age and education adjustments in the clinical practice of neuropsychology based on a study of the effects of age and education on the General Neuropsychological Deficit Scale (GNDS) score. We critique their findings and conclusions on both theoretical and methodological grounds. We then present the results of a similar investigation on the effects of age and education on three different neuropsychological summary scores. In contrast to Reitan and Wolf-son's findings, in the present study age and education had similar effects on neuropsychological summary scores (GNDS, HII, and AIR) whether or not subjects were brain-damaged. Younger or more educated subjects consistently performed better than did older or less educated subjects. This was true even though correlations between age and education with neuropsychological summary scores were low and often statistically nonsignificant in both brain-damaged and pseudoneurologic samples. In addition, the present study demonstrated that the use of demographically adjusted neuropsychological summary scores results in consistently higher diagnostic classification accuracy than the use of nonadjusted scores.

A Comparison of Children Affected by Prenatal Alcohol Exposure and Attention Deficit, Hyperactivity Disorder

Behavioral deficits are often noted in children with fetal alcohol syndrome (FAS) and other individuals with prenatal alcohol exposure, including mental retardation, learning problems, social problems, and deficits in attention. Because attention deficit, hyperactivity disorder (ADHD) has been diagnosed so frequently in children with FAS and other alcohol related birth defects, there has been speculation that alcohol is an etiological factor in ADHD. To examine the relationship between behavior characteristics of children with fetal alcohol exposure and those seen in children with a diagnosis of ADHD, 149 low socioeconomic status (SES), African-American children (mean age = 7.63 years) were given a battery of neuropsychological and behavioral tests. One hundred and twenty-two were a sub-sample from a longitudinal study of prenatal alcohol exposure, whereas twenty-seven were identified in an ADHD Clinic. Children were given two sets of tests: (1) "traditional model" of conventional behavioral and psychiatric measures of ADHD and externalizing behavior; and (2) measures of neurocognitive functioning reflecting a four-factor model of the neurological basis of the components of attention (Mirsky AF, in Integrated Theory and Practice in Clinical Neuropsychology, Hillsdale, NJ, Lawrence Erlbaum Associates, 1989). Results indicated that children with the physical characteristics associated with prenatal alcohol exposure and those with a diagnosis of ADHD had equivalent intellectual abilities with both clinical groups performing more poorly than contrast children from the same SES and ethnic groups. However, there were clear distinctions on behavioral and neurocognitive measures between the two clinical groups with those with ADHD performing more poorly on conventional tests sensitive to attentional problems and conduct disorder. When these two groups were compared on measures designed to measure the model of the four factors of attention by Mirsky, they were noted to have distinct patterns of deficits. These results suggested that the alcohol-affected children did not have the same neurocognitive and behavioral characteristics as children with a primary diagnosis of ADHD.

A Comparison of Children Affected by Prenatal Alcohol Exposure and Attention Deficit, Hyperactivity Disorder

Behavioral deficits are often noted in children with fetal alcohol syndrome (FAS) and other individuals with prenatal alcohol exposure, including mental retardation, learning problems, social problems, and deficits in attention. Because attention deficit, hyperactivity disorder (ADHD) has been diagnosed so frequently in children with FAS and other alcohol related birth defects, there has been speculation that alcohol is an etiological factor in ADHD. To examine the relationship between behavior characteristics of children with fetal alcohol exposure and those seen in children with a diagnosis of ADHD, 149 low socioeconomic status (SES), African-American children (mean age = 7.63 years) were given a battery of neuropsychological and behavioral tests. One hundred and twenty-two were a sub-sample from a longitudinal study of prenatal alcohol exposure, whereas twenty-seven were identified in an ADHD Clinic. Children were given two sets of tests: (1) “traditional model” of conventional behavioral and psychiatric measures of ADHD and externalizing behavior; and (2) measures of neurocognitive functioning reflecting a four-factor model of the neurological basis of the components of attention (Mirsky AF, in Integrated Theory and Practice in Clinical Neuropsychology, Hillsdale, NJ, Lawrence Erlbaum Associates, 1989). Results indicated that children with the physical characteristics associated with prenatal alcohol exposure and those with a diagnosis of ADHD had equivalent intellectual abilities with both clinical groups performing more poorly than contrast children from the same SES and ethnic groups. However, there were clear distinctions on behavioral and neurocognitive measures between the two clinical groups with those with ADHD performing more poorly on conventional tests sensitive to attentional problems and conduct disorder. When these two groups were compared on measures designed to measure the model of the four factors of attention by Mirsky, they were noted to have distinct patterns of deficits. These results suggested that the alcohol-affected children did not have the same neurocognitive and behavioral characteristics as children with a primary diagnosis of ADHD.

Mental representation of knowledge following frontal-lobe or postrolandic lesions

The aims of this study were to examine the role of the prefrontal cortex in the representation of familiar activities using scripts, and to compare both Shallice's [ Phil. Trans. Roy. Soc. Lond. B. Vol. 298, pp. 199–209, 1982] and Grafman's [ Integrating Theory and Practice in Clinical Neuropsychology, pp. 93–138, Lawrence Erlbaum, Hillsdale, New Jersey, 1989] models of schematic representation of knowledge. Twelve patients with frontal-lobe damage, nine with postrolandic lesions, and 13 normal control subjects were asked to generate actions belonging to six different scripts in a forward condition, and to two others in a backward condition. The latter condition was included to test Shallice's hypothesis that damage to the frontal lobes would only affect the execution of non-routine tasks. The results showed that patients with frontal-lobe lesions produced scripts that were deprived of contextual elements and made more sequencing errors in the forward condition than matched normal control subjects, hence suggesting that the frontal cortex contributes to the production of an adequate mental representation of routine events. By contrast, the performance of the two clinical groups did not differ from the control subjects in their ability to generate scripts in the backward condition, although these three groups of subjects generated fewer actions in the latter condition. Further qualitative analyses demonstrated that patients with parietal-, but not with temporal-lobe lesions, produced sequencing errors in both forward and backward conditions. The latter findings suggest that the frontal lobes, together with the parietal cortex, may play a special role in establishing the spatio-temporal position of events within a script. The results of this study are discussed in terms of the recent models developed by Shallice and Grafman concerning the contribution of the frontal lobes in the mental representation of knowledge.

The science of practice and the practice of science: The scientist-practitioner model in clinical neuropsychology.

AbstractThe mutual leavening of, and interplay between, science and practice in clinical neuropsychology is addressed in terms of several principles that are thought to have rather general applicability. An example of these interactions in the case of the development of the syndrome of nonverbal learning disabilities and the white matter model designed to account for its developmental manifestations and dynamics is provided. It is concluded that clinical practice and the science of neuropsychology should continue to reap considerable benefit from the principles nascent in the scientist - practitioner model.IntroductionDiscussion of the interactions between science and practice on the occasion of this award arises because of two reasons: (1) my conviction that the scientist - practitioner model has been of crucial importance with respect to my own scientific and professional endeavours; and, (2) the very positive impact that it has had on the education and training of graduate students in clinical neuropsychology with whose preparation for science and professional practice I have had the privilege to be involved. The model has been useful, fruitful, and heuristic on both counts.What follows are some reflections on the dimensions of science - practice interactions that I feel are particularly important at this juncture in the evolution of Canadian psychology in general, and clinical neuropsychology in particular. They reflect my experiences as a scientist - practitioner and they articulate many of my views regarding the important dimensions of the science and practice of neuropsychology for the foreseeable future (Rourke, 1991a).A Note on FormatEach of the sections that follow begins with a statement of the principle involved; this is followed by an elaboration of it. Principles involving the scientific dimensions of practice are followed by those relating to the impact of practice on science. Hopefully, notions regarding some of the important science practice interactions nascent within these principles will emerge as a result of this exercise.The Science of PracticeRELIABILITY (CONSISTENCY)Principle 1: Replicability is one of the basic hallmarks of science. It is a sine question for scientific advances. It is obvious that considerations of reliability permeate scientific endeavours in psychology. Indeed, it is with some pride that psychologists boast of their commitment to the establishment of reliable procedures and to their objective measurement. An important step in the establishment of reliable results in psychological investigatory efforts is the adoption of a standard procedure that is well described and amenable to straightforward replication in other laboratories.The analogue of these dimensions in professional practice is the necessity for reliable assessment instruments and standardized administration and scoring protocols for them. Indeed, one would expect that virtually all aspects of assessment, including communication between practitioners, would be enhanced as a function of the extent to which standardized procedures are adopted and utilized. Of course, the measurement of the extent to which reliability is achieved should be the norm rather than the exception if confident conclusions regarding clients are to be framed.But, reliability, however well established, is not validity. This is especially troublesome for professional communications when inter - rater reliability is confused with validity. For example, consider the ordinary scenario that unfolds when a naive audience observes the machinations of a skilled illusionist. The illogical conclusions regarding cause and effect that members of the audience formulate as a result of the performances transpiring before their eyes are, in effect, a type of consensual validation; otherwise the illusionist would need to keep his day job. In any case, the point to be made here regarding replicability is simple: Reliable (i. …

Book Review: The TCN Guide to Professional Practice in Clinical Neuropsychology, edited by Kenneth M. Adams and Byron P. Rourke. Published in 1992 by Swets & Zeitlinger, BV, Amsterdam, 234 pages, $29.95 (paperback)

Book Review: The TCN Guide to Professional Practice in Clinical Neuropsychology, edited by Kenneth M. Adams and Byron P. Rourke. Published in 1992 by Swets & Zeitlinger, BV, Amsterdam, 234 pages, $29.95 (paperback)

Neuropsychological assessment in public psychiatric hospitals: The changing state of the practice--1979 to 1989

A ten-year follow-up survey of clinicians in publicly funded adult psychiatric hospitals throughout the United States was conducted to assess changes and trends in the practice of clinical neuropsychology. An 85% response rate was achieved. The survey produced data on the type and number of neuropsychological testing instruments in use, the type of training received by clinicians performing neuropsychological assessments, the psychiatric patient load and proportion of referrals which involve neuropsychological questions, the proportion of institutions employing psychologists with primarily neuropsychological duties, and the perceived efficacy of neuropsychological assessment techniques for discriminating functional from organic disorders. The findings indicate an increase in the level and variety of training as well as in the number of neuropsychological specialists in the field. However, levels of staffing appear to remain below service needs. Additional findings indicate the continued popularity of a small number of neuropsychological test batteries, a marked increase in the variety of testing instruments in use, and a general sense of trust in the efficacy of neuropsychological assessment techniques. The implications of these findings for the future of applied human neuropsychology are discussed.

A response to Mapou.

Mapou (1988) has suggested that detection of brain damage has become an irrelevant task for neuropsychology, and that neuropsychological assessment should be used to generate profiles of cognitive function useful for sophisticated diagnosis and rehabilitation. While agreeing the latter considerations are important and germane, we affirm that the detection of brain damage remains an important task for neuropsychology. This affirmation is based on considerations of the nature of brain damage, the development and validation of neuropsychological tests, the utilization of neuropsychological assessment in current practice and the appropriate professional practice of clinical neuropsychology.

Continuing education: An alternative to respecialization in clinical neuropsychology

Abstract This presentation aims to extend the concept of a Learning and Assessment Center to the establishment and maintenance of competencies for the practice of clinical neuropsychology. The resulting process would begin with an analysis of current practices in the field for the purpose of identifying competencies. After reduction into performance objectives, the necessary knowledge, skills, and attitudes for reaching performance objectives would then be specified. Standardized training protocols and modules would be developed for use at selected sites where necessary supplementary course work can be provided and where the instructional methodology necessary for communicating with individuals in the field is available. The interested trainee in the field would need access to the autotutorial technology required for relating to the central facilities and for processing the sample cases and case simulations necessary for learning. The educational materials would be replicable and exportable to virtually any site that could provide the necessary materials and time/access for the professional in the field. Any resulting modules could be articulated with sponsored conferences and workshops for the purpose of maximizing educational yield, stated in competency-based terms, in what would become a systematic and comprehensive continuing education process. By beginning with the assessment of individual needs or insufficiencies, this model could provide an alternative to respecialization as a means of adding necessary basic scientific knowledge, applied generic core competencies, and specialized clinical neuropsychological competencies for effective practice at an advanced level. The model's flexibility hopefully would serve individuals with the entire range of continuing education needs encountered in a vital and progressive new clinical specialty.

The practice of clinical neuropsychology in the United States

This paper reports the results of a survey of current members of the American Psychological Association's Division of Clinical Neuropsychology and the National Academy of Neuropsychologists on issues regarding practice. Data were compared between groups and to the findings of two 1980 surveys. Specifically, respondents were asked to include their employment setting, source and scope of practice, assessment batteries, typical fees, background training, and extent of practice outside traditional neuropsychological domains. In general, it seems that in the interim 5 years, clinical neuropsychology has experienced a shift in primary work settings. In addition, members of different professional organizations reflect similar types of response patterns to the survey, irrespective of other factors.