Neuropsychological Practice Research Articles

A-61 * Four-Hour Delayed Recall of Logical Memory

Objective: Routine neuropsychological assessment rarely includes delayed recall intervals over 30-minutes in duration, but recent studies have found that individuals with temporal lobe epilepsy may only show abnormal forgetting when longer intervals have been reached. The current study examined whether there is value in adding a 4-hour delayed recall condition to the neuropsychological assessment. Method: In the context of a private neuropsychology practice, a consecutive series of examinees with TBI ranging from mild to severe (n = 43) or with brain damage due to other causes (n = 12) were administered a full neuropsychological assessment. Four hours after the delayed recall condition, examinees were asked to recall the Logical Memory subtest of the Wechsler Memory Scale-III (WMS-III) for a third time. Results: As a percent retention score of 30-minute delayed recall, the mean 4-hour delayed recall for the entire group was 83%, (SD = 16%). There was no correlation of 4-hour retention with immediate or 30-minute delayed recall scores, or with brain injury severity. Seven individuals had 4-hour retention scores of less than 60%. This group consisted of one individual with a left hemisphere stroke, one individual with probable AD, one with a learning disability, three with mild-complicated brain injuries, and one with a mild brain injury. Conclusion(s): There is a stable retention rate for stories at a 4-hour delay, and scores falling below that level may indicate problems that would not have been detected in a routine neuropsychological assessment.

A-60 * Semantic Memory Confidence: A Correlation with Performance on the Wisconsin Card Sorting Test

Objective: Metamemory, defined as the ability to self-evaluate the capacity, accuracy, and operations of one's memory, is not routinely assessed in the standard neuropsychological examination. Metamemory is distinct from memory proficiency, with a purported neuroanatomical locus in the frontal lobes. The present study evaluated whether overconfidence regarding inaccurate semantic information, which is a type of metamemory impairment, is related to neuropsychological impairment in other domains, such as reasoning, memory, and executive functioning. Method: In the context of a private neuropsychology practice, a consecutive series of examinees with TBI ranging from mild to severe (n = 38) or with brain damage due to other causes (n = 11) were administered the Information subtest of the Wechsler Adult Intelligence Scale-III (WAIS-III) as part of a full neuropsychological assessment. After answering the questions, and without any feedback regarding their response accuracy, examinees were asked to rate their answer confidence in the order of original administration, using a seven-point Likert scale (1 = very unsure to 7 = very sure). Examinees, whose ages ranged from 19 to 71, were excluded if they displayed malingering or had a psychiatric diagnosis. Results: Correct answers were rated with more certainty than incorrect answers (p < .0001), and higher confidence for incorrect answers was significantly correlated with poorer performance on the Wisconsin Card Sorting Test (for categories completed r = −.56, p < .0001; for perseverative errors r = .47, p < .005). Conclusion(s): These findings suggests an association between compromised executive functioning and metamemory abilities in retrospective confidence judgments (RCJ).

Supervision in Neuropsychological Assessment: A Survey of Training, Practices, and Perspectives of Supervisors

Within the psychology supervision literature, most theoretical models and practices pertain to general clinical or counseling psychology. Supervision specific to clinical neuropsychology has garnered little attention. This survey study explores supervision training, practices, and perspectives of neuropsychology supervisors. Practicing neuropsychologists were invited to participate in an online survey via listservs and email lists. Of 451 respondents, 382 provided supervision to students, interns, and/or fellows in settings such as VA medical centers (37%), university medical centers (35%), and private practice (15%). Most supervisors (84%) reported supervision was discussed in graduate school “minimally” or “not at all.” Although 67% completed informal didactics or received continuing education in supervision, only 27% reported receiving training specific to neuropsychology supervision. Notably, only 39% were satisfied with their training in providing supervision and 77% indicated they would likely participate in training in providing supervision, if available at professional conferences. Results indicate that clinical neuropsychology as a specialty has paid scant attention to developing supervision models and explicit training in supervision skills. We recommend that the specialty develop models of supervision for neuropsychological practice, supervision standards and competencies, training methods in provision of supervision, and benchmark measures for supervision competencies.

Trends in the neuropsychological assessment of ethnic/racial minorities: a survey of clinical neuropsychologists in the United States and Canada.

Despite the importance of diversity variables to the clinical practice of neuropsychology, little is known about neuropsychologists' multicultural assessment practices and perspectives. The current study was the first to survey issues related to neuropsychologists' assessment of minority populations, proficiency in languages other than English, approaches to interpreting the cognitive scores of minorities, and perceived challenges associated with assessing ethnic/racial minority patients. We also surveyed respondents with regard to their own demographic backgrounds, as neuropsychologists who identify as ethnic/racial minorities are reportedly underrepresented in the field. Respondents were 512 (26% usable response rate; 54% female) doctorate-level psychologists affiliated with the International Neuropsychology Society or the National Academy of Neuropsychology who resided in the United States or Canada. Overall, results suggest that lack of appropriate norms, tests, and referral sources are perceived as the greatest challenges associated with assessment of ethnic/racial minorities, that multicultural training is not occurring for some practitioners, and that some are conducting assessments in foreign languages despite limited proficiency. In addition, ethnic/racial minorities appear to be grossly underrepresented in the field of neuropsychology. Findings are discussed in relation to the need for appropriate education and training of neuropsychologists in multicultural issues and the provision of more valid assessments for ethnic/racial minority individuals.

Assessing metacognition during a cognitive task: impact of "on-line" metacognitive questions on neuropsychological performances in a non-clinical sample.

Whereas metacognition is of great interest for neuropsychological practice, little is known about the impact of metacognitive questions during a neuropsychological assessment. This study explored the impact of measuring "on-line" metacognitive processes on neuropsychological performances in a non-clinical population. Participants were randomly assigned to a "standard" or a "metacognitive" neuropsychological test procedure. The "standard" procedure assessed executive functions (Modified Card Sorting Test), episodic memory ("Rappel libre Rappel indicé" 16), working memory (digit span test Wechsler Adult Intelligence Scale III) and social cognition (Faces Test). In the "metacognitive" procedure, two questions were added after each item of these tests to evaluate "on-line" metacognitive monitoring and control. Working memory performances were better and episodic memory performances lower in the "metacognitive" versus the "standard" procedure. No significant difference was found concerning executive functioning or social cognition. The assessment of "on-line" metacognition might improve working memory performances by enhancing concentration, and might impair episodic memory performances by acting as a distractor. These findings may have implications for the development of cognitive remediation programs.

Exploring the validity of mild cognitive impairment (MCI) subtypes: Multiple-domain amnestic MCI is the only identifiable subtype at longitudinal follow-up

Background: Epidemiological research exploring risk factors for Alzheimer’s dementia resulted in the identification of the mild cognitive impairment (MCI) profile. Subsequently, distinct subtypes of MCI have been proposed; however, the validity of these as diagnostic entities remains uncertain. Design and participants: The aim of the present study was to examine the longitudinal neuropsychological profiles of MCI subtypes. A total of 118 adults aged 60–90 years were classified at screening as amnestic (a-MCI), nonamnestic (na-MCI), and multiple-domain amnestic (a-MCI+) and were assessed at two time points across 20 months on a comprehensive neuropsychological assessment battery. Results: The a-MCI+ group displayed the poorest performance of all groups in terms of episodic memory, working memory, attention, and executive functioning. Conclusions: These findings suggest that the a-MCI+ subtype is the only variant that is recognizable via neuropsychological testing. In contrast, the differentiation between single-domain subtypes and healthy controls is difficult and may not be achievable through current neuropsychological assessment practices.

Coming of Age: Olfaction and Taste in the Practice of Neuropsychology

Coming of Age: Olfaction and Taste in the Practice of Neuropsychology

Integrating Neuropsychology and School Psychology: Potential and Pitfalls

The neurological basis of learning disabilities (LD), and other handicapping conditions commonly found in school-age children, makes the integration of neuropsychology and school psychology plausible. However, there has been longstanding debate over the required level of education, training, supervision, and credentialing needed for the practice of neuropsychology in the school and attempts at integration have thus far been controversial. Although the competent practice of school psychology requires some familiarity with neuropsychology foundations, terminology, techniques, and contributions to the understanding of disorders of childhood and adolescence, training guidelines are lacking. The demarcation between psychoeducational and neuropsychological techniques has become increasingly blurred; neuropsychology is already practiced in schools without consensus regarding training and credentialing. This paper briefly traces the history of neuropsychology in the schools from the early 1980s to the present, describing both the potential and the pitfalls for the integration of clinical child neuropsychology and school psychology, including implications for training.

Epistemological perspectives in the scientific study and evaluation of executive function.

In this article, epistemological perspectives that have shaped and affected the scientific quest for understanding what neuropsychologists term “executive functions” are reviewed. Executive functions refer to the control functions of cognition and behavior. The underlying thesis of the paper is that one’s epistemological orientation determines how one sees the interaction between brain functions and our status in the world. Each different orientation thus carries with it implications with regard to how executive functions operate, as well as how, therefore, one should try to assess them. Until recently, these functions were approached through two primary epistemological points of view. One is analytic, which has its roots in the positivistic movement. The other approach is synthetic, otherwise known as “romantic science”, and forms the basis of the work of the prominent Russian neuropsychologist A.R. Luria. A third epistemological perspective, articulated under the umbrella of ‘embodied cognition’ approaches, has been advanced in the last 20 years, and is associated most closely with the work of Francisco Varela. A review of, and reflection on how these perspectives have affected research and clinical practice in neuropsychology is provided.

Performance on Standard Indexes of Effort Among Patients with Dementia

Assessment of response validity is an integral part of neuropsychological practice. Although many studies have demonstrated the efficacy of stand alone and embedded effort measures in a variety of medical and compensation-seeking contexts, much less is known about the robustness of these measures in elderly populations, particularly in patients with dementia. Although older adults may be viewed as less likely to intentionally feign symptoms for an external gain, there are a variety of other factors that could result in suboptimal effort, including fatigue, lack of interest or cooperation in the testing process, or failure to fully appreciate the implications of the assessment on treatment care and outcome. The current study examined the clinical utility of several stand alone and embedded effort measures including the Repeatable Battery for the Assessment of Neuropsychological Status Effort Index, Trail-Making Test Ratio, Rey 15-Item Test, and the Test of Memory Malingering in a sample of patients with dementia. Results found that the majority of effort indexes demonstrated unacceptably high false-positive error rates with specificity levels as high as 83%. These findings demonstrate the need for caution in interpreting effort measure performance in dementia samples due to the fact that despite their best effort, many patients with dementia fail effort measures and are at risk for being misclassified.

Sport concussion assessment tool-second edition in an emergency department setting

ObjectiveTo investigate the clinical usefulness of the Sport Concussion Assessment Tool-Second Edition (SCAT2) in patients with mild traumatic brain injuries (MTBI).DesignA cross-sectional, descriptive study.SettingEmergency Department of Tampere University Hospital, Finland.PatientsPatients...

Intraindividual neuropsychological test variability in healthy individuals with high average intelligence and educational attainment

Knowledge of patterns of neuropsychological performance among normal, healthy individuals is integral to the practice of clinical neuropsychology, because clinicians may not always account for intraindividual variability (IIV) before coming to diagnostic conclusions. The IIV was assessed among a sample of 46 healthy individuals with high average intelligence and educational attainment, utilizing a battery of neuropsychological tests, including the Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) and Wechsler Memory Scale, Fourth Edition (WMS-IV). The data indicated substantial variability in neurocognitive abilities. All participants were found to demonstrate scores considered impaired by at least 2 standard deviations (SDs). Despite adjusting for outliers, no participant produced a “normal” testing profile with an intraindividual maximum discrepancy (MD) of less than 1 SD in either direction. When WAIS-IV Full Scale IQ (FSIQ) was considered, participants generally demonstrated cognitive test scores ranging from 2 SDs less than to 1.5 SDs greater than their FSIQ. Furthermore, after demographic corrections, the majority (59%) of participants demonstrated at least 1 impaired cognitive test score, as defined by being 1 to 1.5 SDs below the mean. Overall, results substantiate the need for clinicians to consider FSIQ and educational attainment in interpretation of neuropsychological testing results, given the relevant commonality of “abnormal” test scores within this population. This may ultimately reduce the likelihood of making false-positive conclusions of impairment when educational attainment and intelligence are high, thus improving diagnostic accuracy.

Evaluating Research for Clinical Significance: Using Critically Appraised Topics to Enhance Evidence-based Neuropsychology

Meehl’s (1973, Psychodiagnosis: Selected papers. Minneapolis: University of Minnesota Press) distinction between statistical and clinical significance holds special relevance for evidence-based neuropsychological practice. Meehl argued that despite attaining statistical significance, many published findings have limited practical value since they do not inform clinical care. In the context of an ever expanding clinical research literature, accessible methods to evaluate clinical impact are needed. The method of Critically Appraised Topics (Straus, Richardson, Glasziou, & Haynes, 2011, Evidence-based medicine: How to practice and teach EBM (4th ed.). Edinburgh: Elsevier Churchill-Livingstone) was developed to provide clinicians with a “toolkit” to facilitate implementation of evidence-based practice. We illustrate the Critically Appraised Topics method using a dementia screening example. We argue that the skills practiced through critical appraisal provide clinicians with methods to: (1) evaluate the clinical relevance of new or unfamiliar research findings with a focus on patient benefit, (2) help focus of research quality, and (3) incorporate evaluation of clinical impact into educational and professional development activities.

Seminal Treatise on Neuropsychological Practice with Veterans - Neuropsychological Practice with Veterans, Shane S. Bush, (Ed.). 2012. New York: Springer Publishing Company, 424 pp., $70.00 (PB).

Seminal Treatise on Neuropsychological Practice with Veterans - Neuropsychological Practice with Veterans, Shane S. Bush, (Ed.). 2012. New York: Springer Publishing Company, 424 pp., $70.00 (PB). - Volume 19 Issue 3

Clinical practice of forensic neuropsychology: An evidence-based approach

Clinical practice of forensic neuropsychology: An evidence-based approach

Neuroscience and Neurolaw

At the intersection of neuroscience and psychological science stands neuropsychology, providing patients, triers of fact, and other parties a quantifiable, evidence-based method for understanding cognitive, emotional, and behavioral changes that occur in the context of injury or disease. The purposes of this special issue of Psychological Injury and Law are to (1) illustrate the ways in which neuroscience, psychological practice, professional ethics, and laws are intertwined in the evaluation and treatment of persons who have been injured or are experiencing a neurological disease, (2) demonstrate the ways in which neuropsychological practice is applied to forensic questions, and (3) promote quality neuropsychological practice and services to patients, courts, and other consumers of neuropsychological services. This special issue provides a sample of the types of ways that practitioners integrate neuroscience and clinical psychology, informed by and consistent with relevant laws and professional ethics, to understand people who have cognitive, emotional, and/or behavioral problems stemming from neurological injuries or other disorders.

Ethical, Legal and Risk Management Considerations in the Neuropsychological Assessment of Veterans

This article examines the ethical and regulatory issues facing neuropsychologists practicing within the Department of Veterans Affairs (VA) system, either as Veteran Health Administration neuropsychologists or as consultants. The focus is proactive, with an emphasis on preparation consistent with a positive approach to ethical practice and risk management. Given the sheer magnitude of applicable Federal regulations and guidelines, the scope is limited to an overview of select ethical complexities involved in the professional practice of neuropsychology with veterans within VA settings. The article uses a top-down structure, with each section (a) identifying the relevant core biomedical ethical principles, followed by (b) an elaboration of the relevant ethical requirements as defined by the American Psychological Association’s Code of Ethics, and (c) applicable Federal regulations. Suggestions for translating core ethical principles and relevant ethical requirements into pragmatic action consistent with Federal regulation follow. Topics include (a) establishing professional competence, (b) understanding the type of assessment, (c) understanding consent requirements, and (d) understanding the ethical and regulatory issues in assessing veteran symptom presentation.

Neuropsychological Practice with Veterans

Neuropsychological Practice with Veterans

An alternative Cattell–Horn–Carroll (CHC) factor structure of the WAIS-IV: Age invariance of an alternative model for ages 70–90.

The Wechsler Adult Intelligence Scale--Fourth Edition (WAIS-IV) is by the far the most popular intelligence test for the assessment of adults in clinical and neuropsychological practice. Despite a number of studies examining the factor structure of the WAIS-IV from a Cattell-Horn-Carroll (CHC) perspective (Benson, Hulac, & Kranzler, 2010; Ward, Bergman, & Hebert, 2012), a CHC interpretation of the WAIS-IV for individuals ages 70 and above has been absent from the literature. The exclusion of individuals ages 70 and above in previous research is likely due to the absence of several key supplemental subtests used to create a full CHC model. We provide an alternative five-factor CHC model of the WAIS-IV which includes only the subtests administered to individuals ages 70 and above in the standardization sample. Our results show (a) the alternative CHC model fits the data well; (b) this alternative CHC model met criteria for partial strict measurement invariance across the life span (only Similarities showed noninvariance) using strict criteria; (c) the five factors for ages 70-90 measure the same five CHC broad abilities identified in previous analyses reported for ages 16-69; and (d) the five-factor CHC solution for ages 70-90 is valid for the entire WAIS-IV age range and can be used whenever examiners administer the core battery but opt not to administer supplemental subtests.

Évaluation de la cognition sociale en langue française chez l’adulte : outils disponibles et recommandations de bonne pratique clinique

Social cognition is described as the processes underlying interpersonal relationships. The crucial role of these processes in rehabilitation, especially in adult psychiatry, has raised needs of clinical assessment in this particular cognitive domain. However, social cognition is a multidimensional construct which has been studied in numerous recent international researches. This review is aimed at inventorying available tools in French language for social cognition assessment in adults, and at drawing recommendation for practice in clinical neuropsychology. Results show that despite the lack of available tools, the assessment of social cognition is feasible in several dimensions, such as facial emotion recognition, theory of mind, alexithymia and emotional awareness. Each of the identified tools has specific benefits and limits that delimitate their potential usefulness. Globally, the incomplete validation of tools, as well as their heterogeneity and their multidetermination should lead to some caution when assessing performances and interpreting results. However, when crossing assessments and controlling for basic neurocognitive difficulties, the identified tools can provide detailed information about each patient's social cognition profile. Studies remain necessary to further validate existing tools and to allow more reliable and diversified assessment.