Standard Neuropsychological Instruments Research Articles

Description of Neuropsychological Profile in Patients with 22q11 Syndrome

Background: 22q11 deletion syndrome (SD22Q11) is a neurogenetic condition that is associated with a high risk of neurodevelopmental disorders and intellectual disability. People with SD22Q11, both children and adults, often experience significant difficulties in social interactions, as well as neurocognitive deficits, and have elevated rates of autism spectrum disorder (ASD). Despite this, the relationship between basic cognitive processes and cognitive ability in this population has not been well investigated. Methods: the main objective of the present research is to describe the neurocognitive profile of people with SD22Q11 using standardized neuropsychological assessment instruments. For this purpose, a sample of 10 participants aged between 7 and 15 years was administered an assessment battery with the following tests: WISC-V, CELF-5, NEPSY-II, CSAT-R, CARAS-R, TP, MABC-2, BRIEF-2, SENA, DABAS, ABAS-II, SCQ, and ADOS-2. Results: the results showed IQ scores in the borderline normal range, as well as difficulties in language functions, social skills, motor skills, and executive functions. Conclusions: an individualized assessment taking into account the globality of its expression, and a therapeutic approach adapted to the specific needs of children with this syndrome is essential.

The Role of the Patient Partnership in Designing Research on Neuropsychiatric Issues in Hypoparathyroidism.

Hypoparathyroidism is a rare endocrine disease that is associated with hypocalcemia and insufficient parathyroid hormone (PTH) levels. Neuropsychiatric complaints are common in hypoparathyroidism. Yet there is a large knowledge gap in our understanding of cognitive dysfunction in hypoparathyroidism and partnering with patients is essential for filling this hole. Input from hypoparathyroid patients is needed to define objective, performance-based cognitive impairments. Creating patient advisory boards that provide input for planning clinical trials would enable patient perspectives to be shared. This would ensure that meaningful, standardized neuropsychological instruments that prioritize patients' cognitive concerns are selected. Patient partnership is also needed to understand the wide inter-individual variability of cognitive symptoms in hypoparathyroidism, as well as mechanisms aside from calcium shifts that might explain cognitive symptoms, such as low PTH itself, alterations in brain structure, or other hypoparathyroidism-associated comorbidities. With new PTH replacement therapies on the horizon, patient input about studying how these therapies impact, and maybe even reverse, cognitive impairment will also be critical. Ultimately, the inclusion of patient partners in hypoparathyroidism research will advance the design of neuropsychiatric studies and generate key input for understanding how to reduce the burden of this disease.

Introducing an adolescent cognitive maturity index.

Children show substantial variation in the rate of physical, cognitive, and social maturation as they traverse adolescence and enter adulthood. Differences in developmental paths are thought to underlie individual differences in later life outcomes, however, there remains a lack of consensus on the normative trajectory of cognitive maturation in adolescence. To address this problem, we derive a Cognitive Maturity Index (CMI), to estimate the difference between chronological and cognitive age predicted with latent factor estimates of inhibitory control, risky decision-making and emotional processing measured with standard neuropsychological instruments. One hundred and forty-one children from the Adolescent Development Study (ADS) were followed longitudinally across three time points from ages 11-14, 13-16, and 14-18. Age prediction with latent factor estimates of cognitive skills approximated age within ±10 months (r = 0.71). Males in advanced puberty displayed lower cognitive maturity relative to peers of the same age; manifesting as weaker inhibitory control, greater risk-taking, desensitization to negative affect, and poor recognition of positive affect.

Cognitive neuroscience research of language development: the future path and layout

<p indent=0mm>Language is unique to the human brain. Unraveling language brain development is one of the major missions of developmental cognitive neuroscience. In recent decades, significant research progress has been made in language development, reading and brain development, age effect of second language learning, genetic factors of language development. China has also made remarkable progress, especially in Chinese reading acquisition and the cognitive-neural mechanism of reading disorders. Future research may not only examine language brain development with innovative techniques but also shift paradigms to understand how the language brain develops as a self-organized system and how it is related to cognitive, emotional, and social development. By integrating genes, environment, brain, and behavior, the large-scale imaging genetic cohort study may help to transform research on language brain development. In order to advance research on language brain development in China, more efforts shall be invested in developing and adapting standardized neuropsychological instruments with reliability and validity. There is an urgent need to support sustainable capacity building and conduct research on first-class language brain development with the cutting-edge brain imaging techniques. Large-scale prospective cohort studies may well prompt original discoveries led by real needs of improving language development, disorder identification and treatment. With data of high quality being accumulated and shared properly, more innovations will be expected to better understand the brain and language development. Translational research should be given priority to provide solid support for better instructional, clinical practices, and policymaking. To meet the great challenges in scientific research and the translation, individual research interest based exploration and well-designed team collaborative research shall be combined and balanced.

Phenotypic and genetic spectrum of epilepsy with myoclonic atonic seizures.

We aimed to describe the extent of neurodevelopmental impairments and identify the genetic etiologies in a large cohort of patients with epilepsy with myoclonic atonic seizures (MAE). We deeply phenotyped MAE patients for epilepsy features, intellectual disability, autism spectrum disorder, and attention-deficit/hyperactivity disorder using standardized neuropsychological instruments. We performed exome analysis (whole exome sequencing) filtered on epilepsy and neuropsychiatric gene sets to identify genetic etiologies. We analyzed 101 patients with MAE (70% male). The median age of seizure onset was 34months (range = 6-72months). The main seizure types were myoclonic atonic or atonic in 100%, generalized tonic-clonic in 72%, myoclonic in 69%, absence in 60%, and tonic seizures in 19% of patients. We observed intellectual disability in 62% of patients, with extremely low adaptive behavioral scores in 69%. In addition, 24% exhibited symptoms of autism and 37% exhibited attention-deficit/hyperactivity symptoms. We discovered pathogenic variants in 12 (14%) of 85 patients, including five previously published patients. These were pathogenic genetic variants in SYNGAP1 (n=3), KIAA2022 (n=2), and SLC6A1 (n=2), as well as KCNA2, SCN2A, STX1B, KCNB1, and MECP2 (n = 1 each). We also identified three new candidate genes, ASH1L, CHD4, and SMARCA2 in one patient each. MAE is associated with significant neurodevelopmental impairment. MAE is genetically heterogeneous, and we identified a pathogenic genetic etiology in 14% of this cohort by exome analysis. These findings suggest that MAE is a manifestation of several etiologies rather than a discrete syndromic entity.

A-52 An Exploratory Factor Analysis Investigation of the Role of Verbal Mediation in the Interaction between Intelligence and Visual Memory Tasks

Abstract Objective Examine whether verbal mediation may play a role in the interaction between visual memory tasks and the four-factor model of intelligence as operationalized by standard neuropsychological assessment instruments. Method The assessment records of 101 American Veterans with diverse neuropsychiatric conditions were examined using Exploratory Factor and Principal Component Analyses (EFA and PCA respectively). There were no exclusion criteria. All participants completed the Wechsler Adult Intelligence Scale, third edition (WAIS-III), Benton’s Visual Retention Test (BVRT), and Multilingual Aphasia Examination (MAE). Individual assessment instruments were factored using PCA. The factor solution of the BVRT was co-factored with the scales of the WAIS-III, then the resulting factor scales were again factored with the verbal components of the MAE to identify common sources of variance. Results A three-step analysis revealed a four-factor model explaining 69.44% of the shared variance: 1) Items 1-4 of the BVRT (BVRT-E) loaded with Verbal Comprehension and Visual Naming. 2) BVRT-E also loaded with Processing Speed and Controlled Word Association. 3) Items 5-10 of the BVRT (BVRT-L) loaded with Perceptual Organization and the Token Test. 4) Working Memory loaded with Sentence Repetition on a fourth factor. Conclusions The results indicate a strong relationship between assessed performance on visual memory tasks and performance on measures based on the four-factor model of intelligence. The results also appear to support the idea that verbal mediation plays a role in the interaction between visual memory and intelligence, particularly when comparing performance on simple versus more complex visual memory tasks.

Reliable change in neuropsychological assessment of breast cancer survivors.

The purpose of this study was to enhance the current understanding and interpretation of longitudinal change on tests of neurocognitive function in individuals with cancer. Scores on standard neuropsychological instruments may be impacted by practice effects and other random forms of error. The current study assessed the test-retest reliability of several tests and overarching cognitive domains comprising a neurocognitive battery typical of those used for research and clinical evaluation using relevant time frames. Practice effect-adjusted reliable change confidence intervals for test-retest difference scores based on a sample of patient-matched healthy controls are provided. By applying reliable change confidence intervals to scores from two samples of breast cancer patients at post-treatment follow-up assessment, meaningful levels of detectable change in cognitive functioning in breast cancer survivors were ascertained and indicate that standardized neuropsychological instruments may be subject to limitations in detection of subtle cognitive dysfunction over clinically relevant intervals, especially in patient samples with average to above average range baseline functioning. These results are discussed in relation to reported prevalence of cognitive change in breast cancer patients along with recommendations for study designs that enhance detection of treatment effects.

An Open-Label Trial of Memantine for Cognitive Impairment in Patients with Posttraumatic Stress Disorder.

Background. Studies using standard neuropsychological instruments have demonstrated memory deficits in patients with PTSD. We evaluated the efficacy and safety of the N-methyl-D-aspartate antagonist memantine in veterans with PTSD and cognitive impairment. Methods. Twenty-six veterans with PTSD and cognitive impairment received 16 weeks of memantine in an open-label fashion. Cognition was assessed using the Spatial Span, Logical Memory I, and Letter-Number Sequencing subtests of the Wechsler Memory Scale III and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). RBANS measures attention, language, visuospatial skills, and immediate and delayed memories. The Clinician Administered PTSD Scale (CAPS), Hamilton Depression Scale (HAM-D), Hamilton Anxiety Scale (HAM-A), Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), and Sheehan Disability Scale (SDS) were secondary outcome measures. Results. There was a significant improvement in RBANS, both total and subscale scores (P < 0.05), over time. There was a reduction in total CAPS scores, avoidance/numbing symptoms (CAPS-C) and hyperarousal symptoms (CAPS-D), HAM-D, Q-LES-Q, and SDS scores. However, there was no reduction in reexperiencing (CAPS-B) and HAM-A scores. Memantine was well tolerated. Conclusions. Memantine improved cognitive symptoms, PTSD symptoms, and mood in veterans with PTSD. Randomized double-blind studies are needed to validate these preliminary observations.

Cold Pressor-Induced Pain Does Not Impair WAIS-IV Processing Speed Index or Working Memory Index Performance

Chronic pain frequently involves cognitive complaints such as concentration and memory deficits, but studies of the effects of pain on cognition have not consistently demonstrated deficits and have not typically utilized standard neuropsychological instruments. Effects of cold pressor-induced pain on Wechsler Adult Intelligence Scale-Fourth Edition Processing Speed Index (PSI) and Working Memory Index (WMI) performance was examined in nonclinical volunteers (n = 40). All took one PSI subtest and one WMI subtest normally, and then took different PSI and WMI subtests during cold pressor-induced pain or painless warm-water immersion. Scaled scores for normal administration versus pain or painless water immersion did not differ and there was no interaction between group (control vs. pain) and manner of administration, despite moderately severe mean pain ratings (M = 6.8 on a 0–10 pain-rating scale). Results indicate that induced pain in nonclinical volunteers does not impair PSI or WMI performance, and they suggest that chronic pain per se should not be expected to substantially affect these cognitive functions. However, patients with chronic pain may differ from nonclinical volunteers in their experience of pain, potentially limiting generalizability.

Changes in cognitive function associated with syndrome changes on two five‐factor models of the Positive and Negative Syndrome Scale

This study aims to examine the association between neuropsychological function and symptom changes over time on two five-factor models, pentagonal (PM) and Van der Gaag (VDG), of the Positive and Negative Syndrome Scale (PANSS) and to determine the added value of these syndrome models for interpreting neuropsychological changes. Data were collected in a randomized controlled trial comparing second-generation and conventional antipsychotic medications for 108 adult patients diagnosed with schizophrenia and monitored prospectively for 12 months using standard neuropsychological instruments and the PANSS. Random-effects regression was used to estimate the change over time in neuropsychological function and the association of PANSS covariates. Improvements in positive, negative, and cognitive syndromes were significant predictors of change on nine neuropsychological measures. The neuropsychological function was worsening on five of these measures. The PM model represented the best set of predictors examining positive and negative syndrome covariates, whereas the VDG model consistently represented the best predictors examining cognitive syndrome covariates. The PM positive and negative syndrome factors and the VDG disorganized thoughts syndrome factor are differentially associated with changes in neuropsychological function over time. Clinical investigators may want to target their use of these factors from the PANSS according to the outcome variables being measured.

New Frontiers in Neuropsychological Assessment: Assessing Social Perception Using a Standardised Instrument, The Awareness of Social Inference Test

Many clinical disorders lead to impairments in social perception that are not easily detected using standard neuropsychological instruments. In this article, The Awareness of Social Inference Test (TASIT) is described, and evidence for its reliability and validity is reviewed. TASIT was designed to assess the ability to interpret emotional expressions and paralinguistic cues in order to make judgements about speakers' mental states and their conversational meanings, especially when these diverge from the literal meaning of what they say (as in the case of sarcasm). TASIT has three parts: (1) the Emotion Evaluation Test (six basic emotions); (2) Test of Social Inference (Minimal), assessing the ability to understand emotions, mental states, and conversational inferences in sincere and sarcastic interchanges; and (3) Test of Social Inference (Enriched), assessing comprehension of lies and sarcasm, each with alternate forms for re‐testing. TASIT has adequate test–retest and alternate forms reliability. Evidence for construct validity is derived from its relationship to conventional neuropsychological tests, experimental tests of social perception, and real‐world performance. In addition, research using TASIT to examine deficits in social perception in traumatic brain injury, schizophrenia, frontotemporal dementia, Alzheimer's disease, and stroke attest to its sensitivity as a clinical assessment tool.

A short-form version of the Boston Naming Test for language screening in dementia in a bilingual rural community in Galicia (Spain)

Aphasia, one of the core symptoms of cortical dementia, is routinely evaluated using graded naming tests like the Boston Naming Test (BNT). However, the application of this 60-item test is time-consuming and shortened versions have been devised for screening. The hypothesis of this research is that a specifically designed shortened version of the BNT could replace the original 60-item BNT as part of a mini-battery for screening for dementia. The objective of this study was to design a short version of the BNT for a rural population in Galicia (Spain). A clinic group of 102 patients including 43 with dementia was recruited along with 78 healthy volunteers. The clinic and control groups were scored on the Spanish version of the Mini-mental State Examination (MMSE) and BNT. In addition, the clinic group was tested with standard neuropsychological instruments and underwent brain investigations and routine neurological examination. BNT items with specificity and sensitivity above 0.5 were selected to compose a short battery of 11 pictures named BNTOu11. ANOVA and mean comparisons were made for MMSE and BNT versions. Receiver operating characteristics (ROC) curves and internal consistency were calculated. Areas under ROC curves (AUC) did not show statistically significant differences; therefore BNTOu11's AUC (0.814) was similar to the 60-item BNT versions (0.785 and 0.779), to the short versions from Argentina (0.772) and Andalusia (0.799) and to the Spanish MMSE (0.866). BNTOu11 had higher internal consistency than the other short versions. BNTOu11 is a useful and time-saving method as part of a battery for screening for dementia in a psychogeriatric outpatient unit.

Clinical usefulness of the screen for cognitive impairment in psychiatry (SCIP-S) scale in patients with type I bipolar disorder

BackgroundThe relevance of persistent cognitive deficits to the pathogenesis and prognosis of bipolar disorders (BD) is understudied, and its translation into clinical practice has been limited by the absence of brief methods assessing cognitive status in Psychiatry. This investigation assessed the psychometric properties of the Spanish version of the Screen for Cognitive Impairment in Psychiatry (SCIP-S) for the detection of cognitive impairment in BD.MethodsAfter short training, psychiatrists at 40 outpatient clinics administered the SCIP three times over two weeks to a total of 76 consecutive type I BD admissions. Experienced psychologists also administered a comprehensive battery of standard neuropsychological instruments to clinical sample and 45 healthy control subjects.ResultsFeasibility was supported by a brief administration time (approximately 15 minutes) and minimal scoring errors. The reliability of the SCIP was confirmed by good equivalence of forms, acceptable stability (ICC range 0.59 to 0.87) and adequate internal consistency (Chronbach's alpha of 0.74). Construct validity was granted by extraction of a single factor (accounting 52% of the variance), acceptable correlations with conventional neuropsychological instruments, and a clear differentiation between bipolar I and normal samples. Efficiency was also provided by the adequate sensitivity and specificity.LimitationsThe sample size is not very large. The SCIP and the neurocognitive battery do not cover all potentially relevant cognitive domains. Also, sensitivity to change remains unexplored.ConclusionWith minimal training, physicians obtained a reliable and valid estimate of cognitive impairment in approximately 15 minutes from an application of the SCIP to type I BD patients.

Central Nervous System Dysfunction after Noncardiac Surgery and Anesthesia in the Elderly

Central Nervous System Dysfunction after Noncardiac Surgery and Anesthesia in the Elderly

A neuropsychological assessment of frontal cognitive functions in Prader–Willi syndrome

Prader-Willi syndrome (PWS) is associated with a characteristic behavioural phenotype whose main features are, alongside compulsive hyperphagia, deficits in social behaviour: social withdrawal, temper tantrums, perseverative speech and behaviour, mental rigidity, stereotyped behaviour, impulsiveness, etc. Similar symptoms may also be found in autistic spectrum disorders and lesional pathologies of the frontal lobe. In both cases, such symptoms have been related to dysfunctions in frontal cognitive processes such as attention, working memory and executive functions. This study uses standardized neuropsychological instruments to analyse the degree to which these processes are affected in PWS. The sample comprised 16 individuals with a genetically confirmed PWS diagnosis. Subjects' IQ (Wechsler Adult Intelligence Scale), academic level, laterality and body mass index (BMI) were calculated. Attention, memory and executive functions were analysed using standard, widely employed neuropsychological tests. We compared the results of the sample group with the general population. Correlation analyses were carried out with IQ, academic level and BMI. In all the neuropsychological measures focusing on attention, executive functions and visuoperceptual organization, the study sample scored significantly lower than the normative reference population. The scores of the tests used for measuring immediate memory were also significantly lower when trials required sequential processing, although not when they required simultaneous processing. In the memorization of a list of words, subjects showed an initial deficit which disappeared with repetition, enabling them to obtain scores similar to the reference population. No significant correlations were found with BMI, and a higher IQ or academic level did not improve scores in the majority of tests. The study shows a deficit in elementary frontal cognitive processes in PWS patients. This deficit may be involved in the social behaviour disorders that characterize such patients, as described in other development or frontal syndrome pathologies. However, we cannot affirm that the deficits found are specific to PWS; they could also occur in other causes of intellectual disability. Although in the study sample IQ did not correlate with frontal deficits, further research is needed to establish whether the neuropsychological alterations described form part of a cognitive phenotype for PWS. We believe that our understanding of the social behaviours typical of PWS may be improved by taking into consideration the cognitive functioning models of the prefrontal lobe, particularly those applied to pervasive developmental disorders.

ACE Clock Scoring: A Comparison With Eight Standard Correction Methods in a Population of Low Educational Level

The authors compared the accuracy of Addenbrooke's Cognitive Examination Clock Drawing Test scoring method with 8 standard Clock Drawing Test scoring methods in a Spanish speaking population of low educational level. A clinical group composed of 70 patients affected by dementia and 25 patients with memory complaints without dementia was compared with 72 controls matched for gender, age, and educational level. The clinical group was studied with standard neuropsychological instruments and neuroimaging. Clock Drawing Tests extracted from Addenbrooke's Cognitive Examination were randomly distributed and scored by 2 independent raters. There were statistically significant differences between the different scoring methods. Addenbrooke's Cognitive Examination Clock Drawing Test scoring method obtained and optimal areas under the curve and interrater reliability, showing no statistical differences with previously standardized systems. In our population, Addenbrooke's Cognitive Examination and the methods of Cahn, Mendez, Rouleau, Shulman, and Sunderland were of optimal and equivalent usefulness regarding dementia detection.

Validation of the Spanish version of the Addenbrooke's Cognitive Examination in a rural community in Spain

The Addenbrooke's Cognitive Examination (ACE) is a brief cognitive test battery designed to detect and differentiate Alzheimer's disease (AD) and frontotemporal dementia (FTD). Translations of this instrument into French and Malayalam have been recently published To adapt and validate the ACE into Spanish in a rural population of low-educational level. A clinical group, composed of 70 patients affected by dementia and 25 patients with memory complaints without dementia, was compared with 72 controls matched for gender, age and educational level The clinical group was studied with standard neuropsychological instruments, all patients underwent neuroimaging [Computerized Tomography (CT) or Magnetic Resonance Imaging (MRI), and Single Photon Emission Tomography (SPECT) in all cases of suspected FTD], as well as routine neurological examination. Both groups were studied with the ACE and Clinical Dementia Rating scale (CDR). Sensitivity, specificity, area under curve, reliability and Verbal-Language/ Orientation-Memory (VLOM) ratio were calculated. Subsequently, the sample was stratified regarding educational level in two groups. Receiver Operating Characteristics (ROC) curves were calculated for these conditions. Different cut-off points were calculated addressing educational level. ROC curves demonstrated the superiority of the ACE in the sub sample of patients that finished school at over 14 years old. VLOM ratio confirmed its usefulness for differential diagnosis between AD and FTD CONCLUSIONS: The Spanish version of the ACE is a useful instrument for dementia diagnosis. In our sample VLOM ratio results were useful for differential diagnosis between AD and FTD. Different cut-off points must be used for different educational levels.

Research issues in the evaluation of cognitive impairment in intensive care unit survivors.

Neuropsychological assessment has been utilized extensively in the research of cognitive outcomes associated with medical illnesses, such as HIV, and post-surgical procedures, such as coronary artery bypass graft. However, few investigations of intensive care unit (ICU) survivors have examined cognitive function as a clinical outcome. Significant clinical questions exist regarding the impact of critical illness on long-term cognitive function. Many of these questions can be systematically evaluated through the use of standardized neuropsychological assessment instruments within the context of well designed, prospective research trials. This review will provide information for clinical researchers interested in the study of neuropsychological outcomes in intensive care unit survivors ( a comparison article in this issue will address clinical issues related to cognitive functioning).

HUMANS: An English and Spanish Neuropsychological Test Battery for Assessing HIV-1-Infected Individuals—Initial Report

A neuropsychological battery for testing HIV-1-infected individuals in Spanish was developed. We refer to this battery as the HIV/University of Miami Annotated Neuropsychological test battery in Spanish (HUMANS). The HUMANS battery includes recommendations of the National Institute of Mental Health Neuropsychology Workgroup on HIV-1 infection and measures processes in the following 7 cognitive domains: attention, verbal and visual memory, information processing speed, abstraction and executive functioning, language, visuospatial and visuoconstructive, and motor. Administration requires approximately 3 to 4 hr. The English version of the battery is sensitive to HIV-1 serostatus and Centers for Disease Control clinical disease stage. We report on the test selection, translation, and adaptation of this parallel English battery into Spanish using methods to eliminate linguistically and culturally biased items in some tests. The importance of standardized neuropsychological instruments equivalent in different languages to test HIV-1-positive individuals for impairment is emphasized. Validation and reliability studies are in progress.

When only the right hemisphere is left: Studies in language and communication

An adult of above normal intelligence, BL, underwent left hemispherectomy at age five, and subsequently graduated from college and has been regularly employed. Using standardized neuropsychological instruments, previous extensive testing had revealed optimal performance for a hemispherectomized subject. To probe communicative abilities in greater detail, and to examine current questions about linguistic superiority of the left hemisphere and “crowding” of right hemisphere functions, 12 additional protocols were administered. BL performed at normal or above on nearly all protocols. However, performance on production of phonemically complex words was effortful, and deficits were seen on two tests requiring comprehension of linguistic contrasts in prosody (Linguistic Prosody Test) and syntax (the Active–Passive Test). These findings support previous claims of reduced ability in specific, circumscribed linguistic functions in the left hemispherectomized person, and lead to suggestions for further testing of communicative competence in individuals with a single intact hemisphere.