Use Of Neuropsychological Tests Research Articles

Relationship of ethnicity, age, education, and reading level to speed and executive function among HIV+ and HIV– women: The Women's Interagency HIV Study (WIHS) Neurocognitive Substudy

Use of neuropsychological tests to identify HIV-associated neurocognitive dysfunction must involve normative standards that are well suited to the population of interest. Norms should be based on a population of HIV-uninfected individuals as closely matched to the HIV-infected group as possible and must include examination of the potential effects of demographic factors on test performance. This is the first study to determine the normal range of scores on measures of psychomotor speed and executive function among a large group of ethnically and educationally diverse HIV-uninfected, high-risk women, as well as their HIV-infected counterparts. Participants (n = 1,653) were administered the Trail Making Test Parts A and B (Trails A and Trails B), the Symbol Digit Modalities Test (SDMT), and the Wide Range Achievement Test–3 (WRAT–3). Among HIV-uninfected women, race/ethnicity accounted for almost 5% of the variance in cognitive test performance. The proportions ofvariance in cognitive test performance accounted for by age (13.8%), years of school (4.1%), and WRAT–3 score (11.5%) were each significant, but did not completely account for the effect of race (3%). HIV-infected women obtained lower scores than HIV-uninfected women on time to complete Trails A and B, SDMT total correct, and SDMT incidental recall score, but after adjustment for age, years of education, racial/ethnic classification, and reading level, only the difference on SDMT total correct remained significant. Results highlight the need to adjust for demographic variables when diagnosing cognitive impairment in HIV-infected women. Advantages of demographically adjusted regression equations developed using data from HIV-uninfected women are discussed.

The use of neuropsychological tests across Europe: the need for a consensus in the use of assessment tools for dementia

The centres dedicated to dementia throughout Europe use different neuropsychological tests in clinical practice. The European Federation of Neurological Societies task force on neuropsychological tests produced this survey on neuropsychological tests currently being used in different European countries to gather knowledge on the practice of dementia centres and to promote the harmonization of such instruments and future multicentre collaborations. National representatives of 34 countries received a questionnaire and 25 (73.5%) sent it back. A few instruments, Mini-Mental State Examination (MMSE), Trail Making Test (TMT), Verbal Fluency and Clock Drawing Test, were available in all countries. Wechsler Adult Intelligence Scales and MMSE were reported to be valid, respectively, in 20 (80%) and 19 (76%) countries, whereas Verbal Fluency and Stroop Test are valid in 18 (72%) of them. Of the 25 countries, 17 have validation norms for Clock Drawing Test and TMT (68%), and Neuropsychiatric Inventory, Alzheimer's Disease Assessment Scale - Cognitive Subscale, Rey Complex Figure Test, Digit Symbol and Beck Depression Inventory were standardized in 16 countries (64%). The remaining tests were validated, at most, in about half of them. Not all countries certificate neuropsychology. Despite the substantial differences in the tools used by the EFNS countries for most domains surveyed by the questionnaire, there is at least one neuropsychological instrument used by about 80% of the countries. There is clearly the need for a broader consensus in the use of neuropsychological tests for dementia diagnosis.

Local Information Processing in Adults with High Functioning Autism and Asperger Syndrome: The Usefulness of Neuropsychological Tests and Self-Reports

Local information processing in 42 adults with high functioning autism, 41 adults with Asperger syndrome and 41 neurotypical adults was examined. Contrary to our expectations, the disorder groups did not outperform the neurotypical group in the neuropsychological measures of local information processing. In line with our hypotheses, the self-reports did show higher levels of local information processing and a stronger tendency to use systemizing strategies in the two disorder groups. Absent and weak correlations were found between the self-reports and the two neuropsychological tasks in the three groups. The neuropsychological tests and the self-reports seem to measure different underlying constructs. The self-reports were most predictive of the presence of an autism spectrum diagnosis.

Neuropsychological testing and biomarkers in the management of brain metastases

Prognosis for patients with brain metastasis remains poor. Whole brain radiation therapy is the conventional treatment option; it can improve neurological symptoms, prevent and improve tumor associated neurocognitive decline, and prevents death from neurologic causes. In addition to whole brain radiation therapy, stereotactic radiosurgery, neurosurgery and chemotherapy also are used in the management of brain metastases. Radiosensitizers are now currently being investigated as potential treatment options. All of these treatment modalities carry a risk of central nervous system (CNS) toxicity that can lead to neurocognitive impairment in long term survivors. Neuropsychological testing and biomarkers are potential ways of measuring and better understanding CNS toxicity. These tools may help optimize current therapies and develop new treatments for these patients. This article will review the current management of brain metastases, summarize the data on the CNS effects associated with brain metastases and whole brain radiation therapy in these patients, discuss the use of neuropsychological tests as outcome measures in clinical trials evaluating treatments for brain metastases, and give an overview of the potential of biomarker development in brain metastases research.

Avaliação neuropsicológica na esquizofrenia: revisão sistemática

O presente artigo tem como objetivo sintetizar estudos sobre os testes neuropsicológicos que estão sendo mais utilizados em esquizofrenia. Foi realizada uma revisão sistemática da literatura, consultando-se: PubMed, MEDLINE (via PubMed) e LILACS, no período entre 1995 e 2006. As palavras-chave foram: cognition and schizophrenia; evaluation and cognition and schizophrenia; functioning and cognition and schizophrenia. Foi feita uma pesquisa manual de referências dos artigos mais citados, incluindo estudos de metanálise, revisão teórica e da Measurement and Treatment Research to Improve Cognition in Schizophrenia. Critérios de inclusão: estudos com pacientes com esquizofrenia que mencionaram a utilização de testes neuropsicológicos. Foi feita uma revisão sobre os testes mais citados, para verificação de nomenclatura, indicações e quais estavam validados para o Brasil. Foram identificados 98 estudos: 77 empíricos, oito metanálises, seis revisões teóricas e sete da Measurement and Treatment Research to Improve Cognition in Schizophrenia. Foram encontrados 102 diferentes nomes de testes neuropsicológicos, com citação de 10 baterias de testes, na maioria compostas por subtestes já padronizados. Entre os 77 estudos empíricos, 22 (28,57%) foram sobre validação de instrumentos ou baterias de testes. Entre os 10 testes mais citados, apenas três possuem validação para o Brasil (WCST; Wechsler Adult Intelligence Scale; Mini-Mental Status Examination). Esses achados evidenciam uma ampla heterogeneidade nos critérios de seleção dos testes neuropsicológicos, divergências na nomenclatura e certa tendência para a criação de novos testes e baterias para avaliação de funções cognitivas. A relevância e características dos prejuízos cognitivos na esquizofrenia revelam a urgente necessidade de identificação específica e padronizada de métodos de avaliação neuropsicológica para pacientes brasileiros.

Fitness to drive following cerebral pathology: The Rookwood Driving Battery as a tool for predicting on‐road driving performance

The use of neuropsychological testing to determine fitness to drive in people with neuropathology is likely to be an increasingly attractive alternative to on-road testing for many candidates for assessment. The Rookwood Driving Battery has been shown to have good predictive value for determining some who are likely to fail an on-road test in early studies. This study replicated earlier research by examining the predictive value and theoretical validity of the battery on a larger sample of 391 participants, as well as extending earlier analysis by examining the effect of older age (over 70 years) and the interaction between age and pathology on battery and on-road performance. The battery demonstrated good positive and negative predictive values for predicting on-road performance. There were significant effects of older age on both the Rookwood Battery performance and the on-road test, with older adults performing significantly poorer on both. There was no interaction between age and pathology on the Rookwood Battery but on-road age interacted with some pathologies to produce significantly poorer performances. Furthermore, correlation and regression analysis indicate that the battery is a powerful instrument that encompasses tests of core neuropsychological functions needed for driving.

Race-specific norms: Using the model of hypertension to understand issues of race, culture, and education in neuropsychology

Development of appropriate and clear guidelines for proper use of neuropsychological tests among ethnic minorities is a current and significant challenge. Although development of race/ethnicity-specific norms is popular, it is also controversial. Some have argued that these norms will improve the sensitivity and specificity of neuropsychological measures in detecting cognitive impairment. However, two major arguments have surfaced that: (1) race-specific norms ignore underlying cultural and educational factors for which race serves as a proxy, and (2) setting “more lenient” cutoffs for impairment among ethnic minorities denies these groups needed services. In this paper, we argue that recent research on hypertension reveals a number of crucial lessons for neuropsychologists who are struggling with this issue. The model of hypertension is helpful in understanding issues of construct validity in neuropsychological testing, and is also helpful in revealing possible underlying causes of poor cognitive test performance for which race serves as a proxy.

Detection of malingering in a Spanish population using three specific malingering tests

The detection of feigned cognitive impairment remains difficult and may be even more challenging in certain population groups. Studies on the use of neuropsychological tests in ethnic groups for which they were not designed have shown variations in performance associated with cultural differences. With this background, our group studied a Spanish population by applying commonly used procedures [Victoria Symptom Validity Test (VSVT), Test of Memory Malingering (TOMM), and the b test] in a group with post-concussion syndrome (PCS) (whether litigants or not) and in a group of analog malingerers (AN). These tests appeared to function adequately in this Spanish population, who showed similar performances to results published for North Americans.

Conversion Disorder

Conversion Disorder

Neuropsychological functioning in people with ADHD across the lifespan

ADHD is defined by behavioral characteristics similar to neuropsychological disorders of executive dysfunction. This paper is a literature review of the neurocognitive characteristics of ADHD from early childhood through adulthood. The author addresses the development of the concept of attention and executive function (EF) deficits in ADHD, clinical neuropsychological studies of pre-teenage children, teenagers and adults with ADHD, gender and the role of psychiatric co-morbidity including the relationship of learning disabilities to ADHD, heterogeneity of neuropsychological dysfunctions, experimental neuropsychological studies, the relationship of brain structure to function, psychopharmacology of ADHD, and clinical neuropsychological assessment. The group data clearly supports the hypothesis that executive dysfunctions are correlates of ADHD regardless of gender and age, and these EF deficits are exacerbated by co-morbidity with learning disabilities such as dyslexia. However, there is limited data on children under the age of 5, teenagers from age 13–18, and adults with ADHD over the age of 40. Studies of individual classification of people with ADHD compared to healthy, non-psychiatric controls do not support the use of neuropsychological tests for the clinical diagnosis of ADHD, and indicate that not all persons with ADHD have EF deficits. Some persons with ADHD may have deficits in brain reward systems that are relatively independent of EF impairments. Future research should clarify the multiple sources of ADHD impairments, continue to refine neuropsychological tools optimized for assessment, and incorporate longitudinal, developmental designs to understand ADHD across the lifespan.

A Meta-Analysis of the Neuropsychological Effects of Adjuvant Chemotherapy Treatment in Women Treated for Breast Cancer

ABSTRACT Given the improvement in mortality rates associated with breast cancer, the importance of understanding the long-term neuropsychological consequences of chemotherapy is becoming increasingly vital. This study applies meta-analytic techniques to the scant literature on the relationship between contemporary adjuvant chemotherapy treatment for breast cancer and cognitive dysfunction as examined through neuropsychological indices. Seven studies (involving more than 300 participants) were selected from over 200 potential articles, based on three inclusion criteria: presence of breast cancer, administration of chemotherapy treatment, and use of neuropsychological tests. From these, nine treatment-control comparisons were used to generate 129 Hedge's d effect sizes across the cognitive domains of simple attention, working memory short- and long-term memory, speed of processing, language, spatial abilities, and motor function. Small to medium cumulative effect sizes, showing diminished cognitive function for chemotherapy treatment groups compared to control groups, were obtained for each of the eight cognitive domains. Overall, these results suggest that women who undergo adjuvant chemotherapy as treatment for breast cancer may experience subtle yet consequential cognitive decline.

Preclinical Alzheimer's disease: diagnosis and prediction of progression

From the modest but important breakthroughs in the treatment of Alzheimer's disease (AD), diagnostic focus has increasingly shifted to the accurate detection of the earliest phase of the illness. The challenge of distinguishing preclinical AD from changes of normal ageing or established AD, has been recognised in several attempts at clinical classification. Of these attempts, Mayo Clinic's mild cognitive impairment (MCI) has received significant attention, although it has not been internationally accepted. Not all people diagnosed as having MCI will develop AD, hence there is a need to reliably predict progression. Research in the identification of people with MCI who will develop AD via the use of neuropsychological tests, neuroimaging (both structural and functional), CSF analysis, and other biomarkers, either in isolation or in combination, has progressed rapidly. In this article we summarise findings from relevant recent longitudinal studies. WHERE NEXT?: There are increasing calls to recognise the pathological nature of MCI and to develop international diagnostic guidelines. Such uniform application of MCI criteria can then lead to clearer evidence of its diagnostic and therapeutic benefit. In developing these guidelines, the crucial presence of functional deficit arising from cognitive decline (which diagnoses dementia and excludes MCI) needs to be investigated in a standardised manner. Also needed are good-quality normal-values data on the various tests used to predict progression in preclinical AD.

Neuropsychological profiles of persons with mental retardation and dementia

This study examined the use of neuropsychological tests to assist in the differential diagnosis of dementia among persons with mental retardation. The author compared performances of persons with mental retardation and dementia ( n = 10) to persons with mental retardation without dementia ( n = 12). Participants were matched by IQ (mild or moderate mental retardation), age, presence of Down syndrome, and gender. In addition, all participants in the dementia group had corroborative medical tests (i.e., imaging, EEG, or high tau low AB42 protein testing) consistent with diagnosis of dementia. Test performance was compared on measures of attention and executive functions, language, memory and learning, and a dementia screening. Results from MANOVAs and nonparametric tests revealed significantly lower performance for persons with mental retardation and dementia in all areas assessed. Cut-off scores were also developed for the sample in order to maximize sensitivity and specificity for the test battery. Despite the small sample size, these findings suggest that there are significant measurable differences in several neurocognitive domains between the two groups.

Concussion in athletes.

Concussion or mild traumatic brain injury (MTBI) is a major sports medicine issue in the current medical literature and in the popular media. Well-publicized cases of careers ended by the results of multiple concussions as well as the potential for long-term neurocognitive deficits due to multiple concussions have raised concerns. This review will discuss the epidemiology, anatomy, and physiology of concussion, as well as the clinical evaluation, grading scales, risk of chronic traumatic brain injury, and research on genetic risk factors for concussion. The main focus of this article is to review the clinical evaluation and management of concussion, including return to play criteria and use of neuropsychological testing for the practicing physician. An estimated 300,000 sports-related traumatic brain injuries of mild to moderate severity occur in the United States each year.' Football, ice hockey, soccer, and rugby are sports with the highest concussion prevalence. Some studies show that up to 15% of people diagnosed with MTBI experience persistent disabling symptoms.^''

The role of physicians in assessing older drivers: barriers, opportunities, and strategies.

Evaluation of the older driver is a difficult task for primary care physicians. We investigated the physician-perceived barriers to assessing older drivers in primary care practice. Twenty family physicians whose patients had completed a clinical questionnaire and neuropsychological tests participated in one of 2 focus groups. Physicians were asked about barriers to assessing older drivers in primary care and the usefulness of neuropsychological tests for assessing driving ability. A number of themes emerged related to barriers in the assessment of the older driver. Major themes included concerns about being liable for the results of driving related screening and about patients reacting unfavorably to a driving assessment including cognitive tests. Physicians uniformly agreed that a protocol to guide driving assessment would be useful. Physicians encounter a number of barriers to assessing older drivers but recognize the importance of driving within the context of geriatric functional assessment.

HOW TO DETERMINE WHEN AN ATHLETES??S COGNITIVE FUNCTION HAS CHANGED AFTER CONCUSSION

BACKGROUND In concussed athletes, decline in neuropsychological test performance from preseason baseline levels may be cited as evidence that the athlete's brain function has not returned to normal after the injury. Despite the pivotal medical management role that neuropsychological testing can play in such circumstances, the psychometric properties such tests require for accurate detection of cognitive impairments are not well understood. PURPOSE To examine the psychometric properties required for accurate detection of post-concussion impairments in neuropsychological test performance. METHODS 427 athletes performed computerized neuropsychological testing prior to the 2002 Australian football season. Change from baseline to post-concussion in 10 athletes who were symptomatic at the time of post-injury testing are reported. Reliable change indices (RCI) were calculated using a reaction time task requiring 75 responses per athlete. These scores were then re-calculated after selecting 5, 10, 20, 30 and 50 responses at random from both baseline and post-concussion test data. Group mean and individual RCI scores are reported under each of these conditions. RESULTS Highly variable results were obtained when few (5 & 10) responses were included in the RCI calculation. Changes observed under these conditions were inconsistent with the athletes clinical status at the time of testing. These inconsistencies resolved as a greater number of responses were included in the RCI calculation. CONCLUSION Accurate estimates of performance on neuropsychological tests of response time require that at least 20 responses be recorded in every athlete at both baseline and post-concussion evaluations. The use of neuropsychological tests with fewer required responses may lead to erroneous clinical decisions.

The assessment of sport-related concussion: the evidence behind neuropsychological testing and management.

Because of the lack of valid evidence to support the current recommendations for the management of mild traumatic brain injury (concussion), many physicians, athletic trainers, coaches, and athletes have called into question the way concussions are treated in athletics. This review article discusses the current evidence for the management of concussion in high school, college, and professional sports. A complete review of the epidemiologic and neuropsychological studies to date is presented and critically reviewed, as are other assessment and management tools in concussion. The appropriate use of neuropsychological testing, grading scales, and return-to-play recommendations are discussed in depth based on the current evidence. Additionally, areas requiring further research are identified and future trends are briefly discussed.

The diagnosis and neuropsychological assessment of adult attention deficit/hyperactivity disorder. Scientific study and practical guidelines.

The recognition of attention deficit/hyperactivity disorder (ADHD) in adults is a well documented, but relatively new development. Investigations of the disorder have indicated that disturbances in behavior and adjustment are common. These disturbances may be linked to poorly developed executive functions. This paper reviews the neuropsychological studies that have compared persons with ADHD to normal controls and to psychiatric controls. The review indicates that persons with ADHD share many neuropsychological characteristics with other persons with serious psychiatric conditions, although those with ADHD may have a particular profile of slowed performance in tasks of sustained attention and set shifting, and their use of working memory may be particularly impaired. The implications of research for clinical assessment are discussed. We contend that a neuropsychological orientation is necessary for making the diagnosis and gaining a full understanding of adult ADHD. A model for clinical assessment is proposed which utilizes a neuropsychological orientation and the targeted administration of neuropsychological instruments. The careful use of neuropsychological measures is warranted in providing an elaborate picture of a person's functioning, although the use of neuropsychological tests is not necessary to make the diagnosis.

Performance and Strategy Indices of Neuropsychological Tests

Abstract Many studies have related performance on neuropsychological tests to forensic aspects of behavior. Use of neuropsychological tests has to a large extent focused on subject performance. Interest is rarely focused on qualitative aspects of the solution process. In the present study 82 prisoners completed a computerized neuropsychological test battery allowing a detailed analysis of both quantitative and qualitative aspects of a person's test performance. The neuropsychological data could be reduced to a set of meaningful dimensions or factors, combining information from different tests. Some of the factors were associated with personality and criminality attributes. Criminal versatility and violence were significantly associated with verbal deficits, as were also indices of childhood and persistent ADHD. However, there were only few and scattered significant associations with strategy indices, probably because of ceiling effects. In spite ofthat, strategy aspects of neuropsychological test data may...

New developments in forensic psychology

Briefly introduces the concept of forensic psychology, looking at areas such as stalking behaviour, self‐mutilation, and execution competency. Suggests that the forensic psychiatrist needs to remain up to date with recent sexual harassment legislation, the use of neuropsychological testing and the assessment of child abuse. Covers other subjects including hate crime on the Internet, and psychological autopsy. Concludes that to uphold the high principles required by law and to withstand scrutiny by defence lawyers, forensic psychology has defined standards by which to judge a persion and studies continue to develop these measures.