Search

Objective: With the increasing focus on reducing medical errors and the aging of the physician workforce has come growing concern for cognitive impairment among physicians. This study sought to establish and validate an approach to detecting neuropsychological impairment among physicians. Method: The neuropsychological test performance of 30 physicians referred clinically for neuropsychological evaluations was compared to that of 39 normal community-practicing urologists. We derived 9 key variables from the cognitive and motor tests as dependent variables. Impairment among the clinically-referred doctors was operationalized as scoring ≤5th percentile of the community physicians on at least 3, 4, 5, or 6 of the 9 variables. Using this approach, all clinically-referred physicians were classified as either "impaired" or "ambiguous." Results: A cutoff of ≥5 impaired test scores provided the best balance among competing models. Using this criterion, 14 of the clinically-referred doctors (46%) were impaired and 16 remained ambiguous. The impaired physicians: (1) were older, (2) were more often suspected of having a neurodegenerative disorder, and (3) were more likely to have discontinued practicing medicine. These findings serve as initial validation of our methodology. Conclusions: Using conservative criteria derived from normal community physicians, we could identify a substantial subgroup of clinically-referred physicians who are unambiguously neurocognitively impaired. Replication and refinement of our method with larger samples are recommended, as are the development of specialty-specific criteria for impairment. [ABSTRACT FROM AUTHOR]

Bodin and Grote convey their opinion that the field of clinical neuropsychology would be best served by a match system for recruitment into postdoctoral training. We critically review their arguments and offer an alternative point of view. Our view considers the current state of the match system in neuropsychology, incorporates comparisons with other disciplines that rely on a match system, and addresses the role of postdoctoral training and the specialization that takes shape at this level. We make recommendations aimed at promoting greater unity among postdoctoral training programs with the goal of focusing leadership efforts on advancing our shared mission of providing the highest quality training in clinical neuropsychology. [ABSTRACT FROM PUBLISHER]

Objective: Executive dysfunction is common in Parkinson’s disease (PD), yet the relationship between executive functioning (EF) and instrumental activities of daily living (IADLs) is inconsistent. This inconsistency may be due to the limited relationship between EF test scores and behaviors. Rating scales provide a potential way to supplement test scores in predicting patient’s ability to complete IADLs by capturing a wide range of EF behaviors in their everyday environment. We hypothesized that informant-rated EF would provide incremental validity in predicting IADLs above and beyond EF test scores.Methods: Eighty-five patients were selected from a clinical neuropsychological database of PD patients evaluated for deep brain stimulation surgery at The Johns Hopkins Hospital between September 2006 and January 2015. Hierarchical regression was completed to determine the relationship between an EF behavioral rating scale (i.e., FrSBe), EF test scores, and IADLs.Results: The EF behavioral rating scale added incremental validity to neuropsychological test scores in predicting IADLs.Conclusions: Behavioral ratings of EF may provide additional information about how PD patients’ EF is influencing their everyday life. [ABSTRACT FROM AUTHOR]

Naming is a fundamental aspect of language and is virtually always assessed with visual confrontation tests. Tests of the ability to name objects by their characteristic sounds would be particularly useful in the assessment of visually impaired patients, and may be particularly sensitive in Alzheimer's disease (AD). We developed an auditory naming task, requiring the identification of the source of environmental sounds (i.e., animal calls, musical instruments, vehicles) and multiple-choice recognition of those not identified. In two separate studies mild-to-moderate AD patients performed more poorly than cognitively normal elderly on the auditory naming task. This task was also more difficult than two versions of a comparable visual naming task, and correlated more highly with Mini-Mental State Exam score. Internal consistency reliability was acceptable, although ROC analysis revealed auditory naming to be slightly less successful than visual confrontation naming in discriminating AD patients from normal participants. Nonetheless, our auditory naming task may prove useful in research and clinical practice, especially with visually impaired patients. [ABSTRACT FROM AUTHOR]

Patients with amnestic mild cognitive impairment (aMCI) have been described as exhibiting greater impairment on tests of category fluency than letter fluency. This has been offered as evidence that this condition represents pre-clinical Alzheimer's disease (AD). We hypothesized that this pattern of differential impairment is dependent on the specific semantic categories and initial letters selected, and is not specific to AD and aMCI. A total of 40 cognitively normal older adults, 74 MCI patients—25 “amnestic single domain” (aMCI), 27 “amnestic multiple domain”, and 22 non-amnestic—and 29 AD patients were tested with multiple forms of semantic-category and initial-letter fluency tasks. The pattern of deficits within and across groups was highly dependent on the specific categories and letters chosen. Overall, aMCI patients did not demonstrate greater impairment in category than letter fluency. In fact, the level and pattern of their performance resembled that of cognitively normal older adults much more than AD patients. MCI patients with deficits in multiple cognitive domains performed most like AD patients. These findings indicate that verbal fluency performance is highly influenced by the specific tasks used, and impairment on semantic fluency is not characteristic of pure amnestic MCI. [ABSTRACT FROM AUTHOR]

This address to the International Neuropsychological Society membership challenges the wisdom of several common practices in contemporary neuropsychology. It is argued that, in spite of their popularity, the development of race-specific test norms, the indiscriminate use of Bonferroni's correction for multiple comparisons, and the conduct of "quality of life" research are all conceptually problematic. These practices may have untoward sociopolitical effects as well, and neuropsychologists are urged to exercise caution before embracing them. [ABSTRACT FROM AUTHOR]

The present investigation examined the validity of the revised Hopkins Verbal Learning Test (HVLT-R). In a principal components analysis with varimax rotation, measures of new learning and delayed recall loaded on a single factor distinguishable from measures related to general cognitive function and visual memory. The HVLT-R also correlated most strongly with other tests of verbal memory and relatively weakly with a test of general intelligence. Group comparisons showed that normal controls performed better than age- and education-matched patients with probable Alzheimer's disease (AD) or vascular dementia (VaD). Discriminant function analyses and Bayesian statistics revealed high classification accuracies for dementia patients versus controls. When scores on the HVLT-R and other neuropsychological tests were subjected to discriminant function analyses, performance on the HVLT-R delayed recognition task was found to be the most useful in discriminating patients with AD from those with VaD. We conclude that the HVLT-R is a valid test of verbal learning and memory that is best suited for use with elderly patients suspected of dementia. [ABSTRACT FROM AUTHOR]

The relationship between the value of an item borrowed from a patient fora prospective memory task and the number of cues required by the patient forrequesting its return was analyzed in 63 consecutive patients referred forclinical neuropsychological evaluation. The correlation was negligible (ρ= -.001). Number of cues needed was better predicted by score on theMini-Mental State Exam ( r = -.541, p < .001) thanby subject's age, sex, or education, or the value of the item taken. [ABSTRACT FROM AUTHOR]

The administration of many neuropsychological tests includes discontinuation criteria that are often complex and time-consuming. As a result, it is not uncommon for an examiner to unintentionally discontinue the administration of a test prematurely. This investigation of 56 correctly scored Developmental Test of Visual-Motor Integration protocols was conducted to determine how the premature termination of this particular test significantly affects its overall score, and thus, its interpretation. These data indicate that premature discontinuation of this test results in a minimal loss of points overall, and thus, does not invalidate the interpretation of its score. [ABSTRACT FROM AUTHOR]

Patients with amnestic mild cognitive impairment (aMCI) have been described as exhibiting greater impairment on tests of category fluency than letter fluency. This has been offered as evidence that this condition represents pre-clinical Alzheimer's disease (AD). We hypothesized that this pattern of differential impairment is dependent on the specific semantic categories and initial letters selected, and is not specific to AD and aMCI. A total of 40 cognitively normal older adults, 74 MCI patients-25 "amnestic single domain" (aMCI), 27 "amnestic multiple domain", and 22 non-amnestic-and 29 AD patients were tested with multiple forms of semantic-category and initial-letter fluency tasks. The pattern of deficits within and across groups was highly dependent on the specific categories and letters chosen. Overall, aMCI patients did not demonstrate greater impairment in category than letter fluency. In fact, the level and pattern of their performance resembled that of cognitively normal older adults much more than AD patients. MCI patients with deficits in multiple cognitive domains performed most like AD patients. These findings indicate that verbal fluency performance is highly influenced by the specific tasks used, and impairment on semantic fluency is not characteristic of pure amnestic MCI.

This address to the International Neuropsychological Society membership challenges the wisdom of several common practices in contemporary neuropsychology. It is argued that, in spite of their popularity, the development of race-specific test norms, the indiscriminate use of Bonferroni's correction for multiple comparisons, and the conduct of "quality of life" research are all conceptually problematic. These practices may have untoward sociopolitical effects as well, and neuropsychologists are urged to exercise caution before embracing them.

The relationship between the value of an item borrowed from a patient for a prospective memory task and the number of cues required by the patient for requesting its return was analyzed in 63 consecutive patients referred for clinical neuropsychological evaluation. The correlation was negligible (rho = -.001). Number of cues needed was better predicted by score on the Mini-Mental State Exam (r = -.541, p <.001) than by subject's age, sex, or education, or the value of the item taken.