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Objective Asians of Chinese origin are the largest single Asian origin group in the United States and are also the third largest group in Harris County, TX (i.e., the Houston metropolitan area). Mandarin speakers constitute the majority of the group. The linguistic gaps between Chinese (Mandarin) and English make it essential to use appropriate tests and normative data when working with the Mandarin-speaking population. Although it is ideal to develop original tests and/or normative data for Mandarin-speaking patients residing in the United States, the process can be lengthy. Although these indigenous tests are being developed, a neuropsychological battery with tests validated in Mandarin-speaking regions (e.g., Mainland China, Taiwan, and Singapore) can provide valuable information for Mandarin-speaking patients who identify with their home culture/country/region. Methods A systematic review of two electronic databases (PubMed and PsycInfo) was conducted. Results A neuropsychological battery to assess cognitive domains, including global intellectual function, attention/processing speed, executive function, visuospatial/visuoconstruction, language, learning and memory, and emotion, was developed. Cognitive screeners and performance validity measures were also included. The battery consists of core and supplementary measures validated in the Mandarin-speaking population. A case illustration is provided. Conclusion Strengths and limitations of the battery and the role of interpretation in service delivery are discussed. The battery is recommended to clinicians for the evaluation of Mandarin-speaking older adults residing in the United States and other non-Mandarin-speaking regions where local norms are not available.

Objective The training competency of individual and cultural diversity is an advanced, fundamental competency to health service psychology since 2015. However, there is minimal instruction on how to integrate it into training curricula in neuropsychology, especially at the postdoctoral fellowship level. Our objective was to operationalize the individual and cultural diversity standard to provide a tangible application for educational programs on how to develop a competency-based training model for Latinx/a/o-Hispanic (L/H) cultural neuropsychology across the lifespan. Method The knowledge-based and applied-based competencies necessary to train to be a cultural neuropsychologist delivering services to L/H patients and families are defined. For learners to complete these competencies, training programs need to implement clinical, didactic, research, and professional development core guidelines grounded in cultural neuropsychology. We provide a framework on how to transform each core guideline, including a Didactics Core with foundational readings across a range of L/H topics, and a Report Template to guide the documentation of sociocultural information, language usage, normative data, and other relevant factors in a neuropsychological report. Conclusions These cultural neuropsychology competencies and core guidelines need to become a basic core requirement for all neuropsychologists in training. With focused education in culturally based competencies, training programs can cultivate a sense of responsibility, inclusion, justice, and equity to train a generation of neuropsychologists, who intentionally and consistently practice socially responsible neuropsychology.

Objective To serve the over 1.82 million people of Korean descent who reside in the United States, we assembled a core and supplemental battery of culturally and linguistically appropriate neuropsychological measures for differential diagnosis of dementia for Korean-speaking patients. Method Test instruments in Korean were identified through systematic searches of PubMed and Google Scholar, US-based website searches in Korean, and in consultation with Korean-speaking cultural brokers, residing in the United States and Korea. Results A battery assessing cognitive domains and mood was assembled using core measures developed specifically for Korean-speaking individuals within the United States and supplemental English measures that can be administered using translated instructions and English normative data. The rationale for test selection and clinical utility, including strengths and limitations of the proposed measures, is presented. Additionally, a case illustration using the proposed battery is included. Conclusions Given the large and aging population of Korean-speaking residents in the United States, it is imperative to utilize appropriately designed and normed instruments to provide culturally competent assessments to better serve the Korean community.

Objectives To assemble a core battery of culturally and linguistically appropriate neuropsychological measures that can be administered to Vietnamese-speaking patients with suspected dementia. Methods Test instruments in Vietnamese were identified through systematic searches of PubMed, PsychInfo, and Google Scholar, and in consultation with two Vietnamese-speaking cultural brokers. Results A battery assessing the domains of attention, executive function, verbal and visual episodic memory, basic language abilities, visuospatial/visuoconstruction abilities, and mood/anxiety was assembled that included core measures developed either specifically for a Vietnamese-speaking population, or were validated/normed with a Vietnamese-speaking sample either in Vietnam or Vietnamese-speaking persons in the U.S. Supplemental measures were selected that can be administered using translated instructions with U.S. English normative data. The rationale for test selection and caveats for their clinical use are presented. Conclusions The number of neuropsychological measures identified in Vietnamese and/or with Vietnamese normative data was sparse. Given the large and growing population of Vietnamese-speaking residents in the U.S. and the aging of these communities, it is imperative to develop additional, appropriately designed and normed instruments to provide culturally competent assessments to better serve these individuals.

Objective Becoming culturally competent healthcare providers depends on the ability of practitioners to acquire knowledge, awareness, and skills related to other cultures. In building these areas of competence, it is essential to consider geopolitical factors that may influence health and health-seeking behaviors, particularly when working with immigrant populations. When care is sought, they are likely to experience significant barriers to effective care, including lack of providers who speak their language and failure of practitioners to integrate cultural beliefs into treatment plans. This is further complicated by the presence of geopolitical issues, including immigration status, war/conflict in the patient’s country of origin, and/or human rights violations. Method The current study uses a sample case of a Burmese-speaking, Myanmar national to illustrate a culturally informed approach to the assessment of neurobehavioral changes within complex geopolitical circumstances. The sample represents an amalgam of several patients, designed to represent common presentations, sociodemographic situations, and concerns that arise during the neuropsychological assessment process. Results Description of relevant case information including background, clinical observations, and performance on testing is provided. Discussion Awareness of the impact of these life experiences not only has the potential to deepen our understanding of our patients but also results in a more holistic, accurate, and culturally competent conceptualization of their physical and mental health needs.

Objective In adherence to the American Educational Research Association (AERA) guidelines on culturally informed testing practices, this paper aims to review a suggested battery of tests that is linguistically and culturally appropriate for Arabic-speaking patients and to inform the reader of the varied characteristics of the Arab world to aid in providing a culturally informed neuropsychological evaluation. Method Test instruments in Arabic were identified through systematic searches of PubMed and Google Scholar, U.S.-based website searches in Arabic and French, and in consultation with Arabic-speaking cultural brokers. Results A battery assessing cognitive domains and mood was assembled using core measures that were developed using appropriate translations, cultural adaptations, and include normative data of Arabic-speaking individuals. Supplemental measures that can be administered using translated instructions and English normative data are also identified. The rationale for test selection and clinical utility, including strengths and limitations of the proposed measures is presented. Conclusions Given the large number of Arab Americans residing in the United States combined with the dearth of Arabic speaking neuropsychologists, it is essential that non-Arabic speaking neuropsychologists educate themselves regarding culturally informed practices to better service this growing community.

Objective Epilepsy is one of the most common reasons for referral for a pediatric neuropsychological evaluation due its high prevalence in childhood and our well-established clinical role in tertiary care settings. Emerging evidence indicates that racial and ethnic minority populations experience increased epilepsy burden compared with White peers. Although there has been heightened recognition in our specialty regarding the dire need for culturally and linguistically responsive evaluations, the scientific evidence to support effective neuropsychological service delivery for bi/multilingual and bi/multicultural youth with epilepsy is comparatively scant and of poor quality. As a result, significant patient and clinical challenges exist, particularly in high stakes presurgical pediatric epilepsy evaluations of bi/multilingual and bi/multicultural children. Method Given that Spanish is the most common language spoken in the United States after English, this paper will focus on Spanish and English measures, but will provide evidence-based practice considerations that can inform practices with other non-English speaking communities. Cultural and linguistic factors that affect clinical decision-making regarding test selection, test interpretation, and feedback with families are highlighted. Results We offer a review of neuropsychological profiles associated with pediatric epilepsy as well as a flexible, multimodal approach for the assessment of linguistically and culturally diverse children with epilepsy based on empirical evidence and the clinical experiences of pediatric neuropsychologists from diverse backgrounds who work with children with epilepsy. Conclusion Limitations to this approach are discussed, including the lack of available measures and resources for culturally and linguistically diverse pediatric populations. A case illustration highlights a culturally informed assessment approach.

Objective Acculturation has been linked to health outcomes in Hispanics/Latinos (H/Ls). However, there is equivocal evidence of a relationship between acculturation and neuropsychological outcomes. Various factors limit the ability to subject the evidence to systematic/meta-analytic review. We sought to examine the current state of the literature in the context of H/Ls and neuropsychology and describe the various limitations of measuring acculturation across the lifespan. Method Applying a scoping review approach, we identified unique stand-alone (e.g., questionnaires) measures of acculturation. We focused on psychometric (e.g., internal consistency) and other characteristics (e.g., language, structure/format) and description of the validation samples (e.g., cultural background/country of origin). Results A total of 40 unique acculturation measures were identified. Measures spanned various domains (e.g., language proficiency, food preference, music choice), and relied heavily on linguistic behavioral characteristics. Internal consistency varied from unacceptable to clinically acceptable ranges. Variable approaches to development and validation were reported. Validation samples varied from 22 to 2,048 respondents (median = 380), most of which represented a general adult population. Only eight measures were validated for use in pediatric populations; none were developed specifically for use with older adults. Conclusions Published measures are outdated, evidence highly variable psychometric and methodological weaknesses, and lack a lifespan perspective. Several themes in the types of items considered elemental to the acculturative process are revealed and findings are summarized via an “ABC” framework, categorizing items as antecedents, behaviors, and consequent acculturative changes, that lends itself to clinical and research settings.

Objective As the third largest immigrant population in Houston, Texas, Brazilians represent a large bloc of the community in need of culturally and linguistically informed healthcare. In particular, the number of older adults within this population is rapidly growing, emphasizing the increased need to develop socially responsible neuropsychological assessment practices that can meet the needs of this demographic. Additionally, early symptoms of cognitive decline in Brazilian older adults can be culturally perceived as normal aging and may be masked by cultural and lifestyle practices (i.e., scaffolding by family members) that result in lack of appreciation for cognitive and functional decrements. With increased knowledge and awareness of Brazilian culture and customs, we can better understand and assess brain–behavior relationships, provide tailored assessment services, and determine the clinical implications for this population. Methods Test instruments in Portuguese were identified through systematic literature searches, and in consultation with clinicians serving the Portuguese community in the United States, and cultural brokers involved in Brazilian-based neuropsychology. Results A multidomain neuropsychological battery with accompanying normative data for use with adults from this community is presented. A case illustration is utilized to highlight limitations and strengths of the proposed battery, which includes core and supplemental measures. Conclusion Neuropsychologists are encouraged to familiarize themselves with the proposed protocol, understand the psychometric limitations of the available tools, and make an earnest attempt toward providing socially responsible neuropsychological care via the appropriate use of culturally and linguistically tailored instruments and clinical practices.

Objective Provision of supervision is an integral component of training in psychology, a view that was solidified in 2014 with the development of the American Psychological Association created Guidelines for Clinical Supervision in Health Service Psychology ( APA, 2014). Current supervisory standards require several components before a relationship is considered supervisory. Among these are assumptions that the supervisory relationship is respectful and collaborative, that feedback is bidirectional, and that it focuses on the development of competency and professional identity by the supervisee. Although clinical and counseling psychology has created supervision models with a variety of different theoretical orientations focused on multiculturalism, neuropsychology as a specialty lacks cohesive, culture-centric, bidirectional supervisory models. Method A systematic review of two electronic databases (PubMed and PsycInfo) was conducted to search for supervision models designed specifically for training in neuropsychology. Results A new model for supervision in neuropsychology was developed, coined the Culturally Expressive and Responsive (CER) Model for Supervision in Neuropsychology. The model is dynamic, multifaceted, and bidirectional, integrating sociocultural and linguistic considerations throughout the supervisory relationship. Conclusions The different facets of the CER Model are discussed, including its place embedded within a larger equitable healthcare model designed to increase healthcare equity. The CER Model highlights the bidirectional supervisory relationship and is designed to be tailored to the developmental level of the learner, encouraging high quality training and evidenced-based practice. Furthermore, the model encourages a process of identity development that is ongoing and emphasizes self-evaluation and cultural humility rather than a static sense of “competence.”

Objective The Latina(o)/Hispanic (L/H) population represents the largest and fastest-growing ethnic group in the United States. Migration patterns have evolved and greater diversity (i.e., country of origin) is evident, highlighting the ever-changing heterogeneity of this community and the need for the field of neuropsychology to ensure equitable care for linguistically and culturally diverse communities. This paper aims to provide a flexible protocol of neuropsychological instruments appropriate for primarily Spanish-speaking adults residing in the United States. Method Spanish measures were selected based on availability, translations/cultural modifications, accompanying normative data sets, and clinician experience/acumen. Bilingual/bicultural providers of neuropsychological services to Spanish speakers across the training spectrum working at U.S.-based medical centers implemented a multimodal approach (i.e., literature search, clinical practice parameters, and focus groups) in the development of a multi-domain primary protocol that includes core and supplemental measures that are appropriate for individuals with varying linguistic proficiency and sociocultural demographic characteristics. Results A multi-domain, evidence-based, flexible neuropsychological protocol is presented. Recommendations for test selection based on sociocultural demographic factors and examples of clinical assessment practices are provided via a case illustration. Most instruments included may be applied across cultural and regional backgrounds. Conclusion Provision of neuropsychological services to primarily Spanish-speaking adults presents unique challenges. Existing Spanish measures and accompanying data rarely capture the heterogeneity of L/H individuals. Although Spanish has the largest number of neurocognitive instruments, relative to other languages, robust and representative norms continue to be scarce. Future studies should prioritize collecting normative data from educationally and geographically diverse samples.

Objective To assemble a comprehensive neuropsychological battery appropriate for differential diagnosis of dementia in Farsi-speaking Iranian adults in the United States. Method Systematic searches of PubMed, PsychInfo, and Google Scholar databases were conducted to obtain test instruments relevant to Farsi speakers in consultation with a Farsi-speaking cultural broker. Results A proposed battery assessing the domains of attention, executive function, verbal and visual episodic memory, language, visuospatial/visuoconstruction abilities, and mood/anxiety was assembled that includes core measures developed, either specifically for a Farsi-speaking Iranian population or validated/normed with a Farsi-speaking Iranian sample. Though not ideal, additional measures were selected that can be administered using translated instructions with English normative data to supplement the limited tests available for use in this population. The rationale for test selection and caveats for their clinical use are presented along with a case study. Conclusions The number of neuropsychological measures available in Farsi and/or with normative data for Farsi speakers is extremely limited. Cognitive tests either developed for or validated with a bilingual Farsi-English sample also represent a significant gap in the literature. Appropriate measures for these populations are urgently needed to provide a culturally competent assessment of a growing older adult segment of an underserved community.

Diagnosis and treatment of postconcussional syndrome (PCS) is challenging because symptoms are vague, difficult to confirm, and attributable to other conditions. There are no uniformly accepted diagnostic PCS criteria. Clinical care largely focuses on symptom reduction and management. Moreover, the coronavirus disease 2019 (COVID-19) pandemic has increased the challenge because post-acute COVID-19 syndrome symptoms overlap with PCS. Future research should center on base rates of PCS-type symptoms in nonneurological samples and the identification and improved understanding of moderating variables contributing to the frequency, intensity, and duration of PCS symptoms.

The 2nd annual Health Equity Summer Research Summit organized by the Center of Excellence (COE) in Health Equity, Training and Research, Baylor College of Medicine (BCM), was a forum to catalyze the fertilization and exchange of cutting-edge ideas in the area of disparity research in medicine. The summit fosters understanding of current health equity research, training, clinical care, and outreach initiatives, in addition to offering an opportunity for connecting with allies and partners working in the field of health equity and health disparities. The summit provides opportunities for our COE Scholars (undergraduate/post-baccalaureate students and Baylor medical students, clinical fellows and junior faculty) to showcase their research findings which are reflective of their past year's endeavor as scholars at the center. Abstracts in this Book of Abstracts represent a summary of these research efforts. With this summit, BCM continues to build on its long history of educational outreach initiatives to promote diversity in medicine by focusing on programs aimed at increasing the number of diverse and highly qualified medical professionals ready to introduce effective and innovative approaches to reduce or eliminate health disparities. These programs will improve information resources, clinical education, curricula, research and cultural competence as they relate to minority health issues and social determinants of health.

Objective:The Verbal Naming Test (VNT) is an auditory-based measure of naming or word finding. The current multisite study sought to evaluate the reliability and validity of the VNT in the detection of major and mild neurocognitive disorder (NCD).Method:This study analyzed clinical data from two outpatient neuropsychology clinics (N = 188 and N = 77) and a geriatric primary care clinic (N = 104). Cronbach’s alpha and Spearman correlations with other measures were calculated. ROC analyses were used to calculate sensitivity, specificity, positive predictive power, and negative predictive power for the detection of major and mild NCD per DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) criteria.Results:The VNT was found to have strong reliability (Cronbach’s alpha = .90) and high convergent validity with a commonly used picture-naming task (NAB Naming, Spearman’s rho = .65, p < .001). The VNT showed good sensitivity and specificity for the detection of NCDs, particularly major NCD, with an area under the curve of .85, sensitivity of .80, and specificity of .75. A possible discontinue rule is also suggested for clinicians to use.Conclusions:These findings provide compelling evidence for the use of the VNT to detect neurocognitive impairment in a clinical setting. The VNT provides a reliable alternative to picture-naming tasks, which may be advantageous when working with visually impaired patients or conducting evaluations over telehealth.

The success of deep brain stimulation (DBS) for treating Parkinson's disease has led to its application to several other disorders, including treatment-resistant depression. Results with DBS for treatment-resistant depression have been heterogeneous, with inconsistencies largely driven by incomplete understanding of the brain networks regulating mood, especially on an individual basis. We report results from the first subject treated with DBS for treatment-resistant depression using an approach that incorporates intracranial recordings to personalize understanding of network behavior and its response to stimulation. These recordings enabled calculation of individually optimized DBS stimulation parameters using a novel inverse solution approach. In the ensuing double-blind, randomized phase incorporating these bespoke parameter sets, DBS led to remission of symptoms and dramatic improvement in quality of life. Results from this initial case demonstrate the feasibility of this personalized platform, which may be used to improve surgical neuromodulation for a vast array of neurologic and psychiatric disorders.

Background Accumulating evidence suggests that the COVID-19 pandemic has negatively impacted the mental health of individuals. However, the susceptibility of individuals to be impacted by the pandemic is variable, suggesting potential influences of specific factors related to participants’ demographics, attitudes, and practices. Objective We aimed to identify the factors associated with psychological symptoms related to the effects of the first wave of the pandemic in a multicountry cohort of internet users. Methods This study anonymously screened 13,332 internet users worldwide for acute psychological symptoms related to the COVID-19 pandemic from March 29 to April 14, 2020, during the first wave of the pandemic amidst strict lockdown conditions. A total of 12,817 responses were considered valid. Moreover, 1077 participants from Europe were screened a second time from May 15 to May 30, 2020, to ascertain the presence of psychological effects after the ease down of restrictions. Results Female gender, pre-existing psychiatric conditions, and prior exposure to trauma were identified as notable factors associated with increased psychological symptoms during the first wave of COVID-19 (P Conclusions This study highlights the significant impact of the COVID-19 pandemic at the worldwide level on the mental health of internet users and elucidates prominent associations with their demographics, history of psychiatric disease risk factors, household conditions, certain personality traits, and attitudes toward COVID-19.

Objective Neuropsychological assessments with monolingual Spanish and bilingual Spanish/English-speaking adults present unique challenges. Barriers include, but are not limited to, the paucity of test norms, uncertainty about the equivalence of translated neuropsychological tests, and limited proficiency in the provision of culturally competent services. Similar issues generalize to telephone- and video-based administration of neuropsychological tests or teleneuropsychology (TeleNP) with Hispanics/Latinos (as), and few studies have examined its feasibility and validity in this group. The sudden onset of the COVID-19 pandemic prompted neuropsychologists to identify alternative ways to provide equitable care. Clinicians providing TeleNP to this population during (and after) the pandemic must consider safety, professional factors, and systemic barriers to accessing and benefitting from virtual modalities. Method This clinical process manuscript describes how cross-cultural neuropsychologists across five U.S. academic institutions serving Hispanics/Latinos (as) developed TeleNP models of care during the pandemic. Results Workflows, test batteries, and resources for TeleNP assessment with monolingual and bilingual Spanish-speaking patients are included. Factors guiding model development and informing decisions to incorporate virtual administration of neuropsychological tests into their practice are also discussed. Conclusions Provision of TeleNP is a promising modality. Additional research in this area is warranted with focus on cultural and contextual factors that support or limit the use of TeleNP with this community.

Background: The emergence of Corona virus disease (COVID-19) and wide-spread counter-measures, such as quarantine and social distancing, can have a significant impact on mental health of individuals. Methods: This online study anonymously screened 13,332 individuals worldwide for acute psychological symptoms related to Corona virus disease 2019 (COVID-19) pandemic from March 29th to April 14th, 2020. A total of n=12,817 responses were considered valid. n=1077 participants from Europe were screened a second time during May 15th to May 30th to longitudinally ascertain the persistence of psychological effects. Results: Female gender, pre-existing psychiatric condition, and prior exposure to trauma were identified as notable factors associated with increased acute psychological symptoms during COVID-19. The same factors, in addition to, being related to someone who demised due to COVID-19 and using social media more than usual predicted persistence of psychological disturbances. Optimism, ability to share concerns with family and friends like usual, positive prediction about COVID-19, and daily exercise predicted fewer acute and persistent psychological symptoms. Conclusions: Females, psychiatric patients, and individuals with previous exposure to trauma are at increased risk of being persistently psychologically affected by COVID-19.

Concussion and the sequelae have been controversial medico-legal issues for over 150 years. The following topics which are also important in clinical practice are discussed: definitions of concussion, neuroimaging, onset and prognosis of headaches, cognitive impairment, cognitive rehabilitation, post-traumatic stress disorder, and risk of later development of dementia.

This study anonymously screened 13,332 individuals worldwide for psychological symptoms related to Corona virus disease 2019 (COVID-19) pandemic from March 29th to April 14th, 2020. A total of n=12,817 responses were considered valid with responses from 12 featured countries and five WHO regions. Female gender, pre-existing psychiatric condition, and prior exposure to trauma were identified as notable risk factors, whereas optimism, ability to share concerns with family and friends like usual, positive prediction about COVID-19, and daily exercise predicted fewer psychological symptoms. These results could aid in dynamic optimization of mental health services during and following COVID-19 pandemic.

The Boston Naming Test (BNT) is a widely used measure of confrontation naming ability that has been criticized for its questionable construct validity for non-English speakers. This study investigated item difficulty and construct validity of the Spanish version of the BNT to assess cultural and linguistic impact on performance.Subjects were 1298 healthy Spanish speaking adults from Colombia. They were administered the 60- and 15-item Spanish version of the BNT. A Rasch analysis was computed to assess dimensionality, item hierarchy, targeting, reliability, and item fit.Both versions of the BNT satisfied requirements for unidimensionality. Although internal consistency was excellent for the 60-item BNT, order of difficulty did not increase consistently with item number and there were a number of items that did not fit the Rasch model. For the 15-item BNT, a total of 5 items changed position on the item hierarchy with 7 poor fitting items. Internal consistency was acceptable.Construct validity of the BNT remains a concern when it is administered to non-English speaking populations. Similar to previous findings, the order of item presentation did not correspond with increasing item difficulty, and both versions were inadequate at assessing high naming ability.

ObjectivesTo describe the phenomenology and prevalence of leg stereotypy syndrome (LSS), characterised chiefly by repetitive, rhythmical, stereotypic leg movement, especially when sitting.MethodsWe sought to characterise LSS in two groups of subjects: (1) general population (GP) group, defined as individuals accompanying patients during their visits to Baylor College of Medicine Parkinson’s Disease Center and Movement Disorders Clinic who are not genetically related to the patients; and (2) movement disorders (MD) group, composed of consecutive patients with diagnoses of restless legs syndrome, Parkinson’s disease, Tourette syndrome and tardive dyskinesia.ResultsThere were 92 participants enrolled in this study; 7% of 57 individuals in the GP group and 17% of those in the MD group met the diagnostic criteria for LSS. The mean age of individuals with LSS was 44.5 (±11.9) years and mean age at onset of LSS was 17.5 (±5.7) years. In half of the individuals, the ‘shaking’ involved predominantly one leg. All had a positive family history of similar disorder and none had diurnal variation. The seven-item Leg Stereotypy Syndrome Questionnaire was developed as a screening tool to aid in differentiating LSS from other movement disorders.ConclusionsLSS is a common condition, occurring in up to 7% of otherwise healthy individuals, and it is even more common in patients with hyperkinetic movement disorders. Although it phenomenologically may overlap with other stereotypic disorders, we argue that it is a distinct, familial, neurological syndrome.

Obsessive compulsive disorder (OCD) is an anxiety disorder characterized by repeated, unwanted thoughts and behaviors. Individuals with this condition often experience significant emotional distress secondary to their symptoms. Additionally, impairments in attention/concentration, processing speed, and executive functions are typically observed. The exact pathology of OCD remains unknown; consequently, it can be difficult to treat patients with severe symptomatology. Deep brain stimulation (DBS) may be a viable treatment option for individuals who do not respond to medication and/or cognitive behavioral therapy. The following case discusses DBS of the anterior limb of the internal capsule for a patient with severe, therapy-refractory OCD, including pre- to postoperative neurocognitive and psychiatric changes.

ObjectiveTo understand patient burden of treatment of repeated intravitreal injections (IVI) in the management of exudative retinal diseases.Methods and analysisParticipants were sampled from a large urban retina specialty practice in Houston, Texas, USA, based on history of ongoing receipt of IVI. The 50-item Questionnaire to Assess Life Impact of Treatment by Intravitreal Injections questionnaire was developed to evaluate the patient experience including discomfort, anxiety, inconvenience and satisfaction. Categorial principal components analysis (CATPCA) was performed to assess construct validity and internal consistency. A subset of these items was used to establish a measure of total treatment burden, referred to as the IVI Treatment Burden Score (TBS).Results142 patients participated in this study. CATPCA analysis revealed five dimensions of patient burden: disruption of normal routine or capacity, anxiety, frequency of visits, chronicity of disease and perceived treatment value or satisfaction. Together, these dimensions accounted for 67% of variance explained. Cronbach’s alpha was 0.97. The most frequently cited cause of discomfort was the feeling after anaesthetic wore off. The most common source of anxiety was fear of injection and associated discomfort or pain. Regarding inconvenience, patients reported temporary postinjection debilitation, requiring an average of 8 hours for recovery per treatment. The most frequently identified sources of satisfaction were confidence in the provider or treatment and interactions with staff.ConclusionsUnderstanding and quantifying the patient burden associated with repeated IVI for exudative retinal diseases can reveal opportunities to improve delivery methods. The TBS could serve to inform strategies to maximise treatment adherence and optimise patient experiences.

Purpose of reviewPrion diseases are rare neurodegenerative diseases that are caused by abnormal pathogenic agents and can affect both humans and animals. These diseases are categorized as sporadic, inherited, or acquired by infection. Clinical manifestations include psychiatric symptoms, cognitive impairment, and parkinsonism, which are similar to those of other prion diseases and frontotemporal dementia variants.Recent findingsMore recently, scientists discovered a new sporadic prion disease called variably protease-sensitive prionopathy.SummaryThe following case discusses a patient presenting with sudden onset and rapid decline in cognitive, neurobehavioral, and motor functioning and his clinical journey including treatment interventions and diagnostic confirmation.

Objective The competency-based movement within neuropsychology training programs has done much to create uniform standards of training and identify the “readiness” of trainees to progress to the next level. However, there is little research regarding best practices for development of a supervisory style. The successful progression from trainee to independent practitioner requires a training model that evolves, allowing for independence and collegiality, which includes knowledge expansion, changes in professional relationships and successful institutional navigation. Culture mediates interactions in the patient-doctor relationship, case conceptualization, and also within and between institutional frameworks; therefore, a supervision model should include a multicultural perspective at its core. Data Selection: An otherwise unrestricted multi-database search for “Neuropsychology Supervision” within the title of peer-reviewed journals yielded six results with publication years spanning 1999-2017. Only three specifically address models of supervision and only one is US-based (Stucky et al., 2010). Given then demographic shift estimated for 2050 (Passel & Cohn, 2008), there is a call to action to increase culturally competent neuropsychological services, including training and strengthening the student pipeline (Mindt Rivera et al., 2010). Data Synthesis: The proposed Model for Neuropsychology Supervision (Stucky et al., 2010) recommends supervision to be individually tailored, with both process-based and developmental approaches. Conclusions There is a strong need for clear supervision models designed specifically for neuropsychology that integrate culture at all levels of training. Authors propose the Culturally Expressive and Responsive (CER) Supervision Model in Neuropsychology. This is a framework for both trainees and professionals that provides a developmental approach integrating culture and the competency-based standards.

The present study compared the performance of English- and Spanish-speaking healthy controls (HCs) on the Spanish translation of the Dementia Rating Scale-Second edition (ST-DRS-2) and examined the classification accuracy of the ST-DRS-2 and Mini-Mental State Examination (MMSE) with an age- and education-matched clinical sample. In contrast to previous findings with English-speakers, a stronger relationship was observed between ST-DRS-2 Total scores and education than with age, and despite being matched on both of these variables, English-speaking HCs significantly out-performed their Spanish-speaking counterparts on the ST-DRS-2. The greatest between-group difference was found on the Memory subscale, wherein the majority of errors committed by Spanish-speaking HCs were significantly related to level of acculturation. ST-DRS-2 Total and Memory subscale scores produced greater classification accuracy than the MMSE; however, ST-DRS-2 Total scores yielded the greatest corresponding rates of sensitivity and specificity. Normative data are provided and recommended to improve the ST-DRS-2's diagnostic accuracy with Spanish-speakers.

Background and purpose Despite common occurrences of verbal fluency declines following bilateral subthalamic nucleus deep brain stimulation (STN-DBS) for the treatment of Parkinson's disease (PD), alternating fluency measures using cued and uncued paradigms have not been evaluated. Methods Twenty-three STN-DBS patients were compared with 20 non-surgical PD patients on a comprehensive neuropsychological assessment, including cued and uncued intradimensional (phonemic/phonemic and semantic/semantic) and extradimensional (phonemic/semantic) alternating fluency measures at baseline and 6-month follow-up. Results STN-DBS patients demonstrated a greater decline on the cued phonemic/phonemic fluency and the uncued phonemic/semantic fluency tasks compared to the PD patients. For STN-DBS patients, verbal learning and information processing speed accounted for a significant proportion of the variance in declines in alternating phonemic/phonemic and phonemic/semantic fluency scores, respectively, whilst only naming was related to uncued phonemic/semantic performance for the PD patients. Both groups were aided by cueing for the extradimensional task at baseline and follow-up, and the PD patients were also aided by cueing for the phonemic/phonemic task on follow-up. Conclusions These findings suggest that changes in alternating fluency are not related to disease progression alone as STN-DBS patients demonstrated greater declines over time than the PD patients, and this change was related to declines in information processing speed.

To examine the clinical utility of the Test of Memory Malingering (TOMM) with US Spanish speaking patients diagnosed with traumatic brain injury (TBI).The demographic characteristics and neuropsychological functioning of Spanish speaking patients with TBI with valid vs suboptimal performance were compared.Demographic and neuropsychological data were retrospectively collected from charts of patients who underwent neurocognitive evaluations for clinical, med-legal and workmen's compensation purposes. Slick et al. criteria for malingered neurocognitive dysfunction were employed for clinical determination of the validity of participants' neuropsychological profiles, resulting in 16 valid and four suboptimal performers.Valid performers obtained significantly greater scores than suboptimal performers on all trials of the TOMM and generally demonstrated less impairment across neuropsychological domains. The traditional cut-off score for the TOMM misclassified 18.8% of participants not suspected of malingering and lower levels of education appeared to reduce performance on this measure within the valid group.The current findings generally support the use of the TOMM with US primarily Spanish speaking patients diagnosed with TBI. However, caution is recommended when utilizing this measure with individuals having minimal levels of education. Future research with a larger sample and a non-neurological age- and education-matched sample should investigate lower cut-off scores for use with such patients.

This study presents the first empirical evaluation of the predictive value of the Neuropsychological Assessment Battery Shape Learning (NAB-SL) subtest in a sample of patients with unilateral temporal lobe epilepsy. Stimulus characteristics of the NAB-SL may improve predictive ability over other commonly used visual memory tests. Forty-nine patients with unilateral temporal lobe epilepsy were compared on measures of non-verbal and verbal memory (NAB-SL and Wechsler Memory Scale-III subtests). Univariate and forward conditional logistic regressions identified predictive values for each memory test individually and in combination. The NAB-SL delayed memory demonstrated consistently stronger predictive power over visual reproduction at the univariate and multivariate levels. The NAB-SL was a good predictor (80% range) of lateralized seizure onset when combined with a verbal memory measure. These preliminary results provide support for the use of the NAB-SL in preoperative epilepsy evaluations as a predictor of non-dominant temporal lobe dysfunction. Potential benefits of this test are discussed.

Background and purpose: Subthalamic nucleus deep brain stimulation (STN-DBS) has been shown to have beneficial effects on the motor features of Parkinson’s disease (PD), but its impact on non-motor symptoms, most notably mood, has not been fully explored. Methods: In the first study to independently compare the emotional-cognitive and somatic/physiological symptoms of depression, we examined mood differences in 17 bilateral STN-DBS and 22 matched non-surgical PD patients at baseline and 6 months. Results: The STN-DBS group reported higher levels of depression at baseline with significant endorsement of physical symptomatology. Postoperatively, no significant between-group differences in physical symptoms of depression were found. In contrast, a significant group by time interaction for cognitive-emotional symptoms of depression was found, with the STN-DBS group reporting an increase in psychological symptoms of distress. The STN-DBS group also reported an increase in anxiety following surgery. The suicide rate of 5% found in our study is consistent with other postoperative studies in PD. The impact of changes in levodopa and psychotropic medication are also explored. Conclusions: Preliminary results suggest that the motor improvement often observed in patients with PD following bilateral STN-DBS may be partially offset by an increase in affective-cognitive symptoms of depression.

Subthalamic nucleus deep brain stimulation (STN-DBS) is currently the treatment of choice for medication-resistant levodopa-related motor complications in patients with Parkinson’s disease (PD). While STN-DBS often results in meaningful motor improvements, consensus regarding long-term neuropsychological outcome continues to be debated. We assessed the cognitive outcomes of 19 STN-DBS patients compared to a group of 18 medically-managed PD patients on a comprehensive neuropsychological battery at baseline and two years post-surgery. Patients did not demonstrate changes in global cognitive functioning on screening measures. However, neuropsychological results revealed impairments in nonverbal recall, oral information processing speed, and lexical and semantic fluency in STN-DBS patients compared to PD controls 2 years post-surgery in these preliminary analyses. Additionally, reliable change indices revealed that approximately 50% of STN-DBS patients demonstrated significant declines in nonverbal memory and oral information processing speed compared to 25–30% of PD controls, and 26% of STN-DBS patients declined on lexical fluency compared to 11% of PD patients. Approximately 30% of both groups declined on semantic fluency. The number of STN-DBS patients who converted to dementia 2 years following surgery was not significantly different from the PD participants (32% versus 16%, respectively). Our results suggest that neuropsychological evaluations may identify possible mild cognitive changes following surgery.

Psychogenic movement disorders (PMDs) often result in disability and diminished quality of life, yet medical therapies are presently limited and largely ineffective. On the basis of previous reports that transcutaneous electrical nerve stimulation (TENS) is helpful for certain patients with organic movement disorders, the authors studied the effects of TENS in 19 patients with PMDs, utilizing the Psychogenic Movement Disorder Rating Scale (PMDRS) as well as patient-rated assessments of PMD magnitude, persistence, and disability. The PMDRS Severity score significantly improved after a mean follow-up of 6.9 months, and short duration of PMD was found to be the only identifiable predictor of a favorable outcome. Although the tingling sensation produced by TENS makes it poorly suited for a controlled clinical trial, the device has a favorable side-effect profile and is an acceptable palliative treatment for a subset of PMD patients.

Background: The presence of the apolipoprotein E (ApoE) 4 genotype is associated with an earlier age of onset for Alzheimer’s disease (AD) and several other neurodegenerative disorders. The objective of this study was to investigate the effect of ApoE genotypes on the clinical course of amyotrophic lateral sclerosis (ALS). Methods: Eight hundred and fifty-two consecutive patients with sporadic ALS evaluated at a tertiary care center were investigated for the effect of ApoE genotype on age of onset, rate of motor disease progression, cognitive functioning, and survival in ALS. Results: The frequencies of individual ApoE genotypes did not differ between patients with ALS and ALS-free Caucasian populations. Patients with different ApoE genotypes did not differ in the age of onset for ALS (years) (ApoE2 = 57.8 ± 13.7, ApoE3 = 57.3 ± 13.7, ApoE4 = 57.7 ± 13.2; P = 0.97), the rate of disease progression (Appel ALS score/month) (ApoE2 = 2.91 ± 2.66, ApoE3 = 2.67 ± 2.66, ApoE4 = 2.61 ± 2.47; P = 0.89), cognitive status (% cognitively impaired) (ApoE2 = 31.7, ApoE3 = 26.8, ApoE4 = 34.3, P = 0.28), or survival in years (ApoE2 = 3.79 ± 3.70, ApoE3 = 3.17 ± 2.27, ApoE4 = 3.05 ± 1.75; P = 0.85). Conclusions: Our results suggest that ApoE genotype does not modify clinical course of sporadic ALS, in stark contrast to the influence of ApoE genotype on the disease course of AD and other neurodegenerative disorders.

Our objective was to test the hypothesis that changes in body mass index (BMI) are associated with changes in the clinical course of ALS. We examined the relationships between BMI at first clinical visit and changes in BMI up to a two-year follow-up, and multiple clinical variables related to ALS: age of onset, rate of progression of motor symptoms, and survival. Baseline BMI was classified according to the World Health Organization (WHO) criteria. Changes in BMI were classified as a loss of >1 unit, no change, or a gain of >1 unit. Our results showed that baseline BMI was not associated with age of onset, rate of progression or survival. In contrast, a loss of BMI >1 over two years was associated with significantly shorter survival and a faster rate of progression. In a multiple regression model, these results were independent of gender, site of onset, history of diabetes mellitus and apolipoprotein (ApoE) genotype. In summary, a change in BMI after ALS diagnosis was significantly associated with rate of progression and survival. This raises the possibility that early changes in BMI may identify patients likely to have a more malignant course of the disease. However, further research is needed to clarify the relationship between BMI and ALS.

Background Several metabolic derangements associated with diabetes mellitus type 2 (DM) have been associated with a better outcome in amyotrophic lateral sclerosis (ALS), including hyperlipidemia and obesity. Here, we tested the hypothesis that DM would have a positive effect on the motor and cognitive findings of ALS. Methods: We compared data from ALS patients with pre-morbid DM (ALS-DM; n = 175) versus without DM (ALS; n = 2196) with regard to the age of onset, rate of motor progression, survival, and neuropsychological test performance. Results: The age of onset was later for women, Caucasians and patients with bulbar-onset ALS. However, we also found that after adjusting for gender, ethnicity and site of onset, DM was associated with a 4-year later onset of ALS (ALS = 56.3, ALS-DM = 60.3, P

Up to half of patients with ALS develop cognitive impairment during the course of the illness. Despite this, there is no simple tool for screening patients in the clinical setting. This study examines the sensitivity, specificity and accuracy of the ALS Cognitive Behavioral Screen (ALS-CBS). We administered the measure to 112 ALS patients, including 31 who also underwent comprehensive neuropsychological testing. Screen results were validated by determining the accuracy against the full battery. Optimal cut-off scores for predicting the correct diagnosis were determined, and mean scores were compared between patients, controls and different diagnostic groups. The results demonstrated that mean cognitive scores differed between ALS and normal controls (p0.0001). The cognitive section differentiated ALS-FTD from other ALS patients with 100% accuracy. Cognitively normal ALS patients could be distinguished from those with any cognitive deficit with 71% specificity and 85% sensitivity. A separate behavioral score was significantly lower in the ALS cohort compared to controls (p0.0001) and predicted ALS-FTD with 80% sensitivity and 88% specificity. In conclusion, the ALS-CBS can aid in detecting cognitive and behavioral impairment in a clinical setting, although it does not replace formal diagnostic assessment. Further validation with larger sample sizes will clarify its clinical utility.

Several studies have demonstrated impaired cognition in amyotrophic lateral sclerosis (ALS) patients, but it has been difficult to identify risk factors for this impairment. An association between cognitive changes and bulbar site of onset or dysarthria has been suggested, but the findings are variable. We tested for both associations in a large cohort of ALS patients. At the time of diagnosis of sporadic ALS, all patients (n=355) in this prospective study underwent comprehensive neuropsychological testing. In addition, a subset of 175 patients underwent a detailed assessment of dysarthria, which was quantified using the Appel ALS Score (AALSS). ALS patients with bulbar site of onset performed significantly worse than limb onset patients on a few timed ((VSAT-time, p

Background: Professional organizations have recommended guidelines for the optimal investigation and management of dementia. It is unknown whether physicians from different subspecialties investigate and treat dementia in the same manner or according to these guidelines. Methods: We screened 1,401 charts of patients who were seen in neurology, mental health, geropsychiatry and geriatrics clinics. The charts of 410 patients who were diagnosed with dementia were reviewed in detail to determine how they were evaluated and managed. Results: Overall, 40% of patients received a complete laboratory workup to rule out comorbidities, 70% of patients received neuroimaging with either computerized tomography or magnetic resonance imaging of the brain, 63% had a depression screen and 38% of patients underwent neuropsychological testing. However, the frequency with which they were obtained differed significantly across clinics (p < 0.05). The frequency with which acetylcholinesterase inhibitors (CHEIs) were used did not differ significantly (p = 0.07) for patients with Alzheimer’s disease (AD), but differed significantly (p < 0.05) for dementia categories where CHEIs are thought to be useful (AD, vascular dementia and dementia with Lewy bodies). Conclusions: There were significant differences between subspecialties in the evaluation and treatment of dementia. It will be important to investigate whether these differences alter patient outcomes.

Background: Cognitive impairment secondary to frontal lobe atrophy exists in 40–60% of Amyotrophic Lateral Sclerosis (ALS) cases. We aimed to determine the prevalence of frontal-lobe mediated behavioral impairment in (ALS) and to ascertain its relationship to cognitive impairment. Methods: Two-hundred and twenty five patients diagnosed with sporadic ALS were evaluated for behavioral dysfunction using the Frontal Systems Behavior Scale (FrSBe), a validated measure used to examine frontal-lobe mediated behaviors, specifically apathy, executive dysfunction and disinhibition; a total behavior score is also provided. Additionally, a subset of patients also underwent a comprehensive neuropsychological evaluation. Results: Changes in the total FrSBe scores were observed in 24.4% of the patients and 39.6% of the patients had impairment in at least one behavioral domain with symptoms of Apathy being the most common (31.1%). Cognitively impaired ALS patients had worse total (P = 0.05) and apathy scores (P

Objectives: To test for ethnic disparities in the evaluation and treatment of dementia. Methods: We reviewed 1,401 charts of patients from 4 veteran clinics that routinely evaluate dementia patients. A total of 410 patients met criteria for dementia or mild cognitive impairment (MCI) and their charts were reviewed in detail. Results: Regarding their evaluation, laboratory and imaging testing did not differ between ethnic groups (p > 0.05). Depression screening was more common in African-American (AA) patients (p = 0.03). Significantly more Caucasian patients underwent neuropsychologic testing (p = 0.001). Regarding management, in a multivariate analysis, AA patients with Alzheimer’s disease (AD) (odds ratio (OR) 0.09, 95% confidence interval (CI) 0.02–0.5) or ‘all dementia types’ (OR 0.6, 0.3–0.9) were significantly less likely to receive acetylcholinesterase inhibitors (CHEIs). Other independent predictors of CHEI use were age ≥71 years (OR 5.2, 2.8–9.6), a diagnosis of AD (OR 3.1, 1.6–6.3) or MCI (OR 0.3, 0.1–0.7), and if their evaluation included imaging (head CT or MRI; OR 1.9, 1.05–3.3). Conclusions: AA patients underwent comparable evaluations for dementia and the percentage of CHEI-responsive diagnoses rendered was similar across ethnic groups. However, dementia management differed significantly: AAs were prescribed CHEIs at considerably reduced rates. The reasons for this great disparity warrant further investigation because it may produce significantly greater cognitive impairment and hence suffering amongst AA patients.

This study evaluated poor mood state as a moderator of changes in verbal recall ability from before to after unilateral posteroventral pallidotomy in 54 individuals with advanced Parkinson's disease. Repeated-measures analysis of covariance (controlling for motor disease severity) indicated that left-posteroventral pallidotomy subjects with depressed mood performed more poorly on measures of verbal list learning and story recall compared to nondepressed subjects or right-posteroventral pallidotomy subjects with depressed mood both before and after surgery. The results suggest that depressed mood should be taken into account when interpreting memory test performance in Parkinson's disease surgical candidates both before and after surgery.