A neuropsychological profile for high-grade primary central nervous system neuroendocrine tumor (CNS NET): a single-case study.

Objective: Neuroendocrine tumors (NETs) are neoplasms that primarily occur in the lungs, appendix, small intestine, pancreas, and rectum, and typically metastasize to the liver or lymph nodes. However, in rare cases NETs can originate in the central nervous system (CNS). Understanding primary CNS NET neuropsychological manifestations aids in recommendations for neurocognitive follow-up, treatment and lifestyle planning, and future research. Method: Given the dearth of neuropsychological research for CNS NETs, we present a case seen in a 43-year-old woman. Results: Initial and 8-month follow-up neuropsychological evaluations of the patient revealed a Major Neurocognitive Disorder where the pattern of findings was consistent with tumor location and additional treatment-related factors. Reliable change indices at her re-evaluation revealed declines in verbal and visual memory, with statistical, yet not clinical, improvements in different domains. Follow-up monitoring of comprehensive care continued to occur after neuropsychological evaluations. Conclusions: This case study assists in the characterization of initial and follow-up neuropsychological presentation of a primary CNS NET, where evaluations helped inform clinical care and functional recommendations. This case demonstrates the importance for neuropsychologists to have awareness of various conditions, even rare conditions, which can inform a systematic approach to research and clinical care with neuro-oncological populations.

Patients with Cognitive Impairment in Parkinson's Disease Benefit from Deep Brain Stimulation: A Case-Control Study.

Background: Deep brain stimulation (DBS) for Parkinson's disease (PD) is generally contraindicated in persons with dementia but it is frequently performed in people with mild cognitive impairment or normal cognition, and current clinical guidelines are primarily based on these cohorts. Objectives: To determine if moderately cognitive impaired individuals including those with mild dementia could meaningfully benefit from DBS in terms of motor and non-motor outcomes. Methods: In this retrospective case-control study, we identified a cohort of 40 patients with PD who exhibited moderate (two or more standard deviations below normative scores) cognitive impairment (CI) during presurgical workup and compared their 1-year clinical outcomes to a cohort of 40 matched patients with normal cognition (NC). The surgery targeted subthalamus, pallidus or motor thalamus, in a unilateral, bilateral or staged approach. Results: At preoperative baseline, the CI cohort had higher Unified Parkinson's Disease Rating Scale (UPDRS) subscores, but similar levodopa responsiveness compared to the NC cohort. The NC and CI cohorts demonstrated comparable degrees of postoperative improvement in the OFF-medication motor scores, motor fluctuations, and medication reduction. There was no difference in adverse event rates between the two cohorts. Outcomes in the CI cohort did not depend on the target, surgical staging, or impaired cognitive domain. Conclusions: Moderately cognitively impaired patients with PD can experience meaningful motor benefit and medication reduction with DBS.

The trainee leadership blueprint: opportunities, benefits, and a call to action.

OBJECTIVE: Leadership experiences are vital not only to individual long-term career success but also the development, direction, and operation of higher spheres including professional organizations and the field of clinical neuropsychology itself. METHOD: The present paper presents a blueprint guide for neuropsychology trainees on available opportunities and resources for increasing their involvement in professional governance and developing leadership skills. First, we present a discussion of the benefits of leadership and professional service, including the acquisition of interpersonal skills and new professional competencies, the prospect of recognition and advancement, and the opportunity to participate in advocacy efforts. Then, we present an overview of existing opportunities for involvement, followed by the provision of specific, actionable items for trainees, mentors and leadership committees, and for neuropsychology organizations to ensure continued trainee engagement. CONCLUSIONS: These resources can serve as a guide for trainees and early career neuropsychologists seeking to acquire leadership proficiencies, and the recommendations aspire to promote advancement for trainees, professionals, and organizations alike.

Education and Training for Clinical Neuropsychologists in Integrated Care Settings.

The increasing importance of integrated care necessitates that education and training experiences prepare clinical neuropsychologists for competent practice in integrated care settings, which includes (a) general competence related to an integrated/interdisciplinary approach and (b) competence specific to the setting. Formal neuropsychology training prepares neuropsychologists with a wide range of knowledge and skills in assessment, intervention, teaching/supervision, and research that are relevant to such settings. However, less attention has been paid to the knowledge and skills that directly address functioning within integrated teams, such as the ability to develop, maintain, and expand collaboration across disciplines, bidirectional clinical-research translation and implementation in integrated team settings, and how such collaboration contributes to clinical and research activities. Foundational knowledge and skills relevant to interdisciplinary systems have been articulated as part of competencies for entry into clinical neuropsychology, but their emphasis in education and training programs is unclear. Recommendations and resources are provided regarding how competencies relevant to integrated care can be provided across the continuum of education and training (i.e., doctoral, internship, postdoctoral, and post-licensure).

Discriminating cognitive screening and cognitive testing from neuropsychological assessment: implications for professional practice.

OBJECTIVE: To provide clarification on the distinction between cognitive screening, cognitive testing, and neuropsychological assessment and highlight practical implications. METHOD: Non-systematic brief clinical review. RESULTS: There is a present lack of explicit distinction between the various levels of measurement of cognitive functioning with regard to goals, indications for use, levels of complexity, and outcome. There is also a lack of guidance regarding the identification of who should be responsible for the administration and interpretation at each level. CONCLUSIONS: There is a growing awareness of the importance of cognitive health and disability, and of the importance of measurement of cognitive functions across the lifespan. For example, cognitive screening has been mandated by the Patient Protection and Affordable Care Act of 2010, and language contained within new psychiatric diagnostic criteria and healthcare regulatory changes reflect increased consideration of the importance of measurement of cognition. Changes such as these necessitate greater clarity on this important issue as it bears implications for professional practice, which ranges from education and training competencies, practice standards, and the way that neuropsychologists clarify and advocate for the value of specialty referrals for comprehensive assessment in a competitive and ever-changing healthcare market.

Relative Utility of Performance and Symptom Validity Tests.

This investigation adds to the burgeoning body of research concerned with discriminating performance and symptom validity tests (SVTs) through examination of their differential relationships with cognitive performance and symptom self-report measures. To the authors' current knowledge, prior studies have not assessed differences between participants who fail either a performance validity test (PVT) or an SVT but not both. As part of their neuropsychological evaluations at four Veterans Affairs medical centers across the United States, participants were administered a fixed, standardized battery that consisted of performance validity, symptom validity, cognitive performance, and symptom self-report measures. Compared with participants who failed a PVT and an SVT, participants who passed both and participants who only passed a PVT demonstrated better cognitive performance and self-reported fewer symptoms. Results support differential clinical utility of performance validity and SVTs when assessing cognitive performance and symptom self-report.

Misconceptions and Misattributions About Traumatic Brain Injury: An Integrated Conceptual Framework.

The objective of the present narrative review was to provide a conceptual framework to address common misconceptions in the field of traumatic brain injury (TBI) and enhance clinical and research practices. This framework is based on review of the literature on TBI knowledge and beliefs. The comprehensive search of the literature included seminal and current texts as well as relevant articles on TBI knowledge and education, misconceptions, and misattributions. Reviewed materials ranged from 1970 to 2013 and were obtained from PubMed and PubMed Central online research databases. Research findings from the reviewed literature were integrated with existing social and cognitive psychological concepts to develop a framework that includes: (1) the identification antecedents of TBI-related misconceptions and misattribution; (2) understanding of how inaccurate beliefs form and persist as the result of pre- and postinjury cognitive operations such as informational cascades and attribution biases; and (3) a discussion of ways in which these beliefs can result in consequences in all domains of a survivor's life, including physical and mental health, stigma, and discrimination. This framework is intended to serve as a first stage of development of a model that will improve treatment endeavors and service delivery to individuals with TBI and their families.

Criterion Validity of the WAIS-IV Cognitive Proficiency Index (CPI).

OBJECTIVE: The current study sought to validate the Cognitive Proficiency Index (CPI) against similar, well-established measures of attention and processing speed. Additionally, the sensitivity of the CPI and Attention Index of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and their ability to differentiate among clinical groups were compared. METHOD: The first objective was accomplished by calculating correlation coefficients between the CPI and similar attention and processing speed measures. The second objective was accomplished using a clinical group of 25 individuals with Mini-Mental State Exam (MMSE) scores of less than or equal to 23 matched to a non-clinical group of 43 participants with MMSE scores of 30, all derived from the original sample. RESULTS: The CPI correlated in expected ways with other measures of attention and processing speed (magnitude of r = .19-.77). ANCOVA, receiver operating characteristic, and discriminant function analyses suggested that the CPI is superior to the RBANS Attention Index in differentiating between clinical and non-clinical groups. CONCLUSIONS: These findings provide support for convergent validity and criterion-related concurrent validity for the CPI.

The interaction between medical burden and anticholinergic cognitive burden on neuropsychological function in a geriatric primary care sample.

Poorer neuropsychological function is associated with increased medical burden (MB) and the use of more anticholinergic medications. However, the interaction between MB and anticholinergic cognitive burden (AB) on neuropsychological performance is unknown. In a sample of 290 elderly primary care patients, those with a greater level of AB demonstrated poorer Total Index performance on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Further, an interaction effect was noted such that there was a greater anticholinergic effect on RBANS Total, Attention, and Delayed Memory Index scores for participants with fewer MB. Participants with more MB demonstrated poorer performance irrespective of their level of AB. These results indicate that MB effects may be overshadowed by anticholinergic effects in older patients.

Psychotherapeutic treatment of survivors of traumatic brain injury: review of the literature and special considerations.

UNLABELLED: Abstract Primary objective: To provide an overview of useful clinical information for healthcare providers involved in traumatic brain injury (TBI) rehabilitation, including current methods used with survivors of TBI, therapeutic considerations in light of this population's cognitive, emotional and social difficulties and issues regarding the therapeutic working alliance from both survivor and provider perspectives. RESEARCH DESIGN: Non-systematic clinical review. METHOD: The literature was intended to be comprehensive to reflect both past and present contributions to the field. To that end, citations were included from seminal and current texts as well as relevant original and review articles from 1985-2012 in PubMed and PubMedCentral online research databases. MAIN OUTCOMES AND RESULTS: This article highlights the usefulness of psychotherapy for treatment of psychiatric symptoms in the TBI population, reviews available modalities and offers considerations and suggestions to facilitate and improve treatment. CONCLUSIONS: Although challenging and perhaps frustrating at times, psychotherapy with this population can be validly attempted and ultimately very rewarding for both the survivor and therapist. Future research should seek to perform controlled studies to examine therapeutic efficacy and compare gains by injury severity in the hopes of creating best practice guidelines for practitioners.

Cloze probability and completion norms for 498 sentences: behavioral and neural validation using event-related potentials.

Three decades after their publication, Bloom and Fischler's (1980) sentence completion norms continue to demonstrate widespread utility. The aim of the present study was to extend this contribution by expanding the existing database of high-constraint, high cloze probability sentences. Using the criteria established by Bloom and Fischler, we constructed 398 new sentences and presented these along with 100 sentences from their original list to be normed using a sample of 400 participants. Of the 498 sentences presented, 400 met criteria for high cloze probability-that is, .67 or higher probability of being completed by a specific single word. Of these, 321 sentences were from the new set and an additional 79 were from Bloom and Fischler's set. A high degree of correspondence was observed between responses obtained by Bloom and Fischler for their high-constraint set. A second experiment utilized an N400 event-related potential paradigm to provide further validation of the contextual constraint for the newly generated set. As expected, N400 amplitude was greater for sentences that violated contextual expectancy by ending in a word other than the newly established completion norm. Sentence completion norms are frequently used in cognitive research, and this larger database of high cloze probability sentences is expected to be of benefit to the research community for many years to come. The full set of stimuli and sentence completion norms from this study may be downloaded from http://brm.psychonomic-journals.org/content/supplemental.

The relationship of pain catastrophizing to heightened feelings of distress.

This study examined pain catastrophizing in individuals experiencing chronic pain conditions. Total score on the Pain Catastrophizing Scale (PCS) was examined, along with its relationship to several clinical scales of the Minnesota Multiphasic Inventory-Second Edition to answer the question of which scale would have the strongest relationship with total score on the PCS. These three scales have been most commonly implicated in chronic pain conditions. Overall results supported the importance of pain catastrophizing in helping to create heightened feelings of distress. Individuals higher in catastrophizing tend to experience increased pain, distress, anxiety, and depression with lower levels of functioning. A quick measure of catastrophizing is supported that will allow the professional more knowledge of the role of pain in the individual's condition and how pain-related thoughts may modify their quality of life.