Trainee perceptions of multicultural climate and supervision in neuropsychology.

INTRODUCTION: Mentor relationships are important in developing and supporting professional self-efficacy among psychology trainees. Additionally, the rapid diversification of the United States calls for the preparation of clinical neuropsychology trainees to work within a multicultural context. The present study aimed to assess neuropsychology trainees' perceptions of multicultural climate and supervision and if these perceptions differ based on trainee demographics. We also sought to identify aversive experiences of trainees, program strengths or weaknesses, and how programs support trainees. METHOD: Participants were 310 neuropsychology trainees (Mean age = 30.27, SD = 5.67) from clinical psychology graduate (n = 136), pre-doctoral internship (n = 38), and post-doctoral (n = 71) programs across the United States and Canada who completed a survey assessing perceptions to multicultural climate and supervision. 64.5% self-identified as women, 60.3% as heterosexual, and 46.1% as non-Hispanic White. 34.5% of trainees reported at least one American Disabilities Act (ADA) recognized disability. RESULTS: Though satisfied with general supervision, trainees reported overall dissatisfaction with multicultural supervision. Satisfaction with multicultural supervision did not differ by demographics. Trainees also reported various aversive experiences with supervisors, clients, and research participants that negatively impacted their training. These experiences were at times due to an aspect of the trainee's multicultural identity, with Black and Hispanic trainees being more likely to report an aversive experience. Trainees reported ways in which they felt unsupported by their programs. CONCLUSIONS: Important areas of growth for programs are discussed. Issues raised by neuropsychology trainees overlap to some degree with the experiences of trainees in other fields. Recommendations of approaches that have been successfully adopted in other fields to improve trainee satisfaction are provided. Early identification of needs that go above and beyond clinical training will allow programs to respond promptly, improve trainee satisfaction, and potentially improve the retention of trainees from diverse backgrounds.

Current status of inclusion of black participants in neuropsychological studies: A scoping review and call to action.

In recognition that insufficient diversity in research impedes the generalizability of findings and negatively impacts clinical outcomes, the 1993 National Institutes of Health (NIH) Revitalization Act required NIH-funded clinical trials to include and assess outcomes for women and minority participants. Since that time, the American Psychological Association (APA) and the American Academy of Clinical Neuropsychology (AACN) have also acknowledged the reporting of this information as an essential element of research, and they have established similar aspirational goals. Nevertheless, Black communities remain disproportionately underrepresented in neuropsychology research. The objective of this study was to investigate current levels of inclusion and reporting of Black research participation in neuropsychological studies.Publications from high impact neuropsychology journals between 2019-2020 were selected via established methodologies. Studies were analyzed to determine the rates of demographic inclusion and reporting of minority, particularly Black, participants.A total of 1,764 articles were reviewed across seven neuropsychology journals. Of the 653 studies not excluded for other reasons, 43% neglected to include sufficient information about participants' race/ethnicity. Of the subset of eligible studies that did include racial/ethnic demographic information (n = 349), only 61% included any Black participants at all. Only 34.1% of them included enough Black participants equal to or greater than the proportion of Black individuals within the United States.Setting a standard of routinely reporting and analytically reflecting on demographic information is necessary to make valid inferences regarding disease sequelae, treatment, and public health strategies. The authors offer specific recommendations to improve the inclusion and reporting of Black research participation, ensure compliance with established policies, and improve the quality of neuropsychological research.

The Montreal Cognitive Assessment in Veteran Postacute Care: Implications of Cut Scores.

BACKGROUND: The Montreal Cognitive Assessment (MoCA) is often used for cognitive screening across health care settings, especially in rehabilitation centers, where assessment and treatment of cognitive function is considered key for successful multidisciplinary treatment. Although the original MoCA validation study suggested a cut score of <26 to identify cognitive impairment, recent studies have suggested that lower cut scores should be applied. OBJECTIVES: To examine the percentage of positive screens for cognitive impairment using the MoCA in a veteran postacute care (PAC) rehabilitation setting and to identify the most accurate MoCA cut score based on criterion neuropsychological measures. METHODS: We obtained data from 81 veterans with diverse medical diagnoses who had completed the MoCA during their admission to a PAC unit. A convenience subsample of 50 veterans had also completed four criterion neuropsychological measures. RESULTS: Depending on the cut score used, the percentage of individuals classified as impaired based on MoCA performance varied widely, ranging from 6.2% to 92.6%. When predicting performance using a more comprehensive battery of criterion neuropsychological tests, we identified <22 as the most accurate MoCA cut score to identify a clinically relevant level of impairment and <24 to identify milder cognitive impairment. CONCLUSIONS: Our findings suggest that a MoCA cut score of <26 carries a risk of misdiagnosis of cognitive impairment, and scores in the range of <22 to <24 are more reliable for identifying cognitive impairment.

Emerging evidence for speeded alphabet printing as a measure of processing speed and working memory.

Alphabet Printing (in the forward and backward order) is a brief and highly portable test with promise as a screening measure of processing speed and simple working memory, constructs which are only minimally assessed in many of the most commonly-used cognitive screening instruments. The aim of this project was to examine the construct validity of timed Alphabet Printing in a sample of 254 Veterans with cognitive complaints and a history of possible head injury. Criterion measures included more established tests of processing speed and simple working memory, including the Trail Making Test and the Digit Span subtest from the fourth edition of the Wechsler Adult Intelligence Scales. Alphabet Printing scores moderately correlated with the criterion measures of attention, working memory, and processing speed, and demonstrated acceptable classification accuracy in discriminating between individuals with and without evidence of cognitive impairment on Trails B. These findings provide additional support for the possible utility of including Alphabet Printing during cognitive screenings or as part of a larger neuropsychological test battery.

Effects of Delay Duration on the WMS Logical Memory Performance of Older Adults with Probable Alzheimer's Disease, Probable Vascular Dementia, and Normal Cognition.

OBJECTIVE: To examine how the duration of time delay between Wechsler Memory Scale (WMS) Logical Memory I and Logical Memory II (LM) affected participants' recall performance. METHOD: There are 46,146 total Logical Memory administrations to participants diagnosed with either Alzheimer's disease (AD), vascular dementia (VaD), or normal cognition in the National Alzheimer's Disease Coordinating Center's Uniform Data Set. RESULTS: Only 50% of the sample was administered the standard 20-35 min of delay as specified by WMS-R and WMS-III. We found a significant effect of delay time duration on proportion of information retained for the VaD group compared to its control group, which remained after adding LMI raw score as a covariate. There was poorer retention of information with longer delay for this group. This association was not as strong for the AD and cognitively normal groups. A 24.5-min delay was most optimal for differentiating AD from VaD participants (47.7% classification accuracy), an 18.5-min delay was most optimal for differentiating AD versus normal participants (51.7% classification accuracy), and a 22.5-min delay was most optimal for differentiating VaD versus normal participants (52.9% classification accuracy). CONCLUSIONS: Considering diagnostic implications, our findings suggest that test administration should incorporate precise tracking of delay periods. We recommend a 20-min delay with 18-25-min range. Poor classification accuracy based on LM data alone is a reminder that story memory performance is only one piece of data that contributes to complex clinical decisions. However, strict adherence to the recommended range yields optimal data for diagnostic decisions.