Sociodemographic, cultural, linguistic, and test selection considerations for clinical neuropsychological assessment with Japanese and Japanese-American patients in the United States.

Objective: Japanese-Americans are the sixth largest Asian ethnicity in the United States and represent a highly heterogeneous population. Despite representing a large and diverse group, relatively little attention has been paid to clinical best practices for working with this population in the West, particularly for Japanese speakers and issei (first-generation in the United States). This paper offers guidance for providing competent neuropsychological services to Japanese-Americans. Method: Pertinent facets of Japanese culture are presented within the context of the ECLECTIC framework (education and literacy, culture and acculturation, language, economics, communication, testing situation: comfort and motivation, intelligence conceptualization, and context of immigration; Fujii, 2018). The available literature on clinical neuropsychological tests that are translated into Japanese and normed with Japanese samples was reviewed. Results: Specific recommendations for clinicians providing neuropsychological services to Japanese-Americans are presented with an aim of maximizing test fairness by addressing the following issues: comfort with the testing situation, test biases, accessibility, and validity (American Educational Research Association et al., 2014). Additional recommendations for the use of teleneuropsychology; working with geriatric, pediatric, and multiracial populations; and providing useful recommendations and feedback from clinical assessment are provided. Measures that are appropriately translated and/or adapted for use with Japanese populations are presented by cognitive domain to assist clinicians with test selection. Conclusions: This paper provides concrete recommendations for Western neuropsychologists working with patients of Japanese descent in order to address the current gap in cultural competence among clinicians when working with this heterogeneous population.

Cross-cultural considerations for teleneuropsychology with Asian patients.

OBJECTIVE: Recent teleneuropsychology (TeleNP) models provide some degree of guidance in the application of telecommunication technologies toward the practice of neuropsychology. However, there remains a paucity of peer-reviewed data on TeleNP practices with culturally diverse patients, including Asian patients. This manuscript describes the challenges related to TeleNP practices with Asian patients and offers practical recommendations to complement existing TeleNP guidelines. METHOD: Based on extant literature on multicultural applications of neuropsychology, weprovide recommendations for TeleNP services with Asian patients that pertain to specific components of a TeleNP evaluation, such as a) pre-evaluation preparation, b) determining the appropriateness of the referral, c) determining language proficiency, d) working with interpreters, e) informed consent and confidentiality issues, f) conducting a culturally sensitive clinical interview, g) behavioral observations and communication, h) test selection, and i) interpreting data and writing reports. CONCLUSIONS: Our recommendations for TeleNP services with Asian patients highlight the need for flexibility to accommodate cultural differences and commitment to the complex nature of working with patients requiring interpretation services, while also recognizing the importance of preserving the validity of neuropsychological methods. Moving forward, it is imperative that the field of neuropsychology increases the training and accessibility of neuropsychologists who are knowledgeable in providing TeleNP services to Asian patients, and promotes research on the validation of TeleNP for Asian and other ethnic minority groups.

Neuropsychologists' practice adjustments: The impact of COVID-19.

Objective: The field of neuropsychology's response to the COVID-19 pandemic was characterized by a rapid change in clinical practice secondary to physical distancing policies and orders. The current study aimed to further characterize the change in neuropsychologists' professional practice, specifically related to teleneuropsychology (TNP) service provision, and also provide novel data regarding the impact of the pandemic on providers' emotional health. Method: This study surveyed 142 neuropsychologists between 3/30/2020 and 4/10/2020, who worked within a variety of settings (e.g., academic medical centers, general hospitals, Veterans Affairs medical centers, rehabilitation hospitals) across all four U.S. geographic regions. Mixed-model analyses of variance (ANOVAs) were conducted to assess for differences in neuropsychological practice (i.e., total number of patients and proportion of TNP seen per week) across time points (i.e., late February and early April) by practice setting and region. Descriptive statistics were conducted to describe respondents' perceptions of TNP, emotional responses to the pandemic, and perceptions of institutional/employers'/practices' responses. Results: Nearly all respondents (∼98%) reported making practice alterations, with ∼73% providing at least some TNP. Neuropsychologists across all settings and regions reported performing a higher proportion of TNP evaluations by April 2020. On average, respondents reported a medium amount of distress/anxiety related to COVID-19, which had a "somewhat small impact" on their ability to practice overall. Conclusions: The current study further elucidated neuropsychologists' provision of TNP services and offered initial data related to their emotional response to the pandemic. Future research is needed to examine the viability and sustainability of TNP practice.

Intellectual Profiles in Children With ADHD and Comorbid Learning and Motor Disorders.

Objective: Neurodevelopmental disorders, including Reading Disorder, Disorder of Written Expression, and Developmental Coordination Disorder, often co-occur with ADHD. Although research has identified increased functional impairment in the presence of these comorbid diagnoses, few direct comparisons of intellectual profiles have been conducted. Thus, the present study examined Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) profiles of children with ADHD alone and with comorbid neurodevelopmental disorders. Method: Participants included 296 children with ADHD, ADHD with Developmental Coordination Disorder, and ADHD with Reading Disorder and/or Disorder of Written Expression. Results: Comparisons of these groups suggests children with ADHD and language-based Learning Disorders have poorer working memory than children with only ADHD. Furthermore, children with ADHD and Developmental Coordination Disorder perform relatively better on verbal compared with perceptual reasoning indexes. Conclusion: These intellectual profiles may have utility in identifying cognitive weaknesses inherent to these disorders and may be used to guide treatment intervention.

Executive Function Profiles in Pediatric Traumatic Brain Injury.

Traumatic brain injury (TBI) results in heterogeneous patterns of neuropsychological impairment. This study investigated heterogeneity in executive function (EF) using the Comprehensive Trail Making Test (CTMT) to evaluate 121 children and adolescents with TBI and 121 matched normal controls. The TBI group performed approximately two standard deviations below controls. Cluster analyses indicated that a three-cluster solution best classified the TBI group and a four-cluster solution best classified controls. Greater impairment in EF was associated with lower intellectual, achievement, and neuropsychological test performance in the TBI group. Results suggest that EF deficits reflected in CTMT performance may be useful for classifying severity of TBI.

Intraindividual variability in neuropsychological performance predicts cognitive decline and death in HIV.

OBJECTIVE: HIV-associated neurocognitive disorder (HAND) occurs in a significant percentage of HIV-infected (HIV+) adults. Increased intraindividual variability (IIV) in cognitive function may be an early marker of emerging neurocognitive disorder, which suggests that IIV may be a sensitive measure of neurologic compromise in HIV. In the current study, we hypothesize that increased IIV may predict impending morbidity, including future cognitive decline and death. METHOD: In 708 HIV+ participants followed longitudinally for up to 14 years, we assessed the role of dispersion in forecasting death and cognitive decline. Incident neurocognitive impairment was predicted in a mixed-effects ordinal logistic regression model using age, gender, baseline mean cognitive functioning, CD4+, time followed, years of education, and dispersion at the previous visit. Death before the next visit was predicted in a binomial mixed-effects regression model using age, gender, baseline mean cognitive functioning, CD4+, time followed, years of education, and dispersion. RESULTS: Point-in-time dispersion and change in dispersion between visits predict future cognitive decline and death in HIV+ individuals. Individuals with greater dispersion at a visit or who had larger changes in dispersion between visits were more likely to demonstrate greater neurocognitive impairment at the subsequent visit. Greater IIV was also associated with an increased risk of death prior to the subsequent visit, even after controlling for HAND severity and global cognitive functioning. CONCLUSIONS: We conclude that the IIV in cognitive functioning may be more predictive of future disease consequence than mean level of cognitive functioning. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Cognitive and academic achievement changes associated with day hospital rehabilitation in children with acquired brain injury.

An evaluation was made of the outcome of a day hospital rehabilitation program for children who experienced an acquired neurological illness, mainly traumatic brain injury. Participants were administered neuropsychological and academic evaluations upon entry to the program, immediately upon discharge and several months after discharge Repeated measures ANOVA results for variables selected from the Reynolds Intellectual Assessment and the Delis-Kaplan Executive Function System found that comparisons showed significant (≥p < .01) improvement occurred between the first and second assessment, generally with large effect sizes. There were some nonsignificant decrements in performance between the discharge and follow-up assessments. A correlational analysis showed that while the association between cognitive function and academic achievement was robust, correlation coefficients did not differ in strength before and following rehabilitation. The study demonstrates significant improvement in children with acquired neurological disorders following rehabilitation.

Equivalence of mother and father ratings of ADHD in children.

Obtaining data from multiple informants provides a more comprehensive diagnostic picture in the assessment of attention deficit hyperactivity disorder (ADHD). Differences in symptom ratings have been observed between parent- and teacher-report scales, though less information is available regarding differences between mothers and fathers. To address this gap, this study examines the rater agreement between mothers and fathers on the Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV) ADHD Symptom Rating Scale (DSM-ADHD-SRS). The participants consisted of 337 children diagnosed with ADHD who underwent comprehensive neuropsychological assessment. Confirmatory factor analysis indicates that a three-factor model comprising inattention, hyperactivity, and impulsivity symptoms provides the best fit for both mothers' and fathers' ratings. Mothers provided higher mean ratings for the inattention scale. These results suggest that the factor structure for the DSM-ADHD-SRS is the same, regardless of parent gender. However, symptoms of inattention may vary depending upon which parent completes the ratings. This discrepancy could lead to differences in diagnostic impressions in clinical evaluations.

Diagnostic utility of the HIV dementia scale and the international HIV dementia scale in screening for HIV-associated neurocognitive disorders among Spanish-speaking adults.

Given that neurocognitive impairment is a frequent complication of HIV-1 infection in Spanish-speaking adults, the limited number of studies assessing HIV-associated neurocognitive disorders (HAND) in this population raises serious clinical concern. In addition to being appropriately translated, instruments need to be modified, normed, and validated accordingly. The purpose of the current study was to examine the diagnostic utility of the HIV Dementia Scale (HDS) and International HIV Dementia Scale (IHDS) to screen for HAND in Spanish-speaking adults living with HIV infection. Participants were classified as either HAND (N = 47) or No-HAND (N = 53) after completing a comprehensive neuropsychological evaluation. Receiver operating characteristic analyses found the HDS (AUC = .706) was more sensitive to detecting HAND than the IHDS (AUC = .600). Optimal cutoff scores were 9.5 for the HDS (PPV = 65.2%, NPV = 71.4%) and 9.0 for the IHDS (PPV = 59.4%, NPV = 59.1%). Canonical Correlation Analysis found the HDS converged with attention and executive functioning. Findings suggest that while the IHDS may not be an appropriate screening instrument with this population, the HDS retains sufficient statistical validity and clinical utility to screen for HAND in Spanish-speaking adults as a time-efficient and cost-effective measure in clinical settings with limited resources.

Medication Adherence in HIV-Positive African Americans: The Roles of Age, Health Beliefs, and Sensation Seeking.

We examined how two critical constructs, health beliefs and sensation seeking, influence combination antiretroviral therapy adherence in HIV+ African Americans, and whether these factors mediate the association between age and adherence. Two-hundred-and-eighty-six HIV+ African Americans participated in this observational study. Path analyses revealed that higher levels of a specific health belief, perceived utility of treatment, and lower levels of a sensation-seeking component, Thrill and Adventure Seeking, directly predicted optimal adherence. The influence of age on adherence was partially mediated by lower Thrill and Adventure Seeking levels. Depression predicted adherence via perceived utility of treatment and Thrill and Adventure Seeking, whereas current substance abuse and dependence did via Thrill and Adventure Seeking. Poorer neurocognitive function had a direct, adverse effect on adherence. Our findings suggest that supporting the development of more positive perceptions about HIV treatment utility may help increase medication adherence among African Americans. This may be particularly relevant for those with higher levels of depression symptoms, which was directly associated with negative perceptions about treatment. Additionally, clinicians can assess sensation-seeking tendencies to help identify HIV+ African Americans at risk for suboptimal adherence. Compensatory strategies for medication management may help improve adherence among HIV+ individuals with poorer neurocognitive function.

HIV-transmission-related risk behavior in HIV+ African American men: Exploring biological, psychological, cognitive, and social factors.

OBJECTIVES: To identify factors associated with HIV-transmission-related risk behavior among HIV+ African American men. METHOD: We examined biological, psychological, cognitive, and social factors and recent HIV-transmission-related risk behavior (i.e., needle sharing, unprotected sex, exchange sex) among a sample of HIV+ African American men. RESULTS: A binary logistic regression showed that individuals under age 50 (OR=4.2), with clinically-elevated masochism scores (OR=3.9) on the Millon Clinical Multiaxial Inventory-III (MCMI-III), current substance abuse/dependence (OR=2.6), and higher sensation-seeking (OR=1.3) were more likely to report recent risk behavior. CONCLUSIONS: Reducing substance use, addressing self-defeating attitudes, and improving self-control may be avenues for future prevention and intervention research among HIV+ African American men engaging in HIV-transmission-related risk behavior.

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.

Auditory processing deficits in bipolar disorder with and without a history of psychotic features.

OBJECTIVES: Auditory perception deficits have been identified in schizophrenia (SZ) and linked to dysfunction in the auditory cortex. Given that psychotic symptoms, including auditory hallucinations, are also seen in bipolar disorder (BD), it may be that individuals with BD who also exhibit psychotic symptoms demonstrate a similar impairment in auditory perception. METHODS: Fifty individuals with SZ, 30 individuals with bipolar I disorder with a history of psychosis (BD+), 28 individuals with bipolar I disorder with no history of psychotic features (BD-), and 29 normal controls (NC) were administered a tone discrimination task and an emotion recognition task. RESULTS: Mixed-model analyses of covariance with planned comparisons indicated that individuals with BD+ performed at a level that was intermediate between those with BD- and those with SZ on the more difficult condition of the tone discrimination task and on the auditory condition of the emotion recognition task. There were no differences between the BD+ and BD- groups on the visual or auditory-visual affect recognition conditions. Regression analyses indicated that performance on the tone discrimination task predicted performance on all conditions of the emotion recognition task. Auditory hallucinations in BD+ were not related to performance on either task. CONCLUSIONS: Our findings suggested that, although deficits in frequency discrimination and emotion recognition are more severe in SZ, these impairments extend to BD+. Although our results did not support the idea that auditory hallucinations may be related to these deficits, they indicated that basic auditory deficits may be a marker for psychosis, regardless of SZ or BD diagnosis.

Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) intraindividual variability in older adults: Associations with disease and mortality.

UNLABELLED: Cognitive intraindividual variability (IIV), or dispersion, has been associated with pathological changes, including cognitive and functional decline. Dispersion is typically assessed with experimental cognitive measures or subtests selected from several batteries, and few studies have examined IIV from a single neuropsychological battery. METHOD: To address this gap, the current study examined the relationship between the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) IIV, mean cognitive performance, self-reported functioning, and death among 699 individuals between 64 and 94 years of age who were screened for neurological illness and living independently in the community. A coefficient of variation statistic served as the dispersion index and was derived by calculating the within-subject variability of the five RBANS indexes for each participant and dividing this value by the overall test battery mean. RESULTS: Results revealed that increased dispersion and poorer mean performance simultaneously predicted self-reported memory problems. In addition, participants with elevated dispersion at baseline had increased rates of death nine years later, although this lost significance after controlling for comorbid heart disease. Cluster analysis of the higher dispersion scores revealed four distinct profile patterns that did not differ on the outcome variables. CONCLUSIONS: Elevated RBANS dispersion is a proxy of co-occurring health problems and may be a useful metric of functional decline and death within community-dwelling geriatric populations.

A Factor Analytic Approach to the Validation of the Word Memory Test and Test of Memory Malingering as Measures of Effort and Not Memory.

Research has demonstrated the utility of performance validity tests (PVTs) as a method of determining adequate effort during a neuropsychological evaluation. Although some studies affirm that forced-choice PVTs measure effort rather than memory, doubts remain in the literature. The purpose of the current study was to evaluate the relationship between effort and memory variables in a mild traumatic brain injury (TBI) sample (n = 160) by separating memory and effort as distinct factors while statistically controlling for the shared covariance between the variables. A two-factor solution was extracted such that the five PVT variables loaded on Factor 1 and the four memory variables loaded on Factor 2. The pattern matrix, which controls for the covariance between variables, provided clear support of two highly distinct factors with minimal cross-loadings. Our findings support assertions that PVTs measure effort independent of memory in veterans with mild TBI.

Predicting psychosis across diagnostic boundaries: Behavioral and computational modeling evidence for impaired reinforcement learning in schizophrenia and bipolar disorder with a history of psychosis.

There is increasing evidence that schizophrenia (SZ) and bipolar disorder (BD) share a number of cognitive, neurobiological, and genetic markers. Shared features may be most prevalent among SZ and BD with a history of psychosis. This study extended this literature by examining reinforcement learning (RL) performance in individuals with SZ (n = 29), BD with a history of psychosis (BD+; n = 24), BD without a history of psychosis (BD-; n = 23), and healthy controls (HC; n = 24). RL was assessed through a probabilistic stimulus selection task with acquisition and test phases. Computational modeling evaluated competing accounts of the data. Each participant's trial-by-trial decision-making behavior was fit to 3 computational models of RL: (a) a standard actor-critic model simulating pure basal ganglia-dependent learning, (b) a pure Q-learning model simulating action selection as a function of learned expected reward value, and (c) a hybrid model where an actor-critic is "augmented" by a Q-learning component, meant to capture the top-down influence of orbitofrontal cortex value representations on the striatum. The SZ group demonstrated greater reinforcement learning impairments at acquisition and test phases than the BD+, BD-, and HC groups. The BD+ and BD- groups displayed comparable performance at acquisition and test phases. Collapsing across diagnostic categories, greater severity of current psychosis was associated with poorer acquisition of the most rewarding stimuli as well as poor go/no-go learning at test. Model fits revealed that reinforcement learning in SZ was best characterized by a pure actor-critic model where learning is driven by prediction error signaling alone. In contrast, BD-, BD+, and HC were best fit by a hybrid model where prediction errors are influenced by top-down expected value representations that guide decision making. These findings suggest that abnormalities in the reward system are more prominent in SZ than BD; however, current psychotic symptoms may be associated with reinforcement learning deficits regardless of a Diagnostic and Statistical Manual of Mental Disorders (5th Edition; American Psychiatric Association, 2013) diagnosis.

Factor structure of symptom dimensions in attention-deficit/hyperactivity disorder (ADHD).

There is disagreement on whether attention-deficit/hyperactivity disorder (ADHD) symptoms are best characterized along two dimensions consisting of inattention and hyperactivity/impulsivity or three dimensions where hyperactivity and impulsivity are separate. To address this, the current study investigated the underlying symptom dimensions of ADHD by examining two- and three-factor models of ADHD symptom ratings in 400 children and adolescents diagnosed with ADHD. ADHD symptom ratings for each of the 18 DSM-IV Criteria A symptoms were obtained from mothers using a standardized symptom rating scale. Confirmatory factor analysis (CFA) was used to examine whether the 18 symptoms were best explained by two or three latent constructs. Results of the CFA demonstrated that a three-factor model was superior to a two-factor model. Findings support three distinct symptom dimensions that are consistent with previous research demonstrating unique clinical presentations of inattention, hyperactivity, and impulsivity. Differentiating between these three domains may aid in predicting behavioral outcomes in children with ADHD.

Increased neurocognitive intra-individual variability is associated with declines in medication adherence in HIV-infected adults.

OBJECTIVE: There is cross-sectional evidence that neurocognitive intra-individual variability (IIV), or dispersion, is elevated in human immunodeficiency virus (HIV) disease and is associated with declines in activities of daily living, including medication adherence. METHODS: This longitudinal study extends this literature by examining whether increased neurocognitive IIV in HIV-positive persons over time predicts declines in medication adherence above and beyond changes in mean level of performance over a 6-month observation. RESULTS: After controlling for drug use, declines in mean performance, and changes in depressive symptoms, results confirmed that increases in IIV were associated with overall poorer antiretroviral medication adherence. HIV-positive individuals with the greatest increases in dispersion demonstrated marked reductions in adherence by the third month that exceeded what was observed in less variable individuals. CONCLUSIONS: Our results indicate that increases in dispersion are associated with poorer declines in medication adherence in HIV disease, which may have implications for the early detection and remediation of suboptimal antiretroviral adherence.

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.

Interactive effects of neurocognitive impairment and substance use on antiretroviral non-adherence in HIV disease.

While numerous studies have established the adverse independent effects of clinical conditions including neurocognitive dysfunction, psychiatric illness, and substance abuse/dependence on medication adherence among HIV-infected adults, fewer have studied their interactive effects. The current study examined this issue among 204 HIV-infected participants based upon current neurocognitive functioning and DSM-IV-diagnosed psychiatric illness and current substance abuse or dependence. Results confirmed that participants with any of these risk factors demonstrated poorer adherence than individuals with no risk factors. A neurocognitive status × substance abuse/dependence interaction was also identified such that participants with impaired neurocognition and a co-occurring substance abuse/dependence diagnosis demonstrated the poorest adherence. Results confirm the deleterious impact of these risk factors in isolation and also identify a specific interactive effect for individuals with comorbid neurocognitive impairment and a substance abuse/dependence disorder. Findings highlight the need for interventions that simultaneously address these problems.