Diferencias neuropsicológicas en la enfermedad de Alzheimer en función de la edad de presentación / Neuropsychological differences in Alzheimer's disease depending on the age of onset

Introducción La enfermedad de Alzheimer (EA) es la forma más común de demencia entre las personas mayores. La enfermedad de Alzheimer de inicio precoz (EAIP) se ha definido como una demencia debido a EA que se presenta antes de la edad arbitrariamente establecida de 65 años. De los pacientes con EA precoz, 50% debutan con síntomas atípicos y muestran alteraciones neuropsicológicas diferentes de aquellos pacientes que debutan más tarde. Estas atipias conllevan un retraso en el diagnóstico y en el inicio del tratamiento. Métodos Seleccionamos retrospectivamente 359 pacientes con diagnóstico de probable demencia por EA. Subdividimos a los pacientes en tres grupos atendiendo a la edad de aparición de la enfermedad: EAIP, menores de 65 años; EA de inicio tardío (EAIT; entre 65 y 80); y EA de inicio muy tardío (EAIMT; definido como edad de inicio mayor de 80 años) y comparamos sus resultados neuropsicológicos. Resultados Los pacientes de EA con una edad de inicio más joven puntuaron peor en atención, función ejecutiva y habilidades visuoespaciales, mientras que los pacientes de mayor edad puntuaron peor en tareas de memoria y lenguaje. Los pacientes de inicio muy tardío se diferenciaron de los de inicio tardío en un mayor deterioro de la fluidez semántica y la denominación. Conclusión Aunque la edad de 65 años podría corresponder a un punto de separación arbitrario entre la forma precoz y la forma de inicio más tardío de la EA, nuestro estudio demuestra que existen diferencias significativas entre estos grupos desde un punto de vista neuropsicológico. Sin embargo, estas diferencias parecen seguir una tendencia lineal con la edad, en lugar de representar cuadros clínicos fundamentalmente distintos. (AU)

Introduction Early-onset Alzheimer's disease (EOAD) has been defined as a dementia due to AD presenting before the arbitrarily established age of 65 (as opposed to late-onset Alzheimer's disease or LOAD). There is still little research about other age sub-groups, the use of so-called senile dementia has been banished, usually including it within the late-onset Alzheimer's dementia. To the extent of our knowledge, there are no studies comparing the neuropsychological features of very-late-onset patients with early and late-onset ones. Methods We retrospectively selected 359 patients with a diagnosis of probable AD dementia. We subdivided patients into three groups attending to the age of onset of the disease: early-onset AD (EOAD; younger than 65 years old), late-onset AD (LOAD; between 65 and 80) and very-late-onset AD (VLOAD; defined here as onset age older than 80), and then we compared their neuropsychological results. Results AD patients with a younger age at onset scored worse on attention, executive function and visuospatial skills, while older-onset patients scored worse in memory tasks and language. Patients with a very-late-onset differed from the late-onset ones in a greater impairment of semantic fluency and naming. Conclusion Although the point of separation between EOAD and later-onset forms of EA at the age of 65 is an arbitrary one, our study shows that there are significant differences between these groups from a neuropsychological point of view. However, these differences do seem to follow a linear trend with age, rather than representing fundamentally distinct clinical pictures. (AU)

Indagações sobre experiência de quase morte, memória episódica e o psicóide na visão da psicología / Inquiries about near-death experiences, episodic memory and the psychoid from the view of analytical

Busca-se discutir a relação da Experiência de Quase Morte (EQM) a partir dos conceitos junguianos, particularmentea Individuação e a Espiritualidade. Pretende-se ainda, explorar possíveis relações entre a memória da EQM e Neuropsicologia, analisando o arquétipo psicóide e possíveis relações entre ele e a memória episódica, procurando-se possibilidades viáveis de pesquisas exploratórias que possam trazer maiores esclarecimentos na relação entre a experiência de quase morte, o conceito do psicóide da Psicologia analítica de C. G. Jung e a memória episódica tratada em neuropsicologia AU

We seek to discuss the relationship of the Near Death Experience (NDE) from the Jungian concepts, particularly Individuation and Spirituality. It is also intended to explore possible relationships between NDE memory and Neuropsychology, analyzing the psychoid archetype and possible relationships between it and episodic memory, looking for viable possibilities for exploratory research that can bring further clarification on the relationship between the experience of almost death, the psychoid concept from C. G. Jung's Analytical Psychology and the episodic memory treated in neuropsychology AU

Geopolitical Considerations for Working with Medically Complex Patients: A Case Illustration.

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.

Cognitive issues in patients with IDH mutant gliomas: from neuroscience to clinical neuropsychology.

PURPOSE: The understanding of cognitive symptoms in patients with IDH-Mutant gliomas (IDH-Mut) is rapidly developing. In this article, we summarize the neuroscientific knowledge base regarding the influence of IDH-Mut tumors and their treatment on cognition and provide guidance regarding the management of these symptoms in patients. METHODS: We performed a review of peer reviewed publications relevant to IDH-Mut glioma and cognitive outcomes and provide an overview of the literature as well as a case example to clarify management strategies. RESULTS: At the time of presentation, patients with IDH-Mut gliomas have a favorable cognitive profile as compared with those with IDH-wild type (WT) tumors. The relatively low cognitive burden may reflect the slower growth rate of IDH-Mut tumors, which is less disruptive to both local and widespread neural networks. Human connectomic research using a variety of modalities has demonstrated relatively preserved network efficiency in patients with IDH-Mut gliomas as compared with IDH-WT tumors. Risk of cognitive decline from surgery can potentially be mitigated by careful integration of intra-operative mapping. Longer term cognitive risks of tumor treatment, including chemotherapy and radiation, are best managed by instituting neuropsychological assessment as part of the long-term care of patients with IDH-Mutant glioma. A specific timeline for such integrative care is provided. CONCLUSIONS: Given the relative recency of the IDH-mutation based classification of gliomas, as well as the long time course of this disease, a thoughtful and comprehensive strategy to studying patient outcomes and devising methods of cognitive risk reduction is required.

Evidências de validade do teste informatizado para avaliação das funções executivas / Evidence of validity of the computerized test for evaluating executive functions / Evidencia de validez de la prueba computarizada para evaluación de funciones ejecutivas

Funções executivas (FE) referem-se ao conjunto de habilidades que, de forma integrada, coordenam o comportamento e a cognição. Assim, o comprometimento no desenvolvimento das FE está ligado a vários desfechos negativos ao longo da vida. Portanto, a avaliação dessas habilidades na infância é essencial para identificar e prevenir prejuízos na vida adulta. Este estudo teve como objetivo investigar evidências de validade do Teste Informatizado para Avaliação das Funções Executivas (Tafe) pelo critério de idade e pelo padrão de correlação entre medidas do TAFE e outras medidas de FE. Para isso, foi utilizada uma amostra de 51 crianças, entre 4 e 10 anos de idade, matriculadas em uma escola privada na cidade de Goiânia (GO), da pré-escola ao 4º ano do ensino fundamental. Como instrumentos, foram utilizados, além do Tafe, as tarefas de Bloco de Corsi, Teste de Trilhas A e B, Teste de Trilhas Pré-Escolares, Teste de Stroop Pré-Escolares e Subteste Dígitos da Escala Wechsler de Inteligência. Foram conduzidas análises estatísticas Kruskal Wallis para verificar a evidência de validade por relação com idade e análises de correlação não paramétrica de Spearman para avaliar as evidências de validade convergente. O instrumento investigado mostrou-se efetivo para discriminar entre as diferentes faixas etárias, assim, sensível ao desenvolvimento das FE. Os resultados obtidos no Tafe correlacionaram-se aos obtidos em outros testes que também avaliaram FE, mostrando claros padrões de convergência. Logo, as análises dos resultados fornecem evidências de validade ao Tafe, derivadas a partir de diferentes estratégias de investigação.(AU)

Executive functions (EF) refer to the set of skills that, in an integrated way, coordinate behavior and cognition. Thus, the commitment in developing EF is linked to several negative outcomes throughout life. Therefore, the assessment of these abilities in childhood is essential to identify and prevent possible harm in adult life. This study aimed to investigate evidences of validity of the Computerized Test for Evaluation of Executive Functions (TAFE) by the age criterion and by the pattern of correlation between TAFE measures and other EF measures. To this end, a sample of 51 children, between 4 and 10 years old, enrolled in a private school in the municipality of Goiânia (GO), from preschool to the 4th year of elementary school, was used. As instruments, in addition to TAFE, the tasks of Corsi Block, Trails Test A and B, Preschool Trails Test, Preschool Stroop Test and the Digits Subtest of the Wechsler Intelligence Scale were used. Kruskal Wallis statistical analyzes were conducted to verify the evidence of validity by age criteria and Spearman's nonparametric correlation analysis to assess evidence of convergent validation. The instrument investigated was effective to discriminate between different age groups, thus being sensitive to the development of EF. The results obtained in TAFE were correlated with those obtained in other tests that also assess FE, showing patterns of convergence. Therefore, the analysis of the results provides validation evidence to TAFE, derived from different investigation methods.(AU)

Las funciones ejecutivas (FE) se refieren al conjunto de habilidades que coordinan la conducta y la cognición. Así, el deterioro en el desarrollo de FE está relacionado con varios resultados negativos durante la vida. Por tanto, la valoración de estas habilidades en la infancia es fundamental para identificar y prevenir posibles daños en la vida adulta. Este estudio tuvo como objetivo investigar la evidencia de validez de la Prueba Computarizada para Evaluación de Funciones Ejecutivas (Tafe) por el criterio de edad y convergencia entre las medidas Tafe y otras medidas de FE. Para ello, se utilizó una muestra de 51 niños, de entre 4 y 10 años de edad, matriculados en un colegio privado de Goiânia (Goiás, Brasil) desde la preescolar hasta 4.º de primaria. Como instrumentos, además del Tafe, se utilizaron las tareas de Bloque de Corsi, el Test de los senderos A y B, el Test de los Senderos Preescolares, el Test de Stroop Preescolar y la Subprueba de Dígitos de la Escala Wechsler de Inteligencia. Se realizaron análisis estadísticos de Kruskal Wallis para verificar la validez por criterios de edad y análisis de correlación no-paramétrica de Spearman para evaluar la evidencia de validez convergente. Tafe demostró ser efectivo para discriminar entre diferentes grupos de edad, así es sensible al desarrollo de FE. Los resultados en Tafe se correlacionaron con los obtenidos en otras pruebas de FE, lo que muestra claros patrones de convergencia. Por tanto, el análisis aporta evidencias de validez para Tafe, derivadas de diferentes estrategias de investigación.(AU)

Teoría de la mente, ¿un error conceptual en neuropsicología? / Theory of mind, a conceptual error in neuropsychology?

La neuropsicología contemporánea reconoce la teoría de la mente como la capacidad que desarrollan los niños, entre los 4 y 5 años, de interpretar, predecir y explicar el comportamiento propio y de los otros en términos de sus estados mentales subyacentes, ligando su estudio a diversos tipos de trastornos con especial énfasis en los trastornos del espectro autista. El objetivo del artículo se centra en la reflexión sobre lo que debería considerar una teoría que pretenda indagar sobre la mente, abordando los conceptos de inferencias y representaciones, contrastando su contenido con la psicología de sentido común. Se analiza la pertinencia de dirigir la línea de estudio, considerando un cambio conceptual por uno más adecuado y que genere menos vacíos teóricos al momento de establecer su respaldo epistémico. Para tal efecto, la cognición social se presenta como posible candidato a reemplazar la tan polémica teoría de la mente. Desde este punto de vista, es importante enfatizar la importancia que tienen los conceptos a la hora de informar los resultados de las investigaciones, debido a que ellos pueden estigmatizar y/o caricaturizar a los grupos de personas con los que se trabaja, grupos que particularmente propenden a ser diferenciados por el colectivo social dadas las características basales por los que se eligen para formar parte de las investigaciones.

Contemporary neuropsychology recognizes the theory of mind as the capacity that children develop, between the ages of 4 and 5, to interpret, predict and explain their own behavior and that of others in terms of their underlying mental states, linking its study to various types of disorders with special emphasis on autism spectrum disorders. The objective of the article focuses on the reflection on what a theory that seeks to investigate the mind should consider, addressing the concepts of inferences and representations, contrasting its content with folk psychology. The relevance of directing the line of study is analyzed considering a conceptual change for a more appropriate one that generates fewer theoretical gaps at the time of establishing its epistemic support, for this purpose, social cognition is presented as a possible candidate to replace the highly controversial theory of the mind. From this point of view, it is important to emphasize the importance of concepts when informing the results of research, since they can stigmatize and / or caricature the groups of people with whom they work, groups that particularly they tend to be differentiated by the social group given the baseline characteristics by which they are chosen to be part of the research.

All change: a stroke inpatient service's experience of a new clinical neuropsychology delivery model.

Adults presenting to stroke services are frequently faced with the challenge of adjusting to a different life following a stroke. Difficulties often include cognitive impairments, such as memory deficits, attention and language difficulties, and mood disturbances such as anxiety and depression. It has been highlighted that psychological care for this group is just as important as physical rehabilitation. Psychological expertise may therefore be required for the multitude of problems that occur after a stroke. UK National guidelines recommend routine assessment and management of mood and cognition after stroke. The aim of this study was to evaluate a new stroke clinical neuropsychology service developed by the Department of Neuropsychology and Clinical Health Psychology, in order to meet the needs of stroke survivors and their families referred into a large acute hospital. This involved using a different skill mix of staff across one post delivering a service in an acute inpatient stroke unit. This model was evaluated and results revealed that the model delivered increased patient access to neuropsychological support, an expansion in provision of clinical work, along with positive multidisciplinary team feedback. This finding is key as where resources are limited, clinical services may benefit from adopting a 'skill mix' model to meet the varying needs of their patients in a timely manner. This model serves to raise the value of psychology to medical services.

O que o Eletroencefalograma tem a nos dizer sobre a experiência religiosa: uma revisão sistemática / What Electroencephalogram has to tell us about religious experience: a systematic review

É possível observar historicamente o antagonismo delineado entre ciência e religião. Desde Galileu e a revolução científica, foram múltiplas as disciplinas que destinaram seus anseios teóricos para o entendimento dessa interface, a exemplo das neurociências, a partir do século XIX. Atualmente, observa-se um crescente interesse em investigar os correlatos neuronais da experiência religiosa e sua implicação na vida cotidiana. O presente manuscrito apresenta uma revisão sistemática PRISMA dos estudos que buscaram compreender os correlatos neurológicos da experiência religiosa a partir da técnica Eletroencefalograma (EEG) nos últimos dezoitos anos. Para isto, a coleta de dados foi realizada nos bancos de dados Pubmed, PsycINFO, Scielo e Science Direct. Dentre os resultados, a modulação das ondas Gama foi observada nos rituais cristãos e budistas, as ondas Teta apresentaram aumento no Cristianismo e diminuição no Espiritismo e as ondas Alfa nos rituais islâmicos. Os pesquisadores sugerem que esses resultados podem estar correlacionados com maior senso de propósito e significado de vida, bem como amplificação da empatia e compaixão.(AU)

It is possible to observe historically the antagonism outlined between science and religion. From Galileu and the scientific revolution, there were multiple disciplines that aimed their theoretical aspirations for the understanding of this interface, like the neurosciences in the 19th century. There is now a growing interest in investigating the neuronal correlates of religious experience and its implication in everyday life. This manuscript presents a PRISMA systematic review of the studies that sought to understand the neurological correlates of religious experience using the Electroencephalogram (EEG) technique in the last eighteen years. For this, data collection was performed in Pubmed, PsycINFO, Scielo and Science Direct databases. Among the results, Gamma wave modulation was observed in Christian and Buddhist rituals, Theta waves showed an increase in Christianity and a decrease in Spiritualism and Alpha waves in Islamic rituals. The researchers suggest that these findings may be correlated with a greater sense of purpose and meaning in life, as well as amplification of empathy and compassion.(AU)

Emotions, Bodily Changes, and the Social Environment: How Did Early Psychosomatic Medicine Consider the Social Dimension in Health and Disease?

OBJECTIVE: Social relationships play an important role in human health and disease processes, and the field of psychosomatic medicine currently integrates social factors in its theoretical models and clinical interventions. This article provides a historical perspective on the field of psychosomatic medicine in the United States and examines the extent to which early American psychosomatic medicine incorporated the impact of social relationships on health and disease outcomes. METHODS: We searched PubMed across all issues of Psychosomatic Medicine for key words related to emotions versus social processes. Article counts are compared for these key words. We then performed a narrative review to analyze how concepts of associations among emotional, interpersonal, and physiological variables evolved in early publications. RESULTS: Of 5023 articles found in Psychosomatic Medicine, 1453 contained an emotional, 936 a social search term, and 447 contained both. In the qualitative review, influences of the social environment on emotional states and physiology were recognized already in the 1930s but they only played a subordinate role in early Psychosomatic Medicine. Publications often lacked a clear working model how interpersonal events exert their impact on physiology. With increasing understanding of developmental and neural mechanisms, a more differentiated view evolved. CONCLUSIONS: Early publications in psychosomatic medicine mainly focused on associations between emotions and physiology. However, some highlighted the importance of interpersonal and social factors. Later, the understanding of emotions, social relationships, and physiology with their developmental and neurobiological correlates have led to a fuller "biopsychosociocultural" understanding of health and disease, although more research on and within these networks is urgently needed.

Integrative Care Models in Neuropsychology: A National Academy of Neuropsychology Education Paper.

Although collaborative, and more specifically, integrated models of care have existed for years, the 2010 Patient Protection and Affordable Care Act expanded their use, and Medicare has adopted a value-based payment system that further emphasizes service provision within the collaborative health care setting. Neuropsychology as a field is well-situated to work within the integrated health care setting, which presents both opportunities and challenges for clinical neuropsychologists. This education paper details how different neuropsychology clinical practice settings fit into an integrated care framework; discusses challenges to service delivery and fiscal viability in such settings and other health care related settings; and examines future directions for the role of neuropsychology within a dynamic health care system.

Neuropsicología positiva: nuevo enfoque; nuevas oportunidades / Positive neuropsychology: new approach; new opportunities

Desde hace relativamente poco tiempo, se observa un incremento en el número de investigaciones dedicadas a examinar las variables potenciadoras de la salud cognitiva. Este movimiento emergente ha sido denominado como Neuropsicología Positiva (NP). La NP ha sido definida como la orientación práctica y académica enfocada en el estudio y la promoción de la salud cognitiva. La presente revisión teórica, presenta los orígenes de la neuropsicología positiva y sus dominios teórico-metodológicos. Adicionalmente, se discuten evidencias empíricas a favor de este enfoque neuropsicológico. Se realizó un estudio teórico de tipo clásico, seleccionando de manera direccionada los artículos pertinentes a la temática, utilizando como bases de datos primarias a Scopus, Medline y PsycINFO. Como conclusión fundamental, se señala que la promoción de salud cognitiva debe considerar la integración de varios métodos orientados a potenciar el funcionamiento cerebral óptimo, maximizando el rendimiento cognitivo en individuos con limitaciones neuropsicológicas y también en personas cognitivamente sanas.

Since relatively recently, there has been an increase in the number of investigations devoted to examining the cognitive health enhancing variables. This emerging movement has been termed as Positive Neuropsychology (PN). PN has been defined as the practical and academic orientation focused on the study and promotion of cognitive health. The present theoretical review presents the origins of positive neuropsychology and its theoretical-methodological domains. Additionally, empirical evidence in favor of this neuropsychological approach is discussed. A classic theoretical study was carried out, selecting in a targeted manner the articles pertinent to the subject, using as primary databases Scopus, Medline and PsycINFO. As a main conclusion, it is pointed out that the promotion of cognitive health should consider the integration of several methods aimed at enhancing the optimal cerebral functioning, maximizing cognitive performance in individuals with neuropsychological limitations and also in cognitively healthy people.

[Cognitive neurorehabilitation: the foundations and applications of neurologic music therapy]. / Neurorrehabilitacion cognitiva: fundamentos y aplicaciones de la musicoterapia neurologica.

INTRODUCTION: Music is the result of a perception in the brain involving a number of cortical and subcortical areas in both brain hemispheres. Increased knowledge about brain plasticity and the numerous neuroimaging studies conducted in recent years have made it possible to further our understanding of the processing of musical stimuli in the brain. This has led to an interest in analysing and studying its application in the non-invasive treatment of certain dysfunctions or diseases with the aim of helping to achieve an improved quality of life. AIM: To outline the foundations and applications of the musical techniques that are used in cognitive neurorehabilitation. DEVELOPMENT: Following an initial summary of the processing of musical stimuli in the brain, the study goes on to explain the foundations of different techniques, as defined by neurologic music therapy, that are used efficaciously in cognitive neurorehabilitation. Sounds, which are the raw material of music, maintain a temporality and a sequencing that are a useful aid in the formation of temporal patterns of the cognitive functions, and constitute an assembly or framework that facilitates the learning of sequential information processing, such as memory. CONCLUSIONS: The techniques used in neurologic music therapy, which in recent years are being applied for cognitive neurorehabilitation, are not invasive and offer promising results that, together with further research, should be taken into account to be implemented alongside the conventional therapies of cognitive neurorehabilitation and stimulation.

TITLE: Neurorrehabilitacion cognitiva: fundamentos y aplicaciones de la musicoterapia neurologica.Introduccion. El conocimiento de la plasticidad cerebral y los numerosos estudios con neuroimagenes de los ultimos años han permitido un avance en la comprension del proceso cerebral de los estimulos musicales. Ello ha propiciado el interes para analizar y estudiar su aplicacion en el tratamiento no invasivo de determinadas disfunciones o enfermedades con el fin de contribuir a una mejora de la calidad de vida. Objetivo. Exponer los fundamentos y aplicaciones de las tecnicas musicales que se utilizan para la neurorrehabilitacion cognitiva. Desarrollo. A partir de un resumen inicial del proceso cerebral de los estimulos musicales, se exponen los fundamentos de diversas tecnicas, tal como define la musicoterapia neurologica, que se utilizan de forma eficaz en la neurorrehabilitacion cognitiva. Los sonidos, que constituyen la materia prima de la musica, mantienen una temporalidad y una secuenciacion que son utiles para ayudar a la formacion de patrones temporales de las funciones cognitivas y conforman un ensamblaje o armazon que facilita el aprendizaje de los procesos secuenciales de informacion, como por ejemplo, la memoria. Conclusiones. Las tecnicas usadas por la musicoterapia neurologica, que en los ultimos años se aplican en la neurorrehabilitacion cognitiva, no son invasivas y aportan resultados esperanzadores; con una mayor investigacion, deberian considerarse para su implantacion junto a las terapias convencionales de estimulacion y neurorrehabilitacion cognitiva.

The Integrated Care Team Approach of the Department of Veterans Affairs (VA): Geriatric Primary Care.

Historically, integrated mental and behavioral healthcare in the Department of Veterans Affairs (VA) commenced with initiatives in geriatrics. Innovation and system-wide expansion has occurred over decades and culminated in a unified vision for training and practice in the VA medical home model: Patient Aligned Care Team or PACT approach. In one VA hospital, the integration of neuropsychological services in geriatric primary care is pivotal and increases access for patients, as well as contributing to timely and effective care on an interprofessional team. The development and innovative use of an algorithm to identify problems with cognition, health literacy, and mental and behavioral health has been pragmatic and provides useful information for collaborative treatment planning in GeriPACT, VA geriatric primary care. Use of the algorithm also assists with decision-making regarding brief versus comprehensive neuropsychological assessment in the primary care setting. The model presented here was developed by supervising neuropsychologists as part of a postdoctoral residency program in geropsychology. However, postdoctoral residency programs in neuropsychology, as well as neuropsychological clinics, can also use this model to integrate neuropsychological assessment and interventions in geriatric primary care settings.

Introduction to the Special Issue on Neuropsychology Practices in Integrated Care Teams.

This special issue on neuropsychology practices in integrated healthcare teams demonstrates how neuropsychologists have transformed their practices in an evolving healthcare landscape. These contributions are an overview of the many ways in which neuropsychologists function in integrated care teams. The experiences of integrated neuropsychologists serve as a model for those seeking new practice opportunities by providing highly practical, clinically relevant information. Included in this volume are articles on education and reimbursement issues, information about clinical practices that address diagnostic issues, prognostics and clinical management, as well as surgical treatment planning and outcome prediction. Authors highlight the value of their services, their contribution to improving team and patient communication, as well as the biopsychosocial understanding of the patient. Several unexpected challenges are detailed among the pearls and pitfalls of these practices.

Neuropsychologists as primary care providers of cognitive health: A novel comprehensive cognitive wellness service delivery model.

By virtue of their extensive knowledge base and specialized training in brain-behavior relationships, neuropsychologists are especially poised to execute a unique broad-based approach to overall cognitive wellness and should be viewed as primary care providers of cognitive health. This article will describe a novel comprehensive cognitive wellness service delivery model including cognitive health, anti-aging, lifelong wellness, and longevity-oriented practices. These practice areas include brain-based cognitive wellness, emotional and spiritually centric exploration, and related multimodality health interventions. As experts in mind-body connections, neuropsychologists can provide a variety of evidence-based treatment options, empowering patients with a sense of value and purpose. Multiple areas of clinical therapy skill-based learning, tailor-made to fit individual needs, will be discussed including: brain stimulating activities, restorative techniques, automatic negative thoughts and maladaptive thinking reduction, inflammation and pain management techniques, nutrition and culinary focused cognitive wellness, spirituality based practices and mindfulness, movement and exercise, alternative/complimentary therapies, relationship restoration/social engagement, and trauma healing/meaning. Cognitive health rests upon the foundation of counteracting mind-body connection disruptions from multiple etiologies including inflammation, chronic stress, metabolic issues, cardiac conditions, autoimmune disease, neurological disorders, infectious diseases, and allergy spectrum disorders. Superimposed on these issues are lifestyle patterns and negative health behaviors that develop as ill-fated compensatory mechanisms used to cope with life stressors and aging. The brain and body are electrical systems that can "short circuit." The therapy practices inherent in the proposed cognitive wellness service delivery model can provide preventative insulation and circuit breaking against the shock of illness.

The Economics of Healthcare Shape the Practice of Neuropsychology in the Era of Integrated Healthcare.

The healthcare system in the United States is in the midst of a major transformation that has affected all healthcare specialties, including clinical psychology/neuropsychology. If this shift in the economics of healthcare reimbursement continues, it promises to impact clinical practice patterns for neuropsychologists far into the next decade.

The Evolution of Psychology as a Basic Bio-behavioral Science in Healthcare Education.

For over a century, researchers and educators have called for the integration of psychological science into medical school curricula, but such efforts have been impeded by barriers within medicine and psychology. In addressing these barriers, Psychology has re-examined its relationship to Medicine, incorporated psychological practices into health care, and redefined its parameters as a science. In response to interdisciplinary research into the mechanisms of bio-behavioral interaction, Psychology evolved from an ancillary social science to a bio-behavioral science that is fundamental to medicine and health care. However, in recent medical school curriculum innovations, psychological science is being reduced to a set of "clinical skills," and once again viewed as an ancillary social science. These developments warrant concern and consideration of new approaches to integrating psychological science in medical education.