Would people living with epilepsy benefit from palliative care?

Palliative care (PC) is an approach to the care of persons living with serious illness and their families that focuses on improving quality of life and reducing suffering by addressing complex medical symptoms, psychosocial needs, spiritual well-being, and advance care planning. While PC has traditionally been associated with hospice care for persons with cancer, there is now recognition that PC is relevant to many noncancer diagnoses, including neurologic illness, and at multiple points along the illness journey, not just end of life. Despite the recent growth of the field of neuropalliative care there has been scant attention paid to the relevance of PC principles in epilepsy or the potential for PC approaches to improve outcomes for persons living with epilepsy and their families. We believe this has been a significant oversight and that PC may provide a useful framework for addressing the many sources of suffering facing persons living with epilepsy, for engaging patients and families in challenging conversations, and to focus efforts to improve models of care for this population. In this manuscript we review areas of significant unmet needs where a PC approach may improve patient and family-centered outcomes, including complex symptom management, goals of care, advance care planning, psychosocial support for patient and family and spiritual well-being. When relevant we highlight areas where epilepsy patients may have unique PC needs compared to other patient populations and conclude with suggestions for future research, clinical, and educational efforts.

Comparing two models of performance validity assessment in patients with Parkinson's disease who are candidates for deep brain stimulation surgery.

Utility of standalone and embedded performance validity tests (PVTs) as well as the decision-making algorithms used to reach clinical conclusions about credible and noncredible performance can be population specific. To better understand PVT utility in Parkinson's disease candidates for deep brain stimulation (DBS) we present on two aims: 1) establishing the frequency data of below-criterion responding for the Medical Symptom Validity Test and three embedded PVTs in a sample of 47 patients with Parkinson's disease, and 2) comparing the efficacy of two models for clinical-decision making regarding noncredible performance. Consistent with expectations from previous studies and desired specificity values, our retrospective analysis indicated that in this sample of presumably well-motived patients, the rate of below-criterion responding was less than 10% for all PVTs administered. Regarding our model comparison, we compared a typical PVT battery that required administration of a standalone measure in all cases against a recently proposed low risk algorithm that attempts to lower testing burden by relying more heavily on embedded PVTs with administration of a standalone measure only in the event of below-criterion performance on an embedded indicator. Results suggest that for patients with Parkinson's disease judged to be at limited risk for noncredible performance, a low risk PVT model may prove both more efficient and less prone to error than a more typical model. Implications for clinical decision-making are discussed, as are limitations of the study and its generalizability.

Are Established Embedded Performance Validity Test Cut-Offs Generalizable to Patients With Multiple Sclerosis?

OBJECTIVE: Data for the use of embedded performance validity tests (ePVTs) with multiple sclerosis (MS) patients are limited. The purpose of the current study was to determine whether ePVTs previously validated in other neurological samples perform similarly in an MS sample. METHODS: In this retrospective study, the prevalence of below-criterion responding at different cut-off scores was calculated for each ePVT of interest among patients with MS who passed a stand-alone PVT. RESULTS: Previously established PVT cut-offs generally demonstrated acceptable specificity when applied to our sample. However, the overall cognitive burden of the sample was limited relative to that observed in prior large-scale MS studies. CONCLUSION: The current study provides initial data regarding the performance of select ePVTs among an MS sample. Results indicate most previously validated cut-offs avoid excessive false positive errors in a predominantly relapsing remitting MS sample. Further validation among MS patients with more advanced disease is warranted.

Performance Validity Testing in Neuropsychology: Scientific Basis and Clinical Application-A Brief Review.

Performance validity testing refers to neuropsychologists' methodology for determining whether neuropsychological test performances completed in the course of an evaluation are valid (ie, the results of true neurocognitive function) or invalid (ie, overly impacted by the patient's effort/engagement in testing). This determination relies upon the use of either standalone tests designed for this sole purpose, or specific scores/indicators embedded within traditional neuropsychological measures that have demonstrated this utility. In response to a greater appreciation for the critical role that performance validity issues play in neuropsychological testing and the need to measure this variable to the best of our ability, the scientific base for performance validity testing has expanded greatly over the last 20 to 30 years. As such, the majority of current day neuropsychologists in the United States use a variety of measures for the purpose of performance validity testing as part of everyday forensic and clinical practice and address this issue directly in their evaluations. The following is the first article of a 2-part series that will address the evolution of performance validity testing in the field of neuropsychology, both in terms of the science as well as the clinical application of this measurement technique. The second article of this series will review performance validity tests in terms of methods for development of these measures, and maximizing of diagnostic accuracy.

Performance Validity Testing in Neuropsychology: Methods for Measurement Development and Maximizing Diagnostic Accuracy.

In the first column in this 2-part series, Performance Validity Testing in Neuropsychology: Scientific Basis and Clinical Application-A Brief Review, the authors introduced performance validity tests (PVTs) and their function, provided a justification for why they are necessary, traced their ongoing endorsement by neuropsychological organizations, and described how they are used and interpreted by ever increasing numbers of clinical neuropsychologists. To enhance readers' understanding of these measures, this second column briefly describes common detection strategies used in PVTs as well as the typical methods used to validate new PVTs and determine cut scores for valid/invalid determinations. We provide a discussion of the latest research demonstrating how neuropsychologists can combine multiple PVTs in a single battery to improve sensitivity/specificity to invalid responding. Finally, we discuss future directions for the research and application of PVTs.

[Formula: see text]Official Position of the American Academy of Clinical Neuropsychology (AACN): Guidelines for Practicum Training in Clinical Neuropsychology.

Practical experience is central to the education and training of neuropsychologists, beginning in graduate school and extending through postdoctoral fellowship. However, historically, little attention has been given to the structure and requirements of practicum training in clinical neuropsychology. A working group of senior-level neuropsychologists, as well as a current postdoctoral fellow, all from a diverse range of settings (The AACN Practicum Guidelines Workgroup), was formed to propose guidelines for practicum training in clinical neuropsychology. The Workgroup reviewed relevant literature and sought input from professional organizations involved in education and training in neuropsychology. The proposed guidelines provide a definition of practicum training in clinical neuropsychology, detail entry and exit criteria across competencies relevant to practicum training in clinical neuropsychology, and discuss the relationship between doctoral training programs and practicum training sites. The proposed guidelines also provide a methodology for competency-based evaluation of clinical neuropsychology practicum trainees and outline characteristics and features that are integral to an effective training environment. Although the guidelines discussed below may not be implemented in their entirety across all clinical neuropsychology practicum training sites, they are consistent with the latest developments in competency-based education.

Inhibitory capacity in adults with symptoms of Attention Deficit/Hyperactivity Disorder (ADHD).

Adult participants for the current study were placed into one of two groups depending on whether they manifested either high or low symptom levels of Attention Deficit/Hyperactivity Disorder (ADHD) as determined by the Wender Utah Rating Scale. Participants were also assessed on a battery of cognitive tasks as well as symptoms of depression, anxiety and substance abuse. The ADHD symptom groups were comparable in age and symptoms of depression, anxiety, and substance abuse. Adults with greater ADHD symptomatology performed more poorly on cognitive measures of response inhibition (the Stop-Signal task) and visual attention, compared to those with fewer ADHD symptoms. Regression analysis indicated the Stop-Signal task accounted for a greater proportion of the variance of ADHD symptomatology than any other cognitive variable. The conclusions from the findings are discussed in relation to self-regulation model of ADHD.