A scoping review of neuropsychological assessment for Asian Indians in the United States - research and clinical recommendations.

Objective: There is an increasing focus on understanding health disparities among various cultural groups in the United States. The need for heterogeneity in norms and test stimuli across ethnically diverse individuals are being increasingly recognized. However, to date it remains unknown whether and to what extent differences in cognitive norms and tests exist in Asian Indians, a fast-growing population in the U.S. It is essential to understand these differences to improve diagnostic accuracy and provide timely and appropriate clinical care. Method: In this study, we conducted a scoping review of available cognitive tests that were normed, developed, or adapted for Asian Indians living in the U.S. Results: The results suggested a paucity of norms and tests specifically examining cognition in this community. Conclusions: Based on the findings, we provide suggestions for research directions focusing on the development of culturally sensitive neuropsychological tools, normative data representative of this demographic, and interventions addressing healthcare access barriers. Overall, this review provides readers with relevant clinical information to immediately enhance patient care as well as provide actionable items in research to improve the future utility of neuropsychology for Asian Indians in the United States.

Future directions in neuropsychology: Training, education, clinical practice, and advocacy for Asians and Asian Americans.

Objective: Given the need for increased equity, justice, and inclusion in neuropsychology, this paper aimed to present an initial perspective on key areas of understanding necessary to provide ethically and culturally responsive services and training to Asians and Asian Americans. Method: We first reviewed the terms Asian and Asian American and established the large multitude of individuals these terms encompass. Second, a brief review of the foundations for Asian American psychology is provided to set the stage for the unique considerations when evaluating individuals of Asian descent. Lastly, the necessity of using the social justice lens in education and training pipelines needed to propel the field forward is emphasized. Conclusions: Overall, this paper reviewed key information to provide a foundational level of understanding regarding the nuances of working with persons of Asian descent in the field of neuropsychology.

A narrative review of the biopsychosocial and health characteristics of Asian Indians in the United States: Clinical and research implications for neuropsychological functioning.

Objective: The prevailing scientific literature aggregates Asians living in America into one omnibus category and thus can problematically result in a subpar and at times inaccurate understanding of health, social and cultural factors necessary for competent and informed medical care. Method: A literature search was conducted by cultural experts familiar with Asian Indian culture with a focus on immigrants from this community living in the US. Database using search engines was sought in the following domains: immigration patterns, prevalence for key medical and neurological conditions commonly associated with cognitive dysfunction, psychiatric/psychological needs in the community, some preliminary neuropsychological testing considerations while working with this community, and treatment considerations that could affect adherence and efficacy of outcomes. Articles were selected from 2000 to the most recent date, with emphasis on compiling information from review papers and meta-analysis from the past decade. Conclusions: Asian Indians living in the US are distinct from the larger Asian American community. Immigration trends underscore that Asian Indians have a bimodal distribution of wealth. Regarding medical conditions, a key and highly concerning finding is the higher prevalence of cardiovascular risk factors, especially in young males. The lack of non-existent cognitive data in this community is glaring and should serve as an impetus for conducting high-priority research in this community. Preliminary neuropsychological testing considerations are discussed from a practical perspective with emphasis on multilingualism and region of origin. Finally, treatment considerations include understanding attitudes and beliefs regarding traditional medicine.

Language and Acculturation: Neuropsychological Sequalae of COVID-19 in Indian Americans.

Coronavirus 2019 (SARS-CoV-2; COVID-19) has significant mental health and neuropsychological consequences, but data are insufficient on these specific implications of COVID-19, especially for Indian American patients. Few studies have critically explored risk factors and neuropsychological assessment considerations from a cultural and linguistic perspective, including how they impact the evaluation process for Indian Americans. The present paper focuses on cultural and linguistic considerations for case conceptualization, ethical challenges for best practices, and a specific example with a middle-aged Indian American woman. The need for a greater contextual understanding is emphasized as a step forward in establishing methodological and procedural guidelines for working with patients of Indian descent in the United States.

"The journey of a thousand miles begins with one step": An Asian American perspective on mentoring in neuropsychology.

OBJECTIVE: The Asian Neuropsychological Association (ANA) is a recently established cultural identity-based organization with the mission to ensure accessibility and provision of culturally sensitive neuropsychological services for individuals of Asian descent. One of ANA's programmatic goals has been to foster a pipeline of neuropsychologists through mentoring and networking. In this paper, we aim to understand the historical context as well as unique considerations that are relevant for mentoring in the Asian American community. METHODS: A search of the existing literature in psychology and allied fields such as counseling and sociology was conducted to identify and formulate suggestions for mentoring culturally diverse communities, with a specific focus on Asian Americans. Firsthand narrative descriptions of effective examples of mentoring experiences in the context of shared values are discussed. FINDINGS AND IMPLICATIONS: This paper reviews the historical context and establishes an initial contextual foundation for increasing knowledge about best practices that can be used to establish effective mentoring relationships for Asian Americans. Six key considerations were identified: model minority myth, acculturation and enculturation, ethno-racial status and gender, the context of communication, quantity and quality of mentorship, and unique values specific to the Asian American community. Our findings identify the value of cultural identity-based organizations in creating communities that can support the professional development of future neuropsychologists at various career stages. Overall, findings have implications for maintaining the relevance of the field of neuropsychology in adequately serving an increasingly culturally diverse national and international population.

Is asthma associated with cognitive impairments? A meta-analytic review.

INTRODUCTION: Asthma is a chronic disease with significant health burden and socioeconomic and racial/ethnic disparities related to diagnosis and treatment. Asthma primarily affects the lungs, but can impact brain function through direct and indirect mechanisms. Some studies have suggested that asthma negatively impacts cognition, while others have failed to identify asthma-related cognitive compromise. We aimed to conduct a meta-analysis of cognition in individuals with asthma compared to that in healthy controls. We also examined the impact of some key potential moderators. METHOD: Data on cognitive outcome measures and sociodemographic, illness-related, and study-related variables were extracted from studies reporting cognitive test performance in individuals with asthma compared to that in controls. RESULTS: There was no evidence of publication bias. A random-effects model examining differences in task performance between 2017 individuals with asthma and 2131 healthy controls showed significant effects in the small to medium range. Cognitive deficits associated with asthma were global, with strongest effects on broader measures involving academic achievement and executive functioning, but with additional impact on processing speed, global intellect, attention, visuospatial functioning, language, learning, and memory. Severity of asthma was a key moderator, with greatest cognitive deficits associated with severe asthma. Cognitive burden was also greatest in asthma patients who were younger, males, from low socioeconomic backgrounds, and from racial/ethnic minorities. Effects were independent of type of population (child versus adult), type of study (norm-referenced versus control-referenced), or reported use of oral or inhaled corticosteroid medications. CONCLUSIONS: There is cognitive burden associated with asthma, particularly among vulnerable groups with severe asthma. This could be due to increased risk of intermittent cerebral hypoxia in severe asthma. The clinical need to assess cognition in individuals with asthma is underscored.

A meta-analysis of emotion perception and functional outcomes in schizophrenia.

INTRODUCTION: Emotion perception (EP) is impaired in schizophrenia, is stable across clinical state, resistant to antipsychotic treatment and linked to symptom severity. Given its pervasive nature, there is a need to quantitatively examine whether this dysfunction impacts functional outcomes. We used a meta-analytic strategy to combine results from several studies and examine synthesized effect sizes. METHODS: A Meta-analysis of Observational Studies in Epidemiology standard was used to extract data following a PubMed and PsychInfo search. Studies reporting correlations between measures of EP and functional outcomes in schizophrenia spectrum disorders were selected. The impact of potential methodological (task type), demographic (sex, age, race, education, marital status) and clinical (age of onset, duration of illness, setting, symptoms, anti-psychotic medication) moderators on effect sizes were examined. RESULTS: Twenty-five studies met inclusion criteria and included 1306 patients who were 37 years old, with 12 years of education, 64% male and 63% Caucasian. There was a significant relationship between EP and functional outcomes in individuals with schizophrenia or schizoaffective disorder, with effect sizes in the medium range. Medium to large range positive correlations were observed between emotion identification and functional outcome domains involving social problem solving, social skills and community functioning. Significant moderators included task type (emotion identification tasks), sex (% male in sample), race (% Caucasian in sample) and clinical symptoms (negative and positive). CONCLUSIONS: Emotion identification deficits are associated with functional impairments in schizophrenia and moderated by sex, race and symptoms. This has implications for treatment efforts to improve outcomes.

More than just tapping: index finger-tapping measures procedural learning in schizophrenia.

BACKGROUND: Finger-tapping has been widely studied using behavioral and neuroimaging paradigms. Evidence supports the use of finger-tapping as an endophenotype in schizophrenia, but its relationship with motor procedural learning remains unexplored. To our knowledge, this study presents the first use of index finger-tapping to study procedural learning in individuals with schizophrenia or schizoaffective disorder (SCZ/SZA) as compared to healthy controls. METHODS: A computerized index finger-tapping test was administered to 1169 SCZ/SZA patients (62% male, 88% right-handed), and 689 healthy controls (40% male, 93% right-handed). Number of taps per trial and learning slopes across trials for the dominant and non-dominant hands were examined for motor speed and procedural learning, respectively. RESULTS: Both healthy controls and SCZ/SZA patients demonstrated procedural learning for their dominant hand but not for their non-dominant hand. In addition, patients showed a greater capacity for procedural learning even though they demonstrated more variability in procedural learning compared to healthy controls. Left-handers of both groups performed better than right-handers and had less variability in mean number of taps between non-dominant and dominant hands. Males also had less variability in mean tap count between dominant and non-dominant hands than females. As expected, patients had a lower mean number of taps than healthy controls, males outperformed females and dominant-hand trials had more mean taps than non-dominant hand trials in both groups. CONCLUSIONS: The index finger-tapping test can measure both motor speed and procedural learning, and motor procedural learning may be intact in SCZ/SZA patients.

Computerized neurocognitive test performance in schizophrenia: a lifespan analysis.

OBJECTIVE: Computerized neurocognitive batteries based on advanced behavioral neuroscience methods are increasingly used in large-scale clinical and genomic studies. Favorable construct validity in younger schizophrenia patients has been reported, but not in older patients. New variables afforded by computerized assessments were used to clarify age-associated cognitive impairment across the lifespan. METHODS: 624 patients with schizophrenia and 624 healthy comparison (HC) subjects age 16-75 completed a 1-2-hour computerized neurocognitive battery (CNB) that assessed abstraction and mental flexibility, attention, working memory, recognition memory (verbal, facial, spatial), language, visuospatial, and emotion processing. Linear mixed effects models tested for group differences in accuracy, response time, and efficiency scores. Contrasts were stratified by age. RESULTS: 91% of older (45+) and 94% of younger (< 45) groups provided "good" data quality. After controlling for parental education and project, there were significant three-way interactions for diagnosis x domain x age group on all three outcome variables. Patients performed worse than HC across all neurocognitive domains, except in the oldest group of 60+ patients. Age-stratified analyses did not show differences between younger (16-45) and older patients (45-60, 60+), except for the attention domain. Older patients' reduced working memory efficiency was due to worse speed, not accuracy. Older patients were quicker than younger patients in processing emotions. CONCLUSIONS: Computerized assessments are feasible in large cohorts of schizophrenia patients. There is stable and generalized neurocognitive dysfunction across the lifespan in schizophrenia, albeit with fewer differences in some domains between older patients and HC after age 60. Speed-accuracy tradeoff strategies suggest deceleration of some frontal networks and improvements in speed of emotional processing.

Challenges and opportunities for genomic developmental neuropsychology: examples from the Penn-Drexel collaborative battery.

Genomics has been revolutionizing medicine over the past decade by offering mechanistic insights into disease processes and engendering the age of "individualized medicine." Because of the sheer number of measures generated by gene sequencing methods, genomics requires "Big Science" where large datasets on genes are analyzed in reference to electronic medical record data. This revolution has largely bypassed the behavioral neurosciences, mainly because of the paucity of behavioral data in medical records and the labor-intensity of available neuropsychological assessment methods. We describe the development and implementation of an efficient neuroscience-based computerized battery, coupled with a computerized clinical assessment procedure. This assessment package has been applied to a genomic study of 10,000 children aged 8-21, of whom 1000 also undergo neuroimaging. Results from the first 3000 participants indicate sensitivity to neurodevelopmental trajectories. Sex differences were evident, with females outperforming males in memory and social cognition domains, while for spatial processing males were more accurate and faster, and they were faster on simple motor tasks. The study illustrates what will hopefully become a major component of the work of clinical and research neuropsychologists as invaluable participants in the dawning age of Big Science neuropsychological genomics.

Neuropsychological performance in older patients with schizophrenia: a meta-analysis of cross-sectional and longitudinal studies.

OBJECTIVE: Cognitive deficits are among the most reliable predictors of functional impairment in schizophrenia and a particular concern for older individuals with schizophrenia. Previous reviews have focused on the nature and course of cognitive impairments in younger cohorts, but a quantitative meta-analysis in older patients is pending. METHOD: A previously used search strategy identified studies assessing performance on tests of global cognition and specific neuropsychological domains in older patients with schizophrenia and age-matched comparison groups. Both cross-sectional and longitudinal studies were included. Potential methodological, demographic, and clinical moderators were analyzed. RESULTS: Twenty-nine cross-sectional (2110 patients, 1738 comparison subjects) and 14 longitudinal (954 patients) studies met inclusion criteria. Patients were approximately 65 years old, with 11 years of education, 53% male and 79% Caucasian. Longitudinal analysis (range 1-6 years) revealed homogeneity with small effect sizes (d = -0.097) being observed. Cross-sectional analyses revealed large and heterogeneous deficits in global cognition (d = -1.19) and on specific neuropsychological tests (d = -0.7 to -1.14). Moderator analysis revealed a significant role for demographic (age, sex, education, race) and clinical factors (diagnosis, inpatient status, age of onset, duration of illness, positive and negative symptomology). Medication status (medicated vs nonmedicated) and chlorpromazine equivalents were inconsequential, albeit underrepresented. CONCLUSIONS: Large and generalized cognitive deficits in older individuals with schizophrenia represent a robust finding paralleling impairments across the life span, but these deficits do not decline over a 1-6 year period. The importance of considering demographic and clinical moderators in cross-sectional analyses is highlighted.

A fMRI Study of Verbal Working Memory, Cardiac Output, and Ejection Fraction in Elderly Patients with Cardiovascular Disease.

Cardiovascular disease (CVD) is associated with cognitive deficits even in the absence of stroke. We examined the relationship between cardiac performance, as measured by cardiac output (CO) and ejection fraction (EF), and brain activity during a verbal working memory (VWM) task in elderly CVD patients who tend to be at increased risk for vascular cognitive impairments. Seventeen patients were recruited from a cohort participating in an ongoing prospective study examining the effects of CVD on cognitive function in the elderly. Participants were diagnosed with CVD (age 68±8) and completed a 2-back VWM task in a 1.5T fMRI paradigm. CO and EF were calculated from echocardiogram measures. Task-related activation was averaged in a priori regions of interest. The relationship between CO, EF, and 2-back-related activity was modeled using partial correlations (two-tailed p<.05) controlling for age and 2-back accuracy. All participants were globally cognitively intact as indicated by Mini-Mental Status Exam and Dementia Rating Scale scores. Mean accuracy on the 2-back was 78±9% while reaction time averaged 1,027±192 ms. Mean CO and EF values showed a large range (CO: 3.55 to 6.31; EF: 0.36 to 0.76) but average values were within the normal range. After controlling for age and 2-back accuracy, lower EF was related to decrease in left insula activity (r=0.61, p=0.03). There were trends for EF to be related to accuracy (r=0.47, p=0.09) and reaction time (r=-0.48, p=0.09). CO was also related to insula activity (r=0.60, p=0.04) and activity in the supplementary motor area activity (r=0.66, p=0.01). Cardiac performance was related to decreased efficiency in task related brain areas and tended to be related to performance on a VWM task in elderly patients with CVD. Results have implications for a line of investigation indicating that cardiac and systemic vascular indices could be used as proxy measures to examine mechanisms of cerebrovascular dysfunction in the elderly.

The neurocognitive effects of 5 day anesthetic ketamine for the treatment of refractory complex regional pain syndrome.

BACKGROUND: Complex regional pain syndrome I (CRPS) is characterized by severe neuropathic pain that exceeds the severity of an injury and is refractory to traditional treatments. Recent experimental interventions include ketamine infusion therapy. OBJECTIVE: We sought to evaluate the physical, neurocognitive, and emotional effects of extended treatment with anesthetic doses of ketamine in refractory CRPS I patients. METHODS: Nine patients (eight females) received a neuropsychological evaluation pre- and 6 weeks post-treatment that evaluated intellectual and academic abilities, executive functioning/processing speed, attention, learning and memory, and motor functioning. Mood/affect and personality were also evaluated and patients completed an extensive pain questionnaire. RESULTS: There was a marked reduction in the report of both acute and overall pain after treatment. Brief attention and processing speed improved significantly post-treatment, whereas all other cognitive domains remained stable, with the exception of a mild decline in motor strength. CONCLUSIONS: Findings suggest that, at least at a 6-week follow up: (1) deep ketamine therapy is effective for relief of pain CRPS I and (2) there were no adverse cognitive effects of extended treatment with deep ketamine infusion. No definitive conclusions could be drawn about the relationship between mood and personality factors and the presence of CRPS I.

Functional near infrared spectroscopy (fNIRS): an emerging neuroimaging technology with important applications for the study of brain disorders.

Functional near-infrared spectroscopy (fNIRS) is an emerging functional neuroimaging technology offering a relatively non-invasive, safe, portable, and low-cost method of indirect and direct monitoring of brain activity. Most exciting is its potential to allow more ecologically valid investigations that can translate laboratory work into more realistic everyday settings and clinical environments. Our aim is to acquaint clinicians and researchers with the unique and beneficial characteristics of fNIRS by reviewing its relative merits and limitations vis-à-vis other brain-imaging technologies such as functional magnetic resonance imaging (fMRI). We review cross-validation work between fMRI and fNIRS, and discuss possible reservations about its deployment in clinical research and practice. Finally, because there is no comprehensive review of applications of fNIRS to brain disorders, we also review findings from the few studies utilizing fNIRS to investigate neurocognitive processes associated with neurological (Alzheimer's disease, Parkinson's disease, epilepsy, traumatic brain injury) and psychiatric disorders (schizophrenia, mood disorders, anxiety disorders).

Self-face recognition and theory of mind in patients with schizophrenia and first-degree relatives.

OBJECTIVE: The hypothesized relationship between theory of mind (ToM) and self-face recognition as well as its potential genetic associations has not been previously explored in patients with schizophrenia and in first-degree relatives with schizotypal personality traits. METHOD: Ten patients diagnosed with schizophrenia, 10 of their first-degree relatives and 10 healthy controls were included. To assess self-face recognition (SFR), participants were presented images of faces of themselves and others and asked to make rapid 'unfamiliar', 'familiar' and 'self' judgments. As a measure of ToM, subjects were administered the Revised Mind in the Eyes Test (MET [Baron-Cohen, S., Wheelwright, S., Hill, J., Raste, Y., and Plumb, I., 2001. The "Reading the Mind in the Eyes" Test revised version: a study with normal adults, and adults with Asperger syndrome or high-functioning autism. J Child Psychol Psychiatry 42(2), 241-251.]). Schizotypal characteristics in relatives and controls were assessed using a modified version of the Schizotypal Personality Questionnaire (SPQ [Raine, A., 1991. The SPQ: a scale for the assessment of schizotypal personality based on DSM-III-R criteria. Schizophrenia Bulletin 17(4), 555-564.]). RESULTS: Patients took longer and were less accurate on the SFR task than their relatives who in turn performed worse than healthy controls. Specific ToM deficits in schizophrenia were replicated. There was a relationship between accuracy rates on the MET and SFR tasks. High levels of schizotypal traits such as social anxiety, constricted affect and no close friends were important for both tasks. CONCLUSIONS: Face recognition deficits and ToM deficits in schizophrenia are apparent. The critical influence of high levels of select schizotypal traits is also highlighted. A deficit in relatives of schizophrenia patients raises the possibility that ToM and face recognition deficits may be candidate endophenotypes for schizophrenia. Support for the hypothesized link between ToM and face recognition is provided.

Prognostic variables at intake and long-term level of function in schizophrenia.

OBJECTIVE: This study assessed the relationship between symptoms and cognitive measures at intake and functional outcome 2-8 years later (average 3 years) in first-episode and previously treated schizophrenia patients. METHOD: A composite cognitive score was assessed at intake to determine the influence of cognition on later functional outcome. At intake and follow-up, positive and negative symptoms were assessed with the Scale for the Assessment of Positive Symptoms and the Scale for the Assessment of Negative Symptoms, and affective symptoms were assessed with the Hamilton Depression Rating Scale. Level of function in seven domains (social function, occupational function, independent living, symptom severity, fullness of life, extent of psychiatric hospitalization, and overall level of function) at intake and follow-up was assessed with the Strauss-Carpenter Level of Function scale. The contributions of sex, education, and duration of illness to functional outcome were also examined. RESULTS: The results indicated that symptoms at intake had distinct patterns of prognostic significance for functional outcome in previously treated patients, compared with first-episode patients. In addition, male and female patients differed in the degree to which initial symptoms were correlated with later function. CONCLUSIONS: Initial level of function, symptoms, sex, education, and duration of illness are all important predictors for functional outcome in patients with schizophrenia.

Patient and family attitudes toward schizophrenia treatment.

Patient and family member attitudes toward illness, psychopharmacologic and nonpharmacologic treatments in schizophrenia, as well as their attitudes toward psychiatric research are reviewed here. The authors' recent work investigating patient and family member attitudes toward illness, medication, and a new method of receiving medication via surgical implants is also presented. The authors highlight the importance of understanding patient attitudes so that individual treatment plans and new treatments for schizophrenia can be facilitated. The important contribution of family members in caring for their loved ones is also emphasized. Patient participation in biomedical research is also discussed in the context of guiding the treatment of schizophrenia.

Patient attitudes towards surgically implantable, long-term delivery of psychiatric medicine.

The introduction of surgically implantable medication delivery systems provides psychiatric patients with reversible, uninterrupted access to medication for up to 14 months. This study designed and administered a survey to assess patients' attitudes and beliefs towards illness, medication, and this potential new treatment method. The survey included questions about demographics, insight and attitudes towards illness, current and past medication adherence, attitudes towards psychiatric and nonpsychiatric medications, and understanding and attitudes towards surgical implants. The sample of 206 psychiatric patients was almost equally split between favorably and unfavorably considering implants. Patients favorable towards implants ascribed forgetting and failure to refill medication on time as the reasons for missing doses, recognized the benefits of medication in general, and understood that the implant would be inserted under the skin. Favorable consideration of implants was positively correlated with the desire to avoid adverse consequences of missing medicine, stay well, avoid the need for daily oral medications, and decrease family burden. Unfavorable consideration of implants was related to a preference to take medication orally, concern about feeling controlled, unwillingness to try something new, and not understanding that the implant would be placed under the skin. Demographic variables, past/current medications, specific diagnosis, and illness severity did not influence the decision. This survey elucidates patients' attitudes and beliefs towards illness, medication, and surgical implants. The results indicate that a significant proportion of patients recognize the difficulties of medication adherence and the need for better methods to attain therapeutic response. Thus, the study provides impetus for future work in this area.

The significance of circadian phase for performance on a reward-based learning task in hamsters.

In humans and animal models, circadian modulation of learning has been demonstrated on numerous tests. However, it is unclear which aspects of the cognitive process are rhythmically regulated. In these experiments, we used a conditioned place preference task in hamsters to ask whether memory acquisition (hypothesis 1) or memory recall and performance (hypothesis 2) were subject to circadian modulation. In golden hamsters, access to a running wheel has been used as a reward to condition a place preference, but when given unrestricted access to a wheel, animals perform most of their spontaneous running within a few hours each day or circadian cycle. This suggested that either the perceived reward value of the wheel changes through the day or that the response to this reward is temporally restricted. Contrary to the hypotheses, we found that learning was not tied to the time of training nor to the time of testing, but rather animals showed a preference for a reward-paired context only at the circadian time that training had taken place. Timing is not an explicit discriminative cue in these experiments. Hence, the learning mechanism must be predisposed to register circadian time as an attribute during context learning.