Noninvasive Neuromodulation in Parkinson's Disease: Insights from Animal Models.

The mainstay treatments for Parkinson's Disease (PD) have been limited to pharmacotherapy and deep brain stimulation. While these interventions are helpful, a new wave of research is investigating noninvasive neuromodulation methods as potential treatments. Some promising avenues have included transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), electroconvulsive therapy (ECT), and focused ultrasound (FUS). While these methods are being tested in PD patients, investigations in animal models of PD have sought to elucidate their therapeutic mechanisms. In this rapid review, we assess the available animal literature on these noninvasive techniques and discuss the possible mechanisms mediating their therapeutic effects based on these findings.

Fostering telecompetence: A descriptive evaluation of clinical psychology predoctoral internship and postdoctoral fellowship implementation of telehealth education.

PURPOSE: Telehealth education within clinical psychology predoctoral internships and postdoctoral fellowships has become a frequent recommendation designed to prepare future providers with evidence-informed telehealth skills that can be applied to rural populations. Unfortunately, the availability of telehealth training among internships and fellowships, as well as areas for growth, remains unclear. Thus, the current study evaluated graduate clinical psychology internship and fellowship integration of telehealth training components before and after the onset of COVID-19. METHODS: Individuals representing 74 internships and 29 fellowships completed author-created REDCap-hosted demographic and telehealth training surveys. FINDINGS: Before COVID-19, 2 internships and 4 fellowships reported implementing telehealth education, with a majority of materials for both types of programs being optional educational targets and generally encompassing 0-15 hours of student education. After the onset of COVID-19, 72 internships and 27 fellowships indicated implementing telehealth education, with a majority indicating materials as mandatory and encompassing between 0 and 50+ hours. Despite increases, 73.6% of internship programs and 62.1% of fellowship programs noted a desire for their students to receive additional telehealth education in the future. Integrated educational foci are discussed. CONCLUSIONS: The current study demonstrated positive trends in the development of telehealth education among internships and fellowships. Nevertheless, some programs can likely benefit from additional integration of telehealth components, as well as more formal programming built around field-supported competencies and models. While work is required to further clarify field offerings, the current study provided a preliminary evaluation of internship and fellowship telehealth educational offerings.

Educating for the Future: a Preliminary Investigation of Doctoral-Level Clinical Psychology Training Program's Implementation of Telehealth Education.

Literature has reinforced the importance of telehealth-focused education to foster provider competence and optimal patient care. As clinical psychology evolves to meet field needs, many have suggested graduate school as an optimal time to offer comprehensive telehealth education. Despite the rapid expansion of telehealth post-COVID-19, the extent of telehealth-specific doctoral-level programming, as well as the foci of available trainings, has remained unclear. To address this gap and inform future work, the current study evaluated doctoral-level clinical psychology training programs throughout the USA. Fourteen doctoral-level training programs completed author-created REDCap-hosted demographic and telehealth training surveys. Pre-COVID-19, three of fourteen programs reported implementing some form of telehealth-focused education, with a majority of the information being viewed as optional targets for instructors. Contrastingly, thirteen programs indicated implementing telehealth-focused education post-COVID-19, with a majority of the information being indicated as mandatory educational targets. Despite increases in educational activities, a large number of programs endorsed a desire for additional telehealth-focused education for students as they transition into future roles. Educational foci, methods of training, and instructor preparation are discussed. While participation was limited, the current study demonstrated positive trends in the development of telehealth-focused education. Nevertheless, there remains an ongoing need for both specialized coursework and a wider range of educational topics. Ultimately, the current study is believed to have provided a preliminary evaluation of the types and foci of telehealth-focused education among doctoral-level clinical psychology training programs.

Deep brain stimulation for psychiatric disorders and behavioral/cognitive-related indications: Review of the literature and implications for treatment.

While pharmacological and/or behavioral treatments are effective in managing symptoms for many patients with psychiatric diagnoses and disorders with behavioral/cognitive manifestations, a subset of individuals are treatment-refractory, unable to achieve appreciable benefit or symptom relief from traditional methods. In recent years, neuromodulation has gained momentum as an adjunctive treatment for improving outcomes in patients who are treatment-refractory. One form of neuromodulation, deep brain stimulation (DBS), has been investigated for the treatment of various psychiatric disorders and behavioral/cognitive symptoms. The following article provides a review of DBS investigations for several psychiatric and behavioral-related disorders, including depression, obsessive-compulsive disorder, substance use disorder, Alzheimer's disease, anorexia, obesity, schizophrenia, and posttraumatic stress disorder. PubMed, PsycINFO, Scopus, Ovid MEDLINE, and Web of Science were used to identify published articles, and Clinicaltrials.gov was used to identify currently ongoing or planned studies. Findings revealed the potential utility of DBS in improving outcomes for various psychiatric and behavioral/cognitive-related disorders. While promising, there are several limitations present in the available literature, and further well-designed clinical trials are necessary before conclusive decisions regarding the utility of DBS for the treatment of these psychiatric/behavioral/cognitive-related disorders can be made. Regardless, the studies included in this review demonstrate positive preliminary findings for the potential benefit of DBS for treatment of a variety of psychiatric disorders, and further research is warranted to better determine the potential utility of DBS for those who are treatment-refractory and unable to achieve symptom relief with standard care.

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.

Assessing Psychometrists' Practices to Inform Neuropsychological Services.

OBJECTIVE: Quality of life (QOL) is a broad-ranging concept affecting an individual's physical health, psychological state, social relationships, and relationship to their environment. Although the role of psychometrists in clinical neuropsychology is integral to the delivery of services, little is known about their QOL. The current study assessed psychometrists' workload and aspects related to work QOL (e.g., physical and emotional exhaustion, social and work satisfaction). METHOD: Psychometrists (N = 164) from 38 states completed a nationally distributed survey. Participants averaged eight years of experience, ~29% completed board certification, and worked primarily in general hospitals (~36%), academic medical centers (~21%), private practice (~15%), veterans/military hospitals (~13%), and rehabilitation hospitals (~12%). RESULTS: Respondents saw 5.6±2.4 (Mean±Standard Deviation) patients and spent 18.8±6.9 and 9.4±4.9 hours administering and scoring, respectively, per week. Although the majority of respondents felt satisfied with their work QOL, approximately 49% experienced emotional exhaustion, 42% experienced burnout, and 62% reported that fatigue interfered with work, family, or social life. Correlational analyses found a significant relationship between QOL variables and professional activities, particularly with time spent scoring. Additionally, patient load, time spent administering/scoring, and QOL factors varied depending on work setting. CONCLUSION: The current study provides a novel characterization of psychometrists' QOL. Specifically, the prevalence of emotional exhaustion and fatigue appears to be higher than in the general working population in the United States. In addition, these findings highlight the current variability of job responsibilities and QOL across work settings. Ongoing advocacy and practice adjustments for this field are indicated.

Mental Health Practitioners' Immediate Practical Response During the COVID-19 Pandemic: Observational Questionnaire Study.

BACKGROUND: The COVID-19 pandemic has been associated with increased psychological distress, signaling the need for increased mental health services in the context of stay-at-home policies. OBJECTIVE: This study aims to characterize how mental health practitioners have changed their practices during the pandemic. The authors hypothesize that mental health practitioners would increase tele-mental health services and that certain provider types would be better able to adapt to tele-mental health than others. METHODS: The study surveyed 903 practitioners, primarily psychologists/doctoral-level (Psych/DL) providers, social workers/master's-level (SW/ML) providers, and neuropsychologists employed in academic medical centers or private practices. Differences among providers were examined using Bonferroni-adjusted chi-square tests and one-way Bonferroni-adjusted analyses of covariance. RESULTS: The majority of the 903 mental health practitioners surveyed rapidly adjusted their practices, predominantly by shifting to tele-mental health appointments (n=729, 80.82%). Whereas 80.44% (n=625) were not using tele-mental health in December 2019, only 22.07% (n=188) were not by late March or early April 2020. Only 2.11% (n=19) reported no COVID-19-related practice adjustments. Two-thirds (596/888, 67.10%) reported providing additional therapeutic services specifically to treat COVID-19-related concerns. Neuropsychologists were less likely and Psych/DL providers and SW/ML providers were more likely than expected to transition to tele-mental health (P<.001). Trainees saw fewer patients (P=.01) and worked remotely more than licensed practitioners (P=.03). Despite lower rates of information technology service access (P<.001), private practice providers reported less difficulty implementing tele-mental health than providers in other settings (P<.001). Overall, the majority (530/889, 59.62%) were interested in continuing to provide tele-mental health services in the future. CONCLUSIONS: The vast majority of mental health providers in this study made practice adjustments in response to COVID-19, predominantly by rapidly transitioning to tele-mental health services. Although the majority reported providing additional therapeutic services specifically to treat COVID-19-related concerns, only a small subset endorsed offering such services to medical providers. This has implications for future practical directions, as frontline workers may begin to seek mental health treatment related to the pandemic. Despite differences in tele-mental health uptake based on provider characteristics, the majority were interested in continuing to provide such services in the future. This may help to expand clinical services to those in need via tele-mental health beyond the COVID-19 pandemic.

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.

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.

Olfactory deficits in frontotemporal dementia as measured by the Alberta Smell Test.

The study of olfaction in neurodegeneration has primarily focused on Alzheimer's disease. Research of olfaction in frontotemporal dementia (FTD) has generally not been empirically studied. The current study compared olfaction in FTD to major depressive disorder (MDD) using the Alberta Smell Test (AST). Independent-samples t test results suggested olfaction in FTD was impaired when compared with participants diagnosed with MDD. The AST Total score (out of 20 trials) significantly predicted the diagnostic group and accounted for 40% of the variance in diagnostic group status with an odds ratio of 20.08. Results suggested that a cutoff of ≤2/20 differentiated FTD from MDD with 94% accuracy (91% sensitivity, 97% specificity) and a cutoff of ≤1/20 differentiated the groups with a 95.5% hit rate (91% sensitivity, 100% specificity). Results confirmed olfactory identification deficits in FTD and suggested that the AST is an effective tool for the demarcation of FTD from MDD. This is especially important due to the potential for significant overlap in the behavioral/emotional phenotype and cognitive deficits between the two disorders when presented with early stages of FTD.