The transition from Mild Cognitive Impairment of the Amnestic Type to early dementia: A phenomenological and neuropsychological case analysis.

The scientific literature on neuropsychological correlates of Mild Cognitive Impairment of the Amnestic Type (MCI-A) often reports large group findings and employs multivariate statistics to describe domains of cognitive impairment associated with the transition of MCI-A to early dementia, typically of the Alzheimer's Type (AD). Individual patients may vary, however, in terms of specific changes in their neuropsychological test performance as they transition from MCI-A to probable AD. The subjective experiences of individuals during this time of transition can also vary but rarely are reported. Tracking both the patient's subjective experiences and their performance on neuropsychological measures provides a more complete picture of the patient's clinical situation. These combined sets of information help the clinical neuropsychologist provide a more individualized and personally relevant service. We present a phenomenological and neuropsychological case analysis of a 67-year-old woman who transitioned from MCI-A to probable early AD in an attempt to illustrate how such a combined analysis is helpful in their psychological care.

Studying lack of awareness of cognitive decline in neurodegenerative diseases requires measures of both anosognosia and denial.

The cause(s) of lack of awareness of cognitive decline in neurodegenerative diseases can be multifactorial. Yet neurologically oriented research on anosognosia of cognitive decline almost exclusively assumes that the underlying disturbance of neuro-networks that support various cognitive functions accounts for the reduced self-awareness. Cultural and psychosocial factors, including the person's emotional state, however, can contribute to the underreporting or avoidance of admitting to cognitive impairments in neurodegenerative diseases. Research on the causes of lack of awareness of cognitive decline in neurodegenerative disorders needs to include these variables. We briefly present two case examples of underreporting or "unawareness" of memory difficulties in persons with mild cognitive impairment (MCI) (or minor neurocognitive disorder). One presented with classic anosognosia for memory impairment, while the other initially reported no memory impairment but later admitted to "denying" her memory difficulties secondary to anxiety. Based on these patients' clinical presentations and available research, we suggest three potential screening items that may help identify probable denial of memory impairments when studying anosognosia in MCI.

Neuropsychological and Social Characteristics of a 7 Year Old Child with Hypomelanosis of Ito Followed for 11 Years.

Hypomelanosis of Ito (HI) is a neurocutaneous disorder associated with central nervous system abnormalities, including speech delay and intellectual disability. The long term neuropsychological and social characteristics of these children are unknown. Neuropsychological observations and parental reports were obtained yearly on a child with HI from ages 7 to 18 years. Serial measures of intelligence revealed stable verbal and perceptual reasoning scores with later improvements in working memory and processing speed performance. Speech articulation improved at age 12, as did the speed of right-hand finger tapping. Improved social integration occurred, but anxiety persisted throughout this developmental period.

George P. Prigatano's contributions to neuropsychological rehabilitation and clinical neuropsychology: A 50-year perspective.

In the 1970s and 1980s, a multitude of cognitive rehabilitation programs proliferated to facilitate recovery after brain injury. However only a few programs provided a framework for ameliorating disturbances in the cognitive, psychological, and interpersonal spheres of the brain-injured patient. Greatly influenced by Leonard Diller and Yehuda Ben-Yishay's ideas and methods, George P. Prigatano began, in early 1980, a holistic neuropsychological rehabilitation program at the Presbyterian Hospital in Oklahoma City (Oklahoma). The objective of this paper is to summarize the contributions of George P. Prigatano to neuropsychological rehabilitation and clinical neuropsychology during his 50th year of practice. The main body of the paper is structured in three sections. The first section briefly explains the history of neuropsychological rehabilitation in the twentieth century and the emergence of holistic neuropsychological rehabilitation programs in the 1970s. The second section describes the contributions of George P. Prigatano to neuropsychological rehabilitation and clinical neuropsychology (written by AGM). In the third section, the second author (GPP) prepared an autobiographical statement, which attempts to summarize some of the personal and professional experiences which influenced his work. George P. Prigatano's contributions to neuropsychological rehabilitation and clinical neuropsychology are essential to understanding the therapeutic approaches currently used in the treatment of brain-injured patients.

Screening for more than level of cognitive functioning: the BNI screen for higher cerebral functions.

OBJECTIVE: This paper describes the BNI Screen for Higher Cerebral Functions (BNIS) and reviews studies that comment on its reliability, validity, and clinical and research utility. The ability of the BNIS to assess non-cognitive higher brain functions is also described. METHODS: We reviewed the original administration manual, studies published in the BNI Quarterly of the Barrow Neurological Institute, and peer-reviewed studies on the BNI Screen identified by an academic database, PubMed and Google Scholar. Thirty-two studies were reviewed that describe normative data, psychometric properties, sensitivity and specificity estimates, the relationship of demographic factors to test performance, and its research utility. RESULTS: The BNIS is a time efficient screening test often taking no longer than 12-18 minutes. In addition to cognitive functioning, it aids in assessing conation, awareness of memory impairment, and affects expression and perception. Sensitivity estimates ranged from 80% to 92.3%. Specificity estimates ranged from 38.9% to 90%. Its construct, concurrent, and predictive validity have been supported by a series of international studies using different language translations of the test. CONCLUSION: The BNIS is a useful screening test for identifying patients with underlying brain disorders that uniquely measures domains of functioning not sampled by other existing screening tests.

End of Life Neuropsychological Impairments and Psychological Care of Persons With Advanced Parkinsonism.

Decline in executive functioning, before frank dementia occurs, has been reported in patients with a history of stroke and malignant brain tumors. This may also be true in patients with advanced Parkinson's disease (PD). In this paper, we summarize the limited research on the motor and cognitive predictors of mortality in advanced PD. We then provide 2 case vignettes of patients with end of life advanced PD who demonstrated a substantial decline in working memory and speech festination. We contrast these patients' neuropsychological features to a third patient with advanced PD who shows no signs of impending death. Monitoring neuropsychological signs of executive dysfunction, explaining the neuropsychological dysfunctions to the patient and spouse while recognizing the past and retained cognitive competencies of the person is an important component of end of life psychological care. In the context of this type of consultation, the patient may experience an opportunity to communicate their emotional concerns prior to death which further reduces the anxiety associated with death.

Neuropsychological rehabilitation, neuroimaging and neuroplasticity: A clinical commentary.

Initial brain imaging studies on recovery of motor functioning after stroke suggested their potential prognostic value in neurorehabilitation. However, the value of brain imaging in documenting brain changes associated with cognitive and behavioral treatment effects seem less likely. Also, neuroimaging studies at that time seem to have little, if any, value for treatment planning. Advances in neuroimaging technology are beginning to challenge these initial impressions. In this clinical commentary, we propose that advances in the field of neuroimaging have relevance for the future development of neuropsychological rehabilitation. Neuropsychological rehabilitation is entering a new era that involves collaboration with neuroimaging and associated studies on neuroplasticity. We recognize that this may seem "aspirational" rather than practical in most rehabilitation settings. However, we provide examples of how this can be achieved as illustrated by collaborative efforts of clinicians and scientists in the SARAH Network of Rehabilitation Hospitals in Brazil. We also review selective papers on neuroplasticity, spontaneous recovery and diaschisis that have relevance for research which will expand and further develop the field of neuropsychological rehabilitation.

Inhibitory Control of Adjacent Finger Movements while Performing a Modified Version of the Halstead Finger Tapping Test: Effects of Age, Education and Sex.

OBJECTIVE: Selective motor inhibition is known to decline with age. The purpose of this study was to determine the frequency of failures at inhibitory control of adjacent finger movements while performing a repetitive finger tapping task in young, middle-aged and older adults. Potential education and sex effects were also evaluated. METHODS: Kinematic recordings of adjacent finger movements were obtained on 107 healthy adults (ages 20-80) while they performed a modified version of the Halstead Finger Tapping Test (HTFF). Study participants were instructed to inhibit all finger movements while tapping with the index finger. RESULTS: Inability to inhibit adjacent finger movements while performing the task was infrequent in young adults (2.9% of individuals between 20 and 39 years of age) but increased with age (23.3% between the ages of 40 and 59; 31.0% between ages 60 and 80). Females and males did not differ in their inability to inhibit adjacent finger movements, but individuals with a college education showed a lower frequency of failure to inhibit adjacent finger movements (10.3%) compared to those with a high school education (28.6%). These findings were statistically significant only for the dominant hand. CONCLUSION: Selective motor inhibition failures are most common in the dominant hand and occur primarily in older healthy adults while performing the modified version of the HFTT. Monitoring selective motor inhibition failures may have diagnostic significance.

Patient Competency Rating Scale-Brazilian Revised Version (PCRS-R-BR): Normative and Psychometric Data in 154 Healthy Individuals.

Background Patient Competency Rating Scale (PCRS-R-BR) is a clinical tool to evaluate the degree of competence in cognitive skills perceived by patients with brain injuries. However, no studies have investigated the influence of sociodemographic variables on self-report and self-awareness of healthy individuals.Aim This study aimed to (1) present normative data from the PCRS-R-BR in a healthy adult Brazilian sample; and (2) investigate psychometric properties of the scaleMethod One hundred and fifty-four adults that were divided in three age groups and two education groups and their informants completed the PCRS-R-BR.Results Score on the PCRS-R-BR Patient's Form differed as a function of age with younger adults reporting less competency than older individuals. An education effect was found on Attention/Working memory Factor on the Informant's PCRS-R-BR with informants of higher education adults reporting better competency than lower education individuals. A gender effect was observed on the Informant's Form. The Informant's Form scores of informants of women were higher than the scores provided by the informants of men. PCRS-R-BR showed adequate consistency coefficients and six factors.Conclusion PCRS-R-BR scores showed acceptable validity evidence and provides information regarding how age and gender effects may influence ratings in a Brazilian sample.

Self-awareness and underestimation of cognitive abilities in patients with adult temporal lobe epilepsy after surgical treatment.

INTRODUCTION: Self-awareness of cognitive, emotional, functional, and social performance is critical for compliance with treatment. However, few studies have investigated self-awareness and the associated effects on other cognitive variables in patients with temporal lobe epilepsy (TLE) after surgical treatment. AIM: This study was designed to investigate the prevalence of impaired self-awareness (ISA) in patients with TLE who have undergone surgical treatment. Associated correlations with clinical variables (frequency of seizures before surgery, time elapsed since the epilepsy diagnosis, depression, and anxiety) and verbal and visual episodic memory function and differences between patients with right and left TLE were also investigated. METHOD: Twenty-three adults with TLE after surgical treatment were assessed with the Patient Competency Rating Scale (PCRS-R-BR), the Rey Auditory Verbal Learning Task (RAVLT), and the Modified Ruche Visuospatial Learning Test (RUCHE-M). Patients were considered to have memory dysfunction if delayed recall as assessed with the RUCHE-M or RAVLT was at or below the 25th percentile. Patients were considered to have ISA if PCRS-R-BR discrepancy scores were at or above the 75th percentile. Underestimated cognitive ability (UCA) was defined as a PCRS-R-BR discrepancy percentile score ≤25. Results were analyzed using frequency, Spearman correlation, regression analyses, and the Mann-Whitney test. RESULTS: Frequency analysis of the total sample indicated ISA in 39.13% of patients (n = 9), UCA in 39.13% of patients (n = 9), and impaired verbal and/or visual memory performance in 69.56% of patients (n = 16). Moderate positive correlations were found between the frequency of seizures before surgical treatment and relatives' reports, as well as between the duration of time that had elapsed since the epilepsy diagnosis and patient reports. Negative and moderate correlations were found between the frequency of seizures and the discrepancy score, as well as between depression and patient reports. No differences in PCRS-R-BR were found between patients with right vs. left TLE. No clinical variables significantly predicted self-report or self-awareness. CONCLUSION: Patients with TLE exhibit various patterns of ISA and negative effects on cognitive function after surgical treatment. Emotional factors and relatives' reports must be considered when assessing these patients.