Mitochondrial health, physical functioning, and daily affect: Bioenergetic mechanisms of dementia caregiver well-being.

OBJECTIVE: Chronic stress adversely affects mental and physical well-being. However, health outcomes vary among people experiencing the same stressor. Individual differences in physical and emotional well-being may depend on mitochondrial biology, as energy production is crucial for stress regulation. This study investigated whether mitochondrial respiratory capacity corresponds to individual differences in dementia spousal caregivers' mental and physical health. METHODS: Spousal caregivers of individuals with Alzheimer's disease and related dementias (N = 102, mean age = 71, 78% female, 83% White) provided peripheral blood samples and completed self-report questionnaires on quality of life, caregiver burden, and a 7-day affect scale. Multiple and mixed linear regression were used to test the relationship between mitochondrial biology and well-being. RESULTS: Spare respiratory capacity (b = 12.76, CI[5.23, 20.28 ], p = .001), maximum respiratory capacity (b = 8.45, CI [4.54, 12.35], p < .0001), and ATP-linked respiration (b = 10.11, CI [5.05, 15.18], p = .0001) were positively associated with physical functioning. At average (b = -2.23, CI [-3.64, -.82], p = .002) and below average (b = -4.96, CI [-7.22, 2.70], p < .0001) levels of spare respiratory capacity, caregiver burden was negatively associated with daily positive affect. At above average levels of spare respiratory capacity, caregiver burden was not associated with positive affect (p = .65). CONCLUSIONS: Findings suggest that better mitochondrial health is associated with better psychological and physical health - a pattern consistent with related research. These findings provide some of the earliest evidence that cellular bioenergetics are related to well-being.

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.

Developing a Culturally Competent Neuropsychological Battery for Diagnosis of Dementia in Arabic-Speaking Patients in the United States.

OBJECTIVE: In adherence to the American Educational Research Association (AERA) guidelines on culturally informed testing practices, this paper aims to review a suggested battery of tests that is linguistically and culturally appropriate for Arabic-speaking patients and to inform the reader of the varied characteristics of the Arab world to aid in providing a culturally informed neuropsychological evaluation. METHOD: Test instruments in Arabic were identified through systematic searches of PubMed and Google Scholar, U.S.-based website searches in Arabic and French, and in consultation with Arabic-speaking cultural brokers. RESULTS: A battery assessing cognitive domains and mood was assembled using core measures that were developed using appropriate translations, cultural adaptations, and include normative data of Arabic-speaking individuals. Supplemental measures that can be administered using translated instructions and English normative data are also identified. The rationale for test selection and clinical utility, including strengths and limitations of the proposed measures is presented. CONCLUSIONS: Given the large number of Arab Americans residing in the United States combined with the dearth of Arabic speaking neuropsychologists, it is essential that non-Arabic speaking neuropsychologists educate themselves regarding culturally informed practices to better service this growing community.

A Neuropsychological Battery for the Evaluation of Dementia Among Mandarin-Speaking Older Adults in the United States.

OBJECTIVE: Asians of Chinese origin are the largest single Asian origin group in the United States and are also the third largest group in Harris County, TX (i.e., the Houston metropolitan area). Mandarin speakers constitute the majority of the group. The linguistic gaps between Chinese (Mandarin) and English make it essential to use appropriate tests and normative data when working with the Mandarin-speaking population. Although it is ideal to develop original tests and/or normative data for Mandarin-speaking patients residing in the United States, the process can be lengthy. Although these indigenous tests are being developed, a neuropsychological battery with tests validated in Mandarin-speaking regions (e.g., Mainland China, Taiwan, and Singapore) can provide valuable information for Mandarin-speaking patients who identify with their home culture/country/region. METHODS: A systematic review of two electronic databases (PubMed and PsycInfo) was conducted. RESULTS: A neuropsychological battery to assess cognitive domains, including global intellectual function, attention/processing speed, executive function, visuospatial/visuoconstruction, language, learning and memory, and emotion, was developed. Cognitive screeners and performance validity measures were also included. The battery consists of core and supplementary measures validated in the Mandarin-speaking population. A case illustration is provided. CONCLUSION: Strengths and limitations of the battery and the role of interpretation in service delivery are discussed. The battery is recommended to clinicians for the evaluation of Mandarin-speaking older adults residing in the United States and other non-Mandarin-speaking regions where local norms are not available.

Culturally Competent Approaches for Neuropsychological Assessment for Differential Diagnosis of Dementia of Korean-Speaking Patients in the United States.

OBJECTIVE: To serve the over 1.82 million people of Korean descent who reside in the United States, we assembled a core and supplemental battery of culturally and linguistically appropriate neuropsychological measures for differential diagnosis of dementia for Korean-speaking patients. METHOD: Test instruments in Korean were identified through systematic searches of PubMed and Google Scholar, US-based website searches in Korean, and in consultation with Korean-speaking cultural brokers, residing in the United States and Korea. RESULTS: A battery assessing cognitive domains and mood was assembled using core measures developed specifically for Korean-speaking individuals within the United States and supplemental English measures that can be administered using translated instructions and English normative data. The rationale for test selection and clinical utility, including strengths and limitations of the proposed measures, is presented. Additionally, a case illustration using the proposed battery is included. CONCLUSIONS: Given the large and aging population of Korean-speaking residents in the United States, it is imperative to utilize appropriately designed and normed instruments to provide culturally competent assessments to better serve the Korean community.

Developing a Culturally Competent Neuropsychological Assessment Battery for Farsi-speaking Patients with Suspected Dementia.

OBJECTIVE: To assemble a comprehensive neuropsychological battery appropriate for differential diagnosis of dementia in Farsi-speaking Iranian adults in the United States. METHOD: Systematic searches of PubMed, PsychInfo, and Google Scholar databases were conducted to obtain test instruments relevant to Farsi speakers in consultation with a Farsi-speaking cultural broker. RESULTS: A proposed battery assessing the domains of attention, executive function, verbal and visual episodic memory, language, visuospatial/visuoconstruction abilities, and mood/anxiety was assembled that includes core measures developed, either specifically for a Farsi-speaking Iranian population or validated/normed with a Farsi-speaking Iranian sample. Though not ideal, additional measures were selected that can be administered using translated instructions with English normative data to supplement the limited tests available for use in this population. The rationale for test selection and caveats for their clinical use are presented along with a case study. CONCLUSIONS: The number of neuropsychological measures available in Farsi and/or with normative data for Farsi speakers is extremely limited. Cognitive tests either developed for or validated with a bilingual Farsi-English sample also represent a significant gap in the literature. Appropriate measures for these populations are urgently needed to provide a culturally competent assessment of a growing older adult segment of an underserved community.

Developing a Culturally Competent Neuropsychological Assessment Battery for Vietnamese-speaking Patients with Suspected Dementia.

OBJECTIVES: To assemble a core battery of culturally and linguistically appropriate neuropsychological measures that can be administered to Vietnamese-speaking patients with suspected dementia. METHODS: Test instruments in Vietnamese were identified through systematic searches of PubMed, PsychInfo, and Google Scholar, and in consultation with two Vietnamese-speaking cultural brokers. RESULTS: A battery assessing the domains of attention, executive function, verbal and visual episodic memory, basic language abilities, visuospatial/visuoconstruction abilities, and mood/anxiety was assembled that included core measures developed either specifically for a Vietnamese-speaking population, or were validated/normed with a Vietnamese-speaking sample either in Vietnam or Vietnamese-speaking persons in the U.S. Supplemental measures were selected that can be administered using translated instructions with U.S. English normative data. The rationale for test selection and caveats for their clinical use are presented. CONCLUSIONS: The number of neuropsychological measures identified in Vietnamese and/or with Vietnamese normative data was sparse. Given the large and growing population of Vietnamese-speaking residents in the U.S. and the aging of these communities, it is imperative to develop additional, appropriately designed and normed instruments to provide culturally competent assessments to better serve these individuals.

Developing Culturally Competent Foreign Language Neuropsychological Assessments: Portuguese-Speaking Brazilians Living in the United States.

OBJECTIVE: As the third largest immigrant population in Houston, Texas, Brazilians represent a large bloc of the community in need of culturally and linguistically informed healthcare. In particular, the number of older adults within this population is rapidly growing, emphasizing the increased need to develop socially responsible neuropsychological assessment practices that can meet the needs of this demographic. Additionally, early symptoms of cognitive decline in Brazilian older adults can be culturally perceived as normal aging and may be masked by cultural and lifestyle practices (i.e., scaffolding by family members) that result in lack of appreciation for cognitive and functional decrements. With increased knowledge and awareness of Brazilian culture and customs, we can better understand and assess brain-behavior relationships, provide tailored assessment services, and determine the clinical implications for this population. METHODS: Test instruments in Portuguese were identified through systematic literature searches, and in consultation with clinicians serving the Portuguese community in the United States, and cultural brokers involved in Brazilian-based neuropsychology. RESULTS: A multidomain neuropsychological battery with accompanying normative data for use with adults from this community is presented. A case illustration is utilized to highlight limitations and strengths of the proposed battery, which includes core and supplemental measures. CONCLUSION: Neuropsychologists are encouraged to familiarize themselves with the proposed protocol, understand the psychometric limitations of the available tools, and make an earnest attempt toward providing socially responsible neuropsychological care via the appropriate use of culturally and linguistically tailored instruments and clinical practices.

Cultivating a Relevant Supervisory Space: Culturally Expressive and Responsive Model for Supervision in Neuropsychology.

OBJECTIVE: Provision of supervision is an integral component of training in psychology, a view that was solidified in 2014 with the development of the American Psychological Association created Guidelines for Clinical Supervision in Health Service Psychology ( APA, 2014). Current supervisory standards require several components before a relationship is considered supervisory. Among these are assumptions that the supervisory relationship is respectful and collaborative, that feedback is bidirectional, and that it focuses on the development of competency and professional identity by the supervisee. Although clinical and counseling psychology has created supervision models with a variety of different theoretical orientations focused on multiculturalism, neuropsychology as a specialty lacks cohesive, culture-centric, bidirectional supervisory models. METHOD: A systematic review of two electronic databases (PubMed and PsycInfo) was conducted to search for supervision models designed specifically for training in neuropsychology. RESULTS: A new model for supervision in neuropsychology was developed, coined the Culturally Expressive and Responsive (CER) Model for Supervision in Neuropsychology. The model is dynamic, multifaceted, and bidirectional, integrating sociocultural and linguistic considerations throughout the supervisory relationship. CONCLUSIONS: The different facets of the CER Model are discussed, including its place embedded within a larger equitable healthcare model designed to increase healthcare equity. The CER Model highlights the bidirectional supervisory relationship and is designed to be tailored to the developmental level of the learner, encouraging high quality training and evidenced-based practice. Furthermore, the model encourages a process of identity development that is ongoing and emphasizes self-evaluation and cultural humility rather than a static sense of "competence."

Brain Stimulation Using Responsive Neurostimulation Improves Verbal Memory: A Crossover Case-Control Study.

BACKGROUND: The effects of brain stimulation on memory formation in humans have shown conflicting results in previous studies. We hypothesized that direct cortical stimulation using an implanted responsive neurostimulation (RNS) system will improve memory. OBJECTIVE: To evaluate whether direct cortical stimulation using RNS improves memory as measured with recall scores of a list-learning task. METHODS: During outpatient visits, a list-learning task (Hopkins Verbal Learning Test-Revised) was administered to 17 patients with RNS implants. Patients were read a list of 12 semantically related words and asked to recall the list after 3 different learning trials. True or sham stimulations were performed for every third word presented for immediate recall. Most patients had frontotemporal network stimulation-one patient each had insular and parietal stimulations. After a 20-min delay, they were asked to recall the list again, first freely and then through a "yes/no" recognition paradigm. A crossover design was used in which half the patients had true stimulation during the initial visit and half had sham stimulation-followed by crossover to the other group at the next visit. RESULTS: The Hopkins Verbal Learning Test-Revised delayed recall raw score was higher for the stimulation condition compared with the nonstimulation condition (paired t -test, P = .04, effect size d = 0.627). CONCLUSION: Verbal memory improves by direct cortical stimulation during a list-learning task. The RNS system can be effectively used in memory research using direct cortical stimulation. This study has implications in the development of neurostimulation devices for cognitive enhancement in conditions such as epilepsy, dementia, and traumatic brain injury.

Utilization of the Patient Competency Rating Scale in an epileptic and non-epileptic veteran population.

Differentiating between epilepsy and psychogenic non-epileptic events (PNEE) can be difficult given similar presentations. PNEE is often misdiagnosed, resulting in unwarranted treatment with anti-epileptic drugs (AED). While the gold standard for differentiating PNEE from epilepsy is video EEG (VEGG) monitoring, self-reported symptomology has also been shown to discriminate between epilepsy and PNEE with high accuracy, particularly in cases where VEEG is difficult to obtain or when there are no observed events during extended monitoring. The Patient Competency Rating Scale (PCRS) was developed to measure the extent to which individuals are able to function in four domains: activities of daily living, emotional, interpersonal, and cognitive competency. Factor analyses validated the underlying factor structure of the PCRS in this seizure disorder sample. Follow-up MANOVA revealed group differences such that those diagnosed with PNEE reported less competence in all areas of functioning as compared to those diagnosed with epilepsy, with the largest difference being emotional competency. Secondary factor analyses were conducted for each diagnostic category. Two items related strongly to emotional competency loaded equally across the factors for those diagnosed with PNEE, indicating that emotional control is highly correlated with all areas of perceived competence for those with PNEE in this sample and may be considered as an intervention target. This was the first study to validate the use of the PCRS for a seizure disorder sample and to examine group differences in self-reported competency between those diagnosed with epilepsy and PNEE.

Dependency aspect of caregiver burden is uniquely related to cognitive impairment in Veterans.

The psychosocial toll of caring for an individual with dementia is an important, if understudied, concept. For practitioners and researchers alike, understanding the relation between patient characteristics and different facets of caregiver burden is important for guiding treatment and prevention efforts. The current study analyzed the dimensions of caregiver burden and the relation between caregiver burden and results of neuropsychological testing. Participants included 243 dyads of caregivers and Veterans referred for neuropsychological evaluation. Caregivers completed the Zarit Burden Interview (ZBI) to assess caregiver burden. Patients completed a battery of neuropsychological tests measuring the domains of attention/processing speed, memory, language, and executive functioning. A principal components analysis of the ZBI revealed a three-factor structure: psychosocial burden, dependency burden, and guilt. Correlations with neuropsychological test performance by Veteran patients suggested that test performance in the memory, attention, processing speed, executive functioning, and emotional functioning domains were solely related to the caregiver dependency burden factor of the ZBI. Additional analyses suggested severity of dementia and number of tests in the impaired range further influenced reported caregiver burden. The current study is one of the few studies examining caregiver burden in relation to neuropsychological functioning in a mixed clinical sample and has important implications for clinical practice.

Perfectionism moderates stereotype threat effects on STEM majors' academic performance.

Using a randomized, between-subjects experimental design, we tested hypotheses that self-critical perfectionism would moderate the effects of subtle stereotype threat (ST) for women and students in underrepresented racial/ethnic groups who are pursuing traditional degrees in science, technology, engineering, or math (STEM). A diverse sample of freshmen students (N = 294) was recruited from 2 major universities. Students were blocked by gender and race/ethnicity and randomly assigned to experience subtle ST or no ST. Participants in the subtle ST condition were primed to consider their gender, race, and ethnicity prior to completing measures of science self-efficacy. Those in the control condition completed the measures without such priming. Controlling for prior academic performance and university context, ST priming significantly interacted (a) with self-critical perfectionism to predict coping self-efficacy scores and (b) with race/ethnicity to predict end-of-semester STEM grades. A 3-way interaction of ST priming, sex, and self-critical perfectionism also predicted students' grades in courses wherein women and men were more proportionally represented. The Sex × Self-Critical Perfectionism interaction was not significant for those in the ST group but was for those in the control group. Men in the control group had higher grade-point averages (GPAs) at low levels of self-critical perfectionism than they had at higher levels of perfectionism. In contrast, women had lower GPAs when self-critical perfectionism was low, but their GPAs were higher when self-critical perfectionism was high. The findings are discussed in terms of their implications for self-efficacy and performance in the pursuit of a STEM major.