The challenge of neuropsychological assessment of visual/visuo-spatial memory: A critical, historical review, and lessons for the present and future.

A proliferation of tests exists for the assessment of auditory-verbal memory processes. However, from a clinical practice perspective, the situation is less clear when it comes to the ready availability of reliable and valid tests for the evaluation of visual/visuo-spatial memory processes. While, at face value, there appear to be a wide range of available tests of visual/visuo-spatial memory, utilizing different types of materials and assessment strategies, a number of criticisms have been, and arguably should be, leveled at the majority of these tests. The criticisms that have been directed toward what are typically considered to be visual/visuo-spatial memory tests, such as (1) the potential for verbal mediation, (2) over-abstraction of stimuli, (3) the requirement of a drawing response, and (4) the lack of sensitivity to unilateral brain lesions, mean that, in reality, the number of readily available valid tests of visual/visuo-spatial memory is, at best, limited. This article offers a critical, historical review on the existing measures and resources for the neuropsychological assessment of visual/visuo-spatial memory, and it showcases some examples of newer tests that have aimed to overcome the challenges of assessing these important aspects of memory. The article also identifies new trends and examples of how technological advances such as virtual reality may add value to overcome previous obstacles to assessment, thereby offering professionals more reliable, accurate means to evaluate visual/visuo-spatial memory in clinical practice.

Features and psychometric properties of the Montreal Cognitive Assessment: Review and proposal of a process-based approach version (MoCA-PA).

The current study presents a rapid review of the psychometric features of the standard Montreal Cognitive Assessment (MoCA), and the proposal for a modified version of the test, informed by the methodology of the Boston Process Approach to neuropsychological assessment. In order to aid the process of identification of the primary underlying neurocognitive mechanism responsible for defective test performance, the MoCA-Process-Based Approach (MoCA-PA) adds complementary or satellite test conditions in some of its subtests, includes "new" qualitative indices to capture the cognitive processes involved in each cognitive task, and incorporates new qualitative classifications of error subtypes. It provides concurrent assessment of multiple cognitive processes within each task, without significantly increasing administration time or placing significant additional burden upon the respondent. We present preliminary results obtained from an initial sample of 45 community-dwelling older adults attending a University program for seniors. Results suggest the usefulness of additional indices in providing additional information on cognitive deterioration that may be overlooked with the only consideration of quantitative scores. Future research will aim to collect normative data for different clinical populations using the newly developed indices in order to determine the validity and clinical utility of the relatively novel qualitative process-based methods used in the MoCA-PA.

The development, validation and normative data study of the English in Ireland adaption of the Philadelphia repeatable Verbal Learning Test (EirPrVLT-12) for use in an older adult population.

OBJECTIVE: Cultural adaptations of verbal serial list-learning tests such as the California Verbal Learning Test (CVLT) and the Philadelphia (repeatable) Verbal Learning Test (P(r)VLT) have been shown to be clinically necessary. This paper aimed to culturally adapt, validate and provide normative data for an English in Ireland adaptation of the P(r)VLT, i.e. the EirPrVLT-12, in order to improve episodic memory assessments for Irish adults. Method: EirPrVLT-12 word lists were constructed using a word frequency study of Irish adults (n = 58). Two twelve-word, four-trial forms were constructed (standard and alternate form). A normative study included 145 participants who met strict inclusion criteria. Results: EirPrVLT-12 performance varied depending on age, gender, education, estimated IQ and socioeconomic status. Construct validity was established by correlations with other cognitive tests. Principal component analysis yielded a three-factor solution relating to general verbal learning, intrusions and interference. Normed EirPrVLT-12 scaled scores and percentiles stratified by age are available on the Open Science Framework at https://osf.io/vjzsp/, as are regression equations to predict individual scores based on age, gender and education. Conclusions: The data obtained underscores the clinical ultility of the EirPrVLT-12 to assess episodic memory in Irish older adults. Future research was recommended to validate the EirPrVLT-12 in a clinical population, extend normative data to younger populations and develop norms for the alternate form.

Marrying Past and Present Neuropsychology: Is the Future of the Process-Based Approach Technology-Based?

A cognitive assessment strategy that is not limited to examining a set of summary test scores may be more helpful for early detection of emergent illness such as Alzheimer's disease (AD) and may permit a better understanding of cognitive functions and dysfunctions in those with AD and other dementia disorders. A revisit of the work already undertaken by Kaplan and colleagues using the Boston Process-Approach provides a solid basis for identifying new opportunities to capture data on neurocognitive processes, test-taking strategies and response styles. Thus, this critical review will combine traditional process-based assessment strategies with support provided or offered by newer technologies that have the potential to add value to data collection and interpretation. There is now considerable interest in neuropsychological test administration using computer/digital technology, both in research and in clinical settings. To add value, any computerized version of an existing cognitive test should respect the administration procedure for which normative data were obtained, should be time-saving in terms of scoring and interpretation, and should, we argue, facilitate gathering information about the processes and strategies followed in test completion. This article will offer an overview of the steps needed when implementing computerization of neuropsychological tests using a Process-Based Approach (PBA) to these technology-based adaptations and will discuss further developments in this area by linking it to future technological developments that may be possible in the area of neuropsychological assessment. Additionally, an overview of neuropsychological tests that may benefit from computerization will be presented, together with suggestions on the specific processes, strategies and features that may be captured with the aid of such computerization. Finally, hypotheses on how virtual reality could be an asset for the future of the PBA to neuropsychological assessment will also be discussed.

Verbal memory and voxel based morphometry in first episode non-affective psychosis: A process oriented approach.

OBJECTIVE: The present study aimed to comprehensively study the specific neurocognitive constructs underlying verbal memory deficits and their neuroanatomical correlates in first episode psychosis (FEP) patients. METHOD: A total of 218 FEP patients and 145 healthy participants were examined with the Rey Auditory Verbal Learning Test (a widely used verbal memory measure that provides a range of performance indexes to evaluate memory) and voxel-based morphometry (a neuroimaging analysis technique that allows investigation of focal differences in brain anatomy). RESULTS: The analyses showed that the FEP group presented significantly lower scores on acquisition/learning, F(1, 566) = 40.7; p < .001, and delayed recall, F(1, 570) = 74.12; p < .001, as well as higher rates of forgetting, F(1, 566) = 20.03; p < .001. They also exhibited a significant sensitivity to retroactive, F(1, 554) = 8.74; p = .003, but not to proactive interference. Neuroimaging analyses found significant interactions between bilateral frontal lobe morphometry and proactive interference (ρFWE = 0.023). Rate of forgetting also significantly interacted with right occipital cortex morphometry (ρFWE = 0.033). Patients with higher rates of forgetting, proactive and retroactive interference demonstrated further gray matter reductions in frontal and occipital cortical areas. CONCLUSIONS: These findings emphasize the anterior orbitofrontal cortex as the brain region that contributes to verbal memory deficits in FEP patients, and suggest specific relationships between different neuroanatomical structures and discrete verbal memory processes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A Case of Overlap Posterior Cortical Atrophy and Logopenic Variant Primary Progressive Aphasia.

Posterior cortical atrophy (PCA) and logopenic variant primary progressive aphasia (LvPPA) are considered early-onset dementias most commonly caused by Alzheimer pathology. PCA is characterized by a progressive decline in higher order visual processing functions, whereas LvPPA is a form of primary progressive aphasia. The clinical presentation of both syndromes is typically earlier in life relative to the more typical "amnestic" form of Alzheimer disease. Prominent language deficits have been well described in PCA. Here, we describe the case of a 56-year-old man presenting with overlapping anatomic, clinical, and cognitive features of PCA and LvPPA and review the existing literature relating to the clinical features shared by these conditions, exploring the etiology, and implications for clinical practice in cases with a PCA-LvPPA overlap syndrome. In PCA, atrophy occurs in temporoparietal-occipital regions, whereas in LvPPA atrophy occurs at the temporoparietal junctions, with left-sided predominance. A defective phonological loop (a short-term storage system which holds speech sounds in memory for 1 to 2 s) seems to underlie the logopenic syndrome in both conditions. Other parietal lobe deficits, in proximity to both language and visual processing areas, such as dyscalculia and ideomotor apraxia are also commonly found in both conditions. We suspect that cases with an overlap PCA-LvPPA syndrome are relatively underreported which may relate to the fact that these cases occur on a spectrum depending on the stage of disease progression and do not easily fit into strict diagnostic categories according to existing criteria of PCA and LvPPA, respectively.

Rapid review of cognitive screening instruments in MCI: proposal for a process-based approach modification of overlapping tasks in select widely used instruments.

ABSTRACTBackground:A detailed neuropsychological assessment plays an important role in the diagnostic process of Mild Cognitive Impairment (MCI). However, available brief cognitive screening tests for this clinical population are administered and interpreted based mainly, or exclusively, on total achievement scores. This score-based approach can lead to erroneous clinical interpretations unless we also pay attention to the test taking behavior or to the type of errors committed during test performance. METHODS: The goal of the current study is to perform a rapid review of the literature regarding cognitive screening tools for dementia in primary and secondary care; this will include revisiting previously published systematic reviews on screening tools for dementia, extensive database search, and analysis of individual references cited in selected studies. RESULTS: A subset of representative screening tools for dementia was identified that covers as many cognitive functions as possible. How these screening tools overlap with each other (in terms of the cognitive domains being measured and the method used to assess them) was examined and a series of process-based approach (PBA) modifications for these overlapping features was proposed, so that the changes recommended in relation to one particular cognitive task could be extrapolated to other screening tools. CONCLUSION: It is expected that future versions of cognitive screening tests, modified using a PBA, will highlight the benefits of attending to qualitative features of test performance when trying to identify subtle features suggestive of MCI and/or dementia.

Evaluación neuropsicológica basada en los procesos: revisión de la evidencia y propuesta para la mejora de las herramientas de cribado de demencia / Process-based approach neuropsychological assessment: review of the evidence and proposal for improvement of dementia screening tools

Una evaluación neuropsicológica detallada desempeña un papel importante en el proceso diagnóstico del deterioro cognitivo leve. No obstante, las escalas de cribado cognitivo breve disponibles para esta población clínica se administran e interpretan basándose mayoritaria o exclusivamente en las puntuaciones totales obtenidas. Este enfoque basado en las puntuaciones puede conducir a interpretaciones clínicas erróneas, a menos que prestemos también atención a la conducta del evaluado o a los tipos de errores cometidos durante la ejecución de los tests. Los objetivos de esta revisión son exponer los fundamentos del enfoque de evaluación neuropsicológica basada en los procesos, ofrecer una revisión breve sobre la evidencia obtenida hasta la fecha sobre su utilidad, y mostrar los resultados de una revisión sistemática sobre escalas de cribado cognitivo y evaluación neuropsicológica, algunas de las cuales fueron ya elaboradas o modificadas según este enfoque, y otras que podrían beneficiarse de mejoras en su capacidad de cribado si se sometieran a modificaciones según un enfoque basado en los procesos. Se espera que, en un tiempo relativamente corto, se pueda contar con versiones de las escalas de cribado cognitivo con un enfoque basado en los procesos. Estas versiones modificadas no alterarán sustancialmente la administración estándar de estas pruebas, pero aportarán un enfoque para la corrección e interpretación que irá más allá de las puntuaciones totales. Esto permitirá dilucidar con mayor precisión los componentes cognitivos implicados en la resolución exitosa o fallida de estas pruebas cognitivas y facilitará el diagnóstico precoz del deterioro cognitivo leve (AU)

A detailed neuropsychological assessment plays an important role in the diagnostic process of mild cognitive impairment. However, available brief cognitive screening tests for this clinical population are administered and interpreted based mainly, or exclusively, on total achievement scores. This score based approach can lead to erroneous clinical interpretations unless we also pay attention to the test taking behaviour or to the type of errors committed during the test performance. The goals of the current review are to present the grounds for the process-based approach to neuropsychological assessment, to offer a brief review of the evidence obtained so far regarding its usefulness, and to show the results of a systematic review of existing screening and neuropsychological assessment tools, some of which were already created and/or modified using this approach, and others that may benefit in their screening properties if they underwent modifications according to a process-based approach. It is expected that, in a relatively short period of time, processbased approach versions of screening tools will be available. These modified versions will not alter substantially the standard administration procedure, but will provide a way for scoring and interpretation that goes beyond total scores. This will allow clarifying with higher accuracy the underlying cognitive components involved in the successful or unsuccessful performance in cognitive tasks, and thus will facilitate an early diagnosis of mild cognitive impairment (AU)

The contribution of retrospective memory, attention and executive functions to the prospective and retrospective components of prospective memory following TBI.

PRIMARY OBJECTIVE: Despite the prevalence of prospective memory (PM) problems, relatively little is known about the processes underlying impairment following TBI. This study sought to examine PM performance, using a multiple-task, multiple-response video-based paradigm in which initial encoding of the cue-action associations was ensured (Video-Assessment of Prospective Memory; VAPM). RESEARCH DESIGN: VAPM was designed to allow easy identification of reasons for failure (i.e. cue detection and/or specific action retrieval). Patients with moderate/severe TBI (n = 32) and matched controls (n = 16) also completed standardized neuropsychological assessment including evaluation of episodic retrospective memory (RM), attention, information processing, executive functions and mood. MAIN OUTCOMES AND RESULTS: As a group, those with TBI were impaired on PM tasks with 50% failing to complete at least 2/6 required tasks despite near perfect performance by controls. Individual profile analyses revealed different reasons for impairment, with RM contributing significantly to both the prospective and retrospective components. This was supported by correlational analyses illustrating a significant relationship between cue detection and RM measures, in addition to measures of executive functions and attention. CONCLUSIONS: The contribution of RM to both components of PM, along with the finding of heterogeneity in performance among participants have important implications for theoretical understanding and clinical practice.

Detection of prospective memory deficits in mild cognitive impairment of suspected Alzheimer's disease etiology using a novel event-based prospective memory task.

We investigated the relative discriminatory efficacy of an event-based prospective memory (PM) task, in which specificity of the instructions and perceptual salience of the PM cue were manipulated, compared with two widely used retrospective memory (RM) tests (Rivermead Paragraph Recall Test and CERAD-Word List Test), when detecting mild cognitive impairment of suspected Alzheimer's disease etiology (MCI-AD) (N = 19) from normal controls (NC) (N = 21). Statistical analyses showed high discriminatory capacity of the PM task for detecting MCI-AD. The Non-Specific-Non-Salient condition proved particularly useful in detecting MCI-AD, possibly reflecting the difficulty of the task, requiring more strategic attentional resources to monitor for the PM cue. With a cutoff score of <4/10, the Non-Specific-Non-Salient condition achieved a sensitivity = 84%, and a specificity = 95%, superior to the most discriminative RM test used (CERAD-Total Learning: sensitivity = 83%; specificity = 76%). Results suggest that PM is an early sign of memory failure in MCI-AD and may be a more pronounced deficit than retrospective failure, probably reflecting the greater self-initiated retrieval demands involved in the PM task used. Limitations include the relatively small sample size, and the use of a convenience sample (i.e. memory clinic attenders and healthy active volunteers), reducing the generalizability of the results, which should be regarded as preliminary. (JINS, 2009, 15, 154-159.).