Education and Training in Clinical Neuropsychology: Recent Developments and Documents From the Clinical Neuropsychology Synarchy.

The Clinical Neuropsychology Synarchy (CNS) interfaces with the American Psychological Association and affiliated organizations to address issues and advances in specialty training. The past several years have seen the development and dissemination of several initiatives pertinent to specialty training. Among these initiatives was the creation of a taxonomy for education and training in clinical neuropsychology. In additional there has been a movement towards competency-based education that has become codified in the APA's new Standards for Accreditation. Calls for competency-based education have also influenced the expectations of the APA's Committee on Recognition of Specialties and Proficiencies in Professional Psychology. As the convener of national clinical neuropsychology organizations the CNS has overseen the development of relevant documents for our specialty. This paper presents three documents critical to training in our field that were developed through the CNS and approved by its member organizations. The first is the Taxonomy for Education and Training in Clinical Neuropsychology. The second is Entry Level Competencies for Clinical Neuropsychology and the third is a distillation of the entry-level competency document for the purpose of identifying competencies to be addressed at the post-doctoral residency level.

Trastorno específico del lenguaje: subtipos de una patología compleja / Specific language impairment: subtypes of a complex disorder

Existen distintas propuestas sobre marcadores psicolingüísticos y sobre taxonomías del trastorno específico del lenguaje (TEL). Este trabajo presenta los resultados obtenidos en 8 tareas psicolingüísticas por 2 grupos de niños: 31 niños con TEL (GTEL) y 31 niños igualados en edad cronológica (GC). Las tareas han sido elaboradas ad hoc para valorar los marcadores psicolingüísticos en las 4 áreas clásicas: fonología, morfosintaxis, semántica y pragmática. En primer lugar, se comprueba que los niños del GTEL rinden significativamente peor que los niños del GC en las 8 tareas. En segundo lugar, un análisis de conglomerados K-medias clasifica a los 31 sujetos del grupo TEL en 4 conglomerados. En tercer lugar, un análisis discriminante comprueba si la clasificación clínica hecha a priori se mantiene tras los resultados del estudio. Se presenta el perfil de los conglomerados y se discuten sus características respecto a los subtipos de la taxonomía clínica de Rapin y Allen. Finalmente, se analizan las similitudes y diferencias entre ambas tipologías. Los resultados obtenidos ayudan a esclarecer los marcadores psicolingüísticos del TEL en niños de habla española y refuerzan la utilidad clínica de su clasificación en subtipos y la vigencia de la taxonomía de Rapin y Allen (AU)

There are various proposals for psycholinguistic markers and for taxonomies of specific language impairment (SLI). This study presents the results obtained in eight psycholinguistic tasks by two groups of Spanish-speaking children: 31 children with SLI (SLI) and 31 children matched for chronological age (CA). The tasks were developed ad hoc to assess psycholinguistic markers in the four traditional areas: phonology, morphosyntax, semantics and pragmatics. Firstly, we found that SLI group scored significantly worse than CA group in the eight tasks. Secondly, a K-Means cluster analysis distinguished five clusters within the 31 subject of SLI group. Thirdly, a discriminant analysis checks whether an a priori clinical classification is maintained after the study results. We present the profile of these clusters and discuss their features regarding Rapin & Allen taxonomy clinical subtypes. Finally, the similarities and differences between the two classifications are analyzed. The results obtained in this work help shed light on the psycholinguistic markers of the Spanish-SLI and reinforce the clinical utility of its classification into subtypes and the validity of the Rapin & Allen taxonomy (AU)

Los grandes olvidados: Los trastornos cognitivos en la enfermedad de Parkinson / No disponible

Los trastornos cognitivos forman parte de la sintomatología de la enfermedad de Parkinson, son muy frecuentes, heterogéneos y pueden presentarse incluso desde el inicio de la enfermedad. Aunque durante años han recibido poca atención, tanto desde la investigación como desde la práctica clínica, la publicación en 2007 de los criterios de Demencia asociada a la EP y especialmente de Deterioro cognitivo Leve asociado a la EP (DCL-EP) en 2012 ha contribuido a que haya un renovado interés de clínicos y científicos en caracterizar dichos trastornos y en optimizar su tratamiento. Este interés ha hecho que se progrese en pocos años de una manera rápida en esta área. Los datos actuales muestran que es necesario actualizar los criterios de DCL-EP para poder seguir avanzando: requerir una exploración neuropsicológica completa y bien definida, establecer un punto de corte explícito con datos aceptables en sensibilidad y especificidad, y, sobre todo, poder clasificar el DCL-EP en unos subtipos que puedan guiarnos acerca del pronóstico, manejo y tratamiento del paciente

Cognitive disorders are part of the symptomatology of Parkinson’s disease. They are very common, heterogeneous and can be found since the onset of the disease. Nevertheless, for years, cognitive symptoms in PD have received scant attention both from research and from clinical practice. The pu-blication of criteria for dementia associated with PD in 2007 and especially the criteria for Mild Cognitive Impairment associated with PD (PD-MCI) in 2012, has contributed to a renewed interest in clinicians and scientists, to classify these disorders and optimize their treatment. This attention has helped on improving in this area quite fast. Current data show a need to update the criteria for MCI -EP to move forward: Ask for an exhaustive and well defined neuropsychological examination, establish an accurate cut-off with acceptable sensitivity and specificity data, and let classify the DCL-EP in subtypes that can help us the patient’s prognosis, management and treatment

Neuropsychological status of elderly patients with diabetes mellitus.

AIM: Diabetes mellitus (DM) is an important risk factor for Alzheimer's disease (AD) but the relationship between DM and amnestic mild cognitive impairment (aMCI), characterized by isolated memory loss, is unclear. We studied the prevalence of MCI in DM patients. METHODS: Neuropsychological status was evaluated using the Rivermead Behavioral Memory Test (RBMT) and the Mini Mental State Examination (MMSE). Subjects consisted of 103 consecutive diabetic patients hospitalized for diabetic education. Patients with severe diabetic complications or cerebrovascular accidents were excluded. RESULTS: Neuropsychological evaluation of DM patients showed that 71% were normal (MMSE score > or =24 and RBMT score > or =15), 5% had amnestic MCI (aMCI) (MMSE score > or =24 and RBMT score <15) and the remaining 23% had dementia (MMSE score <24). The percentage of patients with dementia was significantly higher in the DM group than in the control group (p<0.04). RBMT score and HbA1c were mildly correlated in diabetic patients. CONCLUSION: High blood sugar may cause deterioration in not only memory function but also other cognitive domains in elderly patients with DM. Monitoring the neuropsychological status of this patient population is important.

La revolución neuropsiquiátrica del siglo XVIII. El nacimiento del estudio científico de las enfermedades mentales y la demencia / XVIII century neuropsychiatry revolution. The birth of scientific study of mental disease and dementia

El principal objetivo de este artículo es la revisión y análisis de la demencia como un concepto histórico, indicando una conexión directa con el periodo de tiempo comprendido entre el final del siglo XVIII y el inicio del XIX. En este tiempo se produce una importante transformación del concepto de la mente y la enfermedad mental, especialmente en lo referente a la demencia. Por este motivo, a este periodo se le denomina Revolución Mental. Este significativo cambio se produjo debido a varios factores fundamentales: difusión de las ideas médicas de Cullen, Chiarugi y Pinel, divorcio de la neuropsiquiatría respecto de la filosofía y la religión, progreso científico en el conocimiento del cerebro, la Revolución Francesa y el desarrollo de la consideración médica y humana de la demencia y de la enfermedad mental

The principal aim of this report is to provide an accurate review and analysis of dementia as historical concept, indicating a direct connection with the time period between at the end of XVIII century and the beginning of the XIX century. In this time it is produced an important transformation of the mind and mental disease concept, specially in rapport to demence. For this reason, this period is called Mental Revolution. This significant change it’s due to several factors as diffusion of Cullen, Chiarugi y Pinel’s medical ideas, divorce between neuropsychiatry and philosophy and religion, scientific progress in brain knowledge, the French Revolution and the human and medical consideration development for the dementia and mental disease

Entendimiento filosófico de la esquizofrenia / A philosophical understanding of schizophrenia

Una orientación filosófica en la esquizofrenia no sobra. Las teorías neuropsicológicasal uso todavía no ofrecen una explicación cabal, después de más de cien años, incluyendola década del cerebro. Y lo que es todavía peor, ahora ni siquiera se proponen ofreceral menos un entendimiento. Así que ni explicación ni comprensión. Ahora bien, sin unentendimiento que se haga cargo de la experiencia y de la conducta que supone el trastornollamado esquizofrenia, difícilmente se puede alcanzar una explicación que merezcael nombre de científica (por mucho vestuario cienti-forme con el que se presente). Elentendimiento que se propone aquí retoma la tradición de la fenomenología, de acuerdocon los nuevos desarrollos que, a pesar de las tendencias dominantes, siguen activos enla psiquiatría y la psicología clínica. Se replantea la esquizofrenia como un trastornobásicamente de la auto-conciencia y del sentido común. En este sentido, se ofrecen unosapuntes de fenomenología aplicados a los síntomas negativos, las alucinaciones y losdelirios. Bien entendido, en todo caso, que se considera la esquizofrenia como una figuraunitaria (no un cuadro) dentro de ser variable su configuración

Among approaches to schizophrenia, the philosophical perspective has every rightto be taken into account. Current neuropsychological theories have yet to provide a soundexplanation, after more than 100 years, including the Decade of the Brain. And worsestill, they no longer even set out to offer an understanding. So we are left with neither anexplanation nor an understanding. But without an attempt to comprehend the experienceand behaviour involved in the disorder called ‘schizophrenia’, there is scarce likelihoodof achieving an explanation worthy of being called ‘scientific’ (however well dressedup in the clothing of scientific forms). The understanding we propose here takes up the phenomenological tradition, in accordance with the new developments that, in spite ofthe dominant tendencies, continue to be active in psychiatry and clinical psychology.Schizophrenia is reappraised as a disorder basically affecting self-awareness and commonsense. Thus, we apply a phenomenological approach to the negative symptoms, hallucinationsand delusions. Bearing in mind, naturally, the consideration of schizophrenia asa unitary concept (not a set of symptoms), albeit variable in its form

Unity within psychology, and unity between science and practice.

The unity of psychology as a science is to be found in its definition as the science of mental life, and its explanation of individual behavior in terms of mental states. This disciplinary focus will help negotiate psychology's relations with other disciplines, such as neuroscience and cognitive science. The unity within psychology between science and practice is to be found in a focus on scientific evidence as the source of the status, autonomy, and privileges of professional practitioners. Psychology should avoid the temptations of reductionism, and assert (and enjoy) its twin status as both a biological science and a social science.

The concept of 'developing the brain': a new natural science for learning and education.

From the viewpoint of biology, learning and education can be defined as the processes of forming neuronal connections in response to external environmental stimuli, and of controlling or adding appropriate stimuli, respectively. Learning and education can thus be studied as a new field of natural sciences with the entire human life span as its subject, thus including various problems such as fetal environment, childcare, language acquisition, general/special education, and rehabilitation. Non-invasive imaging of higher-order brain functions in humans will clarify the brain's developmental processes, and will provide various evidence for learning sciences. This new approach is called 'developing the brain' or 'brain science and education'. The origin of the concept and its present state are described and its future prospects are briefly analyzed.

Are classification accuracy statistics underused in neuropsychological research?

The prevalence of classification accuracy statistics was calculated in five prominent neuropsychology journals and five leading neurology journals for the years 2000 and 2001. Only 29% of neuropsychological articles judged to be appropriate for classification accuracy statistics presented sufficient data to calculate a full range of such analyses. Moreover, classification accuracy statistics were significantly less prevalent in neuropsychology journal articles than in studies published in neurology journals during the same time period. Various indices of sensitivity and/or specificity were present in 31% of neuropsychology articles, whereas fewer than 3% reported predictive values or risk ratios. These findings indicate that classification accuracy statistics, most notably predictive values and risk ratios, are potentially underused in neuropsychology. Investigators and research consumers are encouraged to consider the applicability of classification accuracy statistics as a means of evaluating the clinical relevance of neuropsychological research findings.

National Academy of Neuropsychology/Division 40 of the American Psychological Association practice survey of clinical neuropsychology in the United States, Part I: practitioner and practice characteristics, professional activities, and time requirements.

Leaders of the National Academy of Neuropsychology and Division 40 (Clinical Neuropsychology) of the American Psychological Association determined that current information on the professional practice of clinical neuropsychology within the United States (U.S.) was needed. These two organizations co-sponsored a national survey of U.S. clinical neuropsychologists that was conducted in September 2000. The primary goal of the survey was to gather information on such topics as: practitioner and practice characteristics, economic variables (e.g., experience with major third party payors, such as Medicare and managed care), practice expenses, billing methods, experiences with Current Procedural Terminology (CPT) codes, time spent on various clinical tasks, use of assistants, and income. The adjusted return rate of 33.5% (n = 1,406) reflects the number of surveys returned with sufficient data by licensed doctoral level clinicians with membership in one or both sponsoring organizations. In this first of two articles describing the survey results, characteristics of practitioners and practices, various types of professional activities, and time requirements for clinical tasks are presented and discussed. It was noted that the proportion of women in the field is increasing rapidly. Private practice is the predominant employment setting. Findings also document that members of the two sponsoring organizations are very similar with regard to employment setting, professional characteristics, and weekly activities. That is, involvement in clinical practice and research, as well as private practice versus institutional employment, was very similar between organizations. However, across organizations, work setting (private practice vs. institution) was associated with significant and meaningful differences. Private practitioners have a more diverse set of weekly clinical activities, are less likely to use assistants, and engage in more forensic activities. Across work setting, with the exception of forensic evaluations, those using assistants invest a greater number of hours per evaluation, but bill approximately the same numbers of hours per evaluation.

National survey of clinical neuropsychology postdoctoral fellows.

The present study was designed to survey postdoctoral fellows in clinical neuropsychology about their perceptions of a variety of training standards and recommendations. Survey packets were mailed to the 78 training directors listed in Cripe's (1998) most recent listing of postdoctoral training programs at the time of survey. A response rate of 44% was achieved. Results were notable in that most fellows had been trained in clinical psychology, and mostly in Ph.D. programs. Approximately half had been trained and/or supervised by diplomates in clinical neuropsychology from the American Board of Professional Psychology. Continuing education was judged by respondents to be an insufficient substitute for formal training. Most respondents completed internships and postdoctoral residencies in a hospital setting, with greater than 50% of their time devoted to clinical neuropsychology.

Ten-year follow-up survey of clinical neuropsychologists: part II. Private practice and economics.

Analyses of a 10-year follow-up survey of clinical neuropsychologists demonstrated significant changes in employment settings away from institutions, placing a clear majority of the field in private practice settings in 1999 (Sweet, Moberg, & Suchy, 2000). The present paper compares characteristics of practices and beliefs of clinical neuropsychologists who work in institutions versus private practice, using data from 1989, 1994, and 1999. Previous survey data had not been analyzed along the dimension of work setting. Among the significant findings are differences in age, referral sources, hours per week engaged in specific professional activities (clinical, neuropsychological, forensic, supervisory, research, teaching), ages of patients, type and frequency of data gathered in assessments, hours spent per evaluation, use of an assistant to gather data, and journal subscriptions. Economic changes within the last 5 years have had a differential impact for the two groups in terms of yearly income and hourly reimbursement. However, approximately half of the neuropsychologists in both groups have increased hours performing clinical work, hours performing administrative duties, and patient load to compensate for economic changes in the last 5 years. Decreases in clinical research and teaching activities are apparent in both groups, but in different amounts.