The meaning of significant mean group differences for biomarker discovery.

Over the past decade, biomarker discovery has become a key goal in psychiatry to aid in the more reliable diagnosis and prognosis of heterogeneous psychiatric conditions and the development of tailored therapies. Nevertheless, the prevailing statistical approach is still the mean group comparison between "cases" and "controls," which tends to ignore within-group variability. In this educational article, we used empirical data simulations to investigate how effect size, sample size, and the shape of distributions impact the interpretation of mean group differences for biomarker discovery. We then applied these statistical criteria to evaluate biomarker discovery in one area of psychiatric research-autism research. Across the most influential areas of autism research, effect size estimates ranged from small (d = 0.21, anatomical structure) to medium (d = 0.36 electrophysiology, d = 0.5, eye-tracking) to large (d = 1.1 theory of mind). We show that in normal distributions, this translates to approximately 45% to 63% of cases performing within 1 standard deviation (SD) of the typical range, i.e., they do not have a deficit/atypicality in a statistical sense. For a measure to have diagnostic utility as defined by 80% sensitivity and 80% specificity, Cohen's d of 1.66 is required, with still 40% of cases falling within 1 SD. However, in both normal and nonnormal distributions, 1 (skewness) or 2 (platykurtic, bimodal) biologically plausible subgroups may exist despite small or even nonsignificant mean group differences. This conclusion drastically contrasts the way mean group differences are frequently reported. Over 95% of studies omitted the "on average" when summarising their findings in their abstracts ("autistic people have deficits in X"), which can be misleading as it implies that the group-level difference applies to all individuals in that group. We outline practical approaches and steps for researchers to explore mean group comparisons for the discovery of stratification biomarkers.

The APPCN multisite didactic initiative: Development, benefits, and challenges.

Objective: The Covid-19 pandemic disrupted instructional activity in neuropsychology training programs. In response, the Association of Postdoctoral Programs in Clinical Neuropsychology (APPCN) launched a multisite didactic initiative (MDI). This manuscript describes the development and implementation of the MDI and presents findings from a recently conducted online survey concerning MDI participation.Methods: Faculty and trainees at APPCN member programs were recruited to complete the MDI survey, administered using the Qualtrics platform, through email announcements and via website link and on-screen quick response code shared at online didactic sessions. The MDI survey instrument was designed to capture basic demographics and professional role; information regarding level of site participation, benefits of participation, barriers to participation, online conference platform(s) used, and interest in continued participation; as well as anxiety and work engagement ratings.Results: The response rate was estimated to be 21-29%. Transition to videoconferencing for didactics was noted by 80% due to Covid-19, with 17% of respondents experiencing cancellation or reduction in didactic activities. About 79% endorsed that participation in MDI activities was always or nearly always beneficial. Barriers to participation included not having time, difficulty accessing didactic information, and not knowing about the MDI. Interestingly, trainees at nonparticipating sites reported greater anxiety than trainees at participating sites.Conclusion: It is hoped that these findings will inform future efforts to develop and implement online training activities. The benefits reported by respondents suggest that this work is warranted, while reported barriers to participation identify areas for improvement.

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.

Professional practices, beliefs, and incomes of U.S. neuropsychologists: The AACN, NAN, SCN 2020 practice and "salary survey".

OBJECTIVE: This portion of the 2020 survey updates practice information, beliefs, and income data of clinical neuropsychologists who practice within the United States. Methods: Doctoral-level neuropsychology practitioners were invited via numerous methods, with multiple reminders, to participate in a web-based survey from January 17 through April 2, 2020. The useable U.S. sample of 1677 doctoral-level practitioners was 6.2% larger than the comparable group in the prior 2015 practice survey. Results: Whereas women practitioners predominate, which continues a steeply increasing trend across time, increases in overall ethnic/racial diversity continue at a slow pace. Median age has remained very similar over the last 30 years, reflecting a continuous influx of young practitioners. A relatively small minority of neuropsychologists work part time. The proportion of board-certified neuropsychologists continues to show meaningful increase; interest in subspecialization certification is relatively high. Reliance on technicians remains popular, especially for neuropsychologists who work in institutions or are board certified. Although implementation of new CPT codes in 2019 and related payor policies appear to have had more negative than positive effects, psychology-related annual incomes of neuropsychologists have again increased compared to prior surveys. Variables such as specific work setting, state, region, years in practice, forensic practice hours, board certification, and basis for determining income (e.g. hours billed, revenue collected, relative value units) have an impact on income. More than half of practitioners engage in forensic neuropsychology, with the number of related practice hours per week again increasing. There is very high agreement regarding the use of response validity measures in clinical practice and forensic practice. Neurologists remain the number one referral source whether working in an institution, private practice, or a combination of both, and regardless of maintaining a pediatric, adult, or lifespan practice. Career satisfaction ratings for income, job, and work-life balance remain high, with the majority of ratings regarding the future of the specialty in the positive range. Additional data summaries related to a wide range of professional and practice topics are provided. Conclusions: Updating and comparing survey information at five-year intervals continues to provide insights and perspectives regarding relative stabilities and changes in practice activities, beliefs, and incomes of U.S. clinical neuropsychologists. Such information also provides guidance regarding the future of the specialty.

O perfil da produção científica neuropsicológica no Brasil: uma revisão integrativa / The profile of neuropsychological scientific production in Brazil: an integrative review

A neuropsicologia surgiu a partir de interações entre diferentes áreas e busca compreender a relação cérebro e mente, com enfoque na base anatômica das funções cognitivas. O presente artigo apresenta um panorama da neuropsicologia no Brasil nos últimos cinco anos, por meio de uma revisão integrativa. Os dados foram coletados selecionando cinco recursos informacionais: Literatura Latino Americano e do Caribe em Ciências da Saúde - LILACS, Scientific Electronic Library Online - SciELO, Periódicos Eletrônicos em Psicologia - PePSIC, Index Psi Periódicos Técnico-Científicos e Google acadêmico. A amostra final é composta por 20 artigos, cuja abordagem metodológica predominante é do tipo quantitativa. O periódico com mais publicações foi a Revista Neuropsicologia Latinoamericana e, as palavras-chave identificadas, "neuropsicologia", "cognição" e "funções executivas" foram as mais adotadas nos artigos. Concluiu-se, com a presente revisão bibliográfica integrativa, que a temática mais abordada no contexto da neuropsicologia no Brasil são os transtornos mentais.

Neuropsychological assessment in the Israeli healthcare system: a practitioners' survey.

BACKGROUND: The current study examines self-reported professional practices and attitudes of Israeli neuropsychologists, in an attempt to understand how they contribute to funding of neuropsychological assessment (NPA) through the Israeli healthcare system. METHODS: Two hundred seventy-nine neuropsychologists (176 board-certified experts and 103 interns) participated in an online survey that targeted characteristics of NPA practice in Israel, attitudes toward NPA, and familiarity with healthcare referral procedures. RESULTS: Overall, 68% of respondents conducted NPA, with a smaller proportion of experts (56%) doing so than interns (88%). The most common purpose of NPA was to provide treatment recommendations, and respondents listed indications for NPA that matched indications for neuropsychological rehabilitation. Almost two thirds of respondents reported that none of the NPAs that they performed received healthcare funding. While all practitioners believed that the healthcare system should fund NPA, the majority demonstrated lack of familiarity with referral procedures. CONCLUSIONS: To increase referral rates and create effective neuropsychological services within the Israeli healthcare system, neuropsychologists should work more closely with physicians in integrated care teams. In addition, they should engage in greater advocacy activities that will emphasize the need for publicly funded NPA.

Systematic Review of Recent Pediatric Down Syndrome Neuropsychology Literature: Considerations for Regression Assessment and Monitoring.

OBJECTIVES: To conduct a systematic review of recent pediatric Down syndrome (DS) neuropsychology research that may be useful to clinicians and researchers examining regression in this population. METHODS: We reviewed original peer-reviewed articles published between 2013 and 2018 studying neuropsychological profiles in DS. RESULTS: Thirty-one articles (of 1231 included in the original search) passed all inclusion criteria, were evaluated for bias, and were included in the analysis. CONCLUSION: Findings argued against a single "DS profile" and revealed multiple within-group differences as well as expected and unexpected differences relative to typically developing children and children with other intellectual and developmental disabilities. Areas identified as most germane to regression monitoring included working memory, inhibition, letter and word identification, navigational route learning, motor skills (when strong at baseline), single word receptive/expressive vocabulary, and adaptive function.

The Practice of Child Neuropsychology in Spanish-speaking Countries: What We've Learned and Where to Go from Here.

The characteristics and current situation of pediatric neuropsychologists across Spanish-speaking countries was examined. A total of 409 self-identified professionals working in child neuropsychology from 12 Latin American countries and Spain completed an online survey between June and October 2018. Results revealed that pediatric neuropsychology as a related but distinct discipline within neuropsychology presents with a series of unique challenges to practitioners in Spanish-speaking countries. Efforts and initiatives are required to increase awareness of the field, define the core competencies, foster more opportunities for training, and conduct research to understand sociocultural characteristics and develop culturally specific tools.

Walking Speed Drives the Prognosis of Older Adults with Cardiovascular and Neuropsychiatric Multimorbidity.

BACKGROUND: We investigated the impact of multiple cardiovascular and neuropsychiatric diseases on all-cause and cause-specific mortality in older adults, considering their functional status. METHODS: This cohort study included 3241 participants (aged ≥60 years) in the Swedish National study of Aging and Care in Kungsholmen (SNAC-K). Number of cardiovascular and neuropsychiatric diseases was categorized as 0, 1, or ≥2. Functional impairment was defined as walking speed of <0.8m/s. Death certificates provided information on 3- and 5-year mortality. Hazard ratios (HR) were derived from Cox models (all-cause mortality) and Fine-Gray competing risk models (cardiovascular and non-cardiovascular mortality). RESULTS: After 3 years, compared with participants with preserved walking speed and without either cardiovascular or neuropsychiatric diseases, the multivariable-adjusted HR (95% confidence interval) of all-cause mortality for people with functional impairment in combination with 0, 1, and ≥2 cardiovascular diseases were 1.88 (1.29-2.74), 3.85 (2.60-5.70), and 5.18 (3.45-7.78), respectively. The corresponding figures for people with 0, 1, and ≥2 neuropsychiatric diseases were, respectively, 2.88 (2.03-4.08), 3.36 (2.31-4.89), and 3.68 (2.43-5.59). Among people with ≥2 cardiovascular or ≥2 neuropsychiatric diseases, those with functional impairment had an excess risk for 3-year all-cause mortality of 18/100 person-years and 17/100 person-years, respectively, than those without functional impairment. At 5 years, the association between the number of cardiovascular diseases and mortality resulted independent of functional impairment. CONCLUSIONS: Functional impairment magnifies the effect of cardiovascular and neuropsychiatric multimorbidity on mortality among older adults. Walking speed appears to be a simple clinical marker for the prognosis of these two patterns of multimorbidity.

[The return of the statisticians. On the value of statistics in clinical neuropsychology]. / El regreso de los estadisticos. Sobre el valor de la estadistica en neuropsicologia clinica.

There was a time when clinicians looked down on any decision-making that did not depend on their own judgement. Statisticians laughed at such naivety, as they were fully aware of the extent to which the heuristics that guide human decisions are capable of error, even in the most highly trained individuals. More than 60 years after the beginning of this conflict, the two standpoints have still not been adopted in clinical psychology or in neuropsychology. This work defends the practical application of statistics in clinical decision-making and shows that even intuitive-type judgement is somehow based on applying the basic use of statistical concepts, without neglecting the fact that statistical instruments have sometimes been misused. To this end, this study compares the opinions offered by some clinicians in sentence form with the bibliography consulted, which spans the period from the earliest works by the clinical psychologist Paul Meehl to the present day. We have no intention whatsoever of imposing an opinion, but instead of discussing the advantage of adopting an approach that uses mathematical knowledge to support clinical decision-making. Attention is also drawn to the need for multidisciplinary teams in the special units of our hospitals.

TITLE: El regreso de los estadisticos. Sobre el valor de la estadistica en neuropsicologia clinica.Hubo un tiempo en que los clinicos despreciaban cualquier toma de decisiones que no dependiera de su propio juicio. Los estadisticos se reian de tal ingenuidad, conociendo lo falible de los heuristicos que guian las decisiones humanas, incluso en los individuos mas entrenados. Tras mas de 60 años del inicio del enfrentamiento, ambas posturas aun no se han asimilado en psicologia clinica ni en neuropsicologia. El presente trabajo respalda la aplicacion practica de la estadistica en la toma de decisiones clinica y muestra que incluso el juicio de tipo intuitivo descansa de algun modo en la aplicacion del uso basico de conceptos estadisticos, sin obviar que en ocasiones se ha hecho mal uso de las herramientas estadisticas. Para ello contrasta las opiniones ofrecidas por algunos clinicos en forma de frase con la bibliografia consultada, que se extiende desde los primeros trabajos del psicologo clinico Paul Meehl hasta la actualidad. Lejos de querer imponer una opinion, se comenta la ventaja de asumir un enfoque que aproveche los conocimientos matematicos como apoyo a la toma de decisiones clinica. Finalmente se comenta la necesidad de equipos multidisciplinares en las unidades especiales de nuestros centros hospitalarios.

Neuropsychology as a profession in Italy.

The purpose of this study was to analyze the characteristics of individuals working in the field of neuropsychology in Italy, as part of a larger study examining the practice of neuropsychology across various countries. They were asked about their background, professional training, current work situation, types of assessment, preferred diagnostic procedures, as well as the rehabilitation techniques, their targeted populations, teaching responsibilities, and research activities. A total of 154 professionals completed an online survey from April 28, 2016 through June 30, 2016. The majority of participants were women, with a mean age of 42.6 years. Participants reported working for the National Health System, in private practice, or in private rehabilitation facilities. Overall, they reported being very satisfied with their work. Those who identified themselves as neuropsychologists primarily assessed individuals with dementia, stroke, movement disorders, and traumatic brain injury. While the majority of participants declared no problems with the instruments they used, others reported complaints, including but not limited to the financial cost of current neuropsychological tests and the lack of psychometric support. The main perceived obstacles were the lack of willingness to collaborate among professionals, the scarcity of academic training programs, and the lack of clinical training opportunities.

Presidential Address National Academy of Neuropsychology Conference Boston 2017.

This presidential address attempts to predict the future directions of neuropsychology. Predicting the future is always a difficult thing. By examining population trends such as aging and demographics, a clearer picture becomes visible. The population is getting older and more ethnically diverse. Also, examination of the spending trends in health care indicates that neuropsychology needs to be able to adapt to working with larger population-based patient care as well as individual patient care. Shifts in the demographics of neuropsychology, in that the profession previously was 70% male dominate and now is >70% female dominant are also discussed. Trends in NAN's speaker and leader demographics are examined as well as the need to stay current in the trends and latest neuropsychological research lest we become dinosaurs in the next 5-10 years. Recommendations for new neuropsychologists and post-doctoral fellows are also presented.

Gender in clinical neuropsychology: practice survey trends and comparisons outside the specialty.

OBJECTIVE: This paper describes gender-related trends within clinical neuropsychology, based primarily on recurrent practice surveys within the specialty and, to a lesser extent, job-related information from medical specialties and the general U.S. labor market. METHOD: Chronological and cross-sectional analyses of professional practice survey data from 2005, 2010, and 2015 relevant to gender. As is common with survey data, descriptive analysis and independent samples t-tests were conducted. Longitudinal data allowed for examination of gender trends, as well as observations of change and stability of factors associated with gender, over time. RESULTS: Women have become dominant in number in clinical neuropsychology, and also comprise a vast majority of practitioners entering the specialty. Gender differences are noted in professional identity, work status, work settings, types of career satisfaction, and retirement expectations. Women are more likely to identify work environment and personal/family obstacles to aspects of career satisfaction. A gender pay gap was found at all time points and is not narrowing. As is true nationally, multiple factors appear related to the gender pay gap in clinical neuropsychology. CONCLUSIONS: Women in neuropsychology are now dominant in number, and their presence is strongly associated with specific practice patterns, such as greater institutional employment, less involvement in forensic practice, and strong involvement in pediatric practice, which may be maintaining the sizeable gender pay gap in neuropsychology. As the proportion of women neuropsychologists continues to increase, flexible work hours, and alternative means of remuneration may be needed to offset current disproportionate family-related responsibilities.

Neuropsychology in South Africa.

This survey forms part of an international research study conducted in 39 countries and is the first to describe the characteristics of individuals engaged in the practice of neuropsychology in South Africa (SA). The purpose was to analyze the characteristics of individuals working in the profession of neuropsychology in order to understand their background, professional training, current work situation, assessment and diagnostic procedures, rehabilitation techniques, teaching responsibilities, and research activities. Ninety-five professionals working in neuropsychology completed an online survey between July and November 2015. The majority of participants were female and the mean age was 46.97 years. The majority of professions working in neuropsychology have a background in psychology, with additional specialized training and supervised clinical practice. Over half work in private practice and are on average satisfied with their work. Participants identified as clinicians primarily work with TBI and ADHD individuals. The main limitation for the use of neuropsychological instruments is the lack of normative data in SA and the main barrier to the field is the lack of academic training programs. There is a need to improve graduate curriculums, enhance existing clinical training, develop professional certification programs, validate existing neuropsychological tests, and create new, culturally relevant instruments.

ILAE survey of neuropsychology practice in pediatric epilepsy surgery evaluation.

To determine the extent to which specific neuropsychological measures are in common use around the world for the assessment of children who are candidates for epilepsy surgery. As part of the work of the International League Against Epilepsy Pediatric Surgical Task Force, a survey was developed and distributed online. The survey consisted of questions related to demographics, training experience, general practice, and specific measures used and at what frequency. Seventy-eight clinicians with an average of 13.5 years of experience from 19 countries responded to the survey; 69% were English-speaking. Pre- and post-neuropsychological evaluations were conducted with a majority of children undergoing surgical resection for epilepsy. There was high consistency (>90%) among the domains evaluated, while consistency rate among specific measures was more variable (range: 0-100%). Consistency rates were also lower among respondents in non-English-speaking countries. For English-speaking respondents, at least one measure within each domain was used by a majority (>75%) of clinicians; 19 specific measures met this criterion. There is consensus of measures used in neuropsychological studies of pediatric epilepsy patients which provides a basis for determining which measures to include in establishing a collaborative data repository to study surgical outcomes of pediatric epilepsy. Challenges include selecting measures that promote collaboration with centers in non-English-speaking countries and providing data from children under age 5.

Neuropsychology and Rehabilitation Services in the United States: Brief Report from a Survey of Clinical Neuropsychologists.

OBJECTIVE: To provide a brief presentation of preliminary data on rehabilitation services provided by clinical neuropsychologists within the United States. METHOD: This survey utilized data extracted from a larger international research study conducted in 39 countries including N = 173 professionals who reported to engage in neuropsychological rehabilitative services within the past year (63.6% female, 44.36 ± 11.83 years of age) took part in the study. RESULTS: Neuropsychologists providing rehabilitation services in the United States in the past year were more likely to provide individual versus group therapy, likely to employ technology (e.g., personal computers, mobile phones/smartphones) as part of treatment services, see a range of diagnostic groups most prominently traumatic brain injury and stroke/vascular conditions, and work to address a range of both cognitive (e.g., memory, attention/concentration, and executive functioning) and psychological (e.g., emotional/behavioral adjustment and well-being, awareness of disability/disease) issues. CONCLUSIONS: Prior published surveys suggest that clinical neuropsychologists have a growing involvement in rehabilitation services within the United States but with little clarity as to the actual characteristics of actual professional activities and practices. The present study aimed to provide such information and hopefully will be helpful in promoting additional systematic studies in this area.

Profession of neuropsychology in Latin America.

The purpose of this study was to analyze characteristics of individuals working in the profession of neuropsychology in Latin America in order to understand their background, professional training, current work situation, assessment and diagnostic procedures used, rehabilitation techniques employed, population targeted, teaching responsibilities, and research activities. A total of 808 professionals working in neuropsychology from 17 countries in Latin America completed an online survey between July 2013 and January 2014. The majority of participants were female and the mean age was 36.76 years (range 21-74 years). The majority of professionals working in neuropsychology in Latin America have a background in psychology, with some additional specialized training and supervised clinical practice. Over half work in private practice, universities, or private clinics and are quite satisfied with their work. Those who identify themselves as clinicians primarily work with individuals with learning problems, ADHD, mental retardation, TBI, dementia, and stroke. The majority respondents cite the top barrier in the use of neuropsychological instruments to be the lack of normative data for their countries. The top perceived barriers to the field include: lack of academic training programs, lack of clinical training opportunities, lack of willingness to collaborate between professionals, and lack of access to neuropsychological instruments. There is a need in Latin America to increase regulation, improve graduate curriculums, enhance existing clinical training, develop professional certification programs, validate existing neuropsychological tests, and create new, culturally-relevant instruments.

Test de comparación perceptual de Salthouse: normalización y estandarización de la prueba en población española / The Salthouse Perceptual Comparison Test: normalization and standardization for Spanish population

Introducción. El test de comparación perceptual de Salthouse (TCPS) evalúa la velocidad de percepción y de procesamiento. Aunque es un test ampliamente utilizado en neuropsicología, no cuenta hasta la fecha con baremos normativos adaptados a la población española. Objetivo. Normalizar y estandarizar el TCPS en población española, teniendo en cuenta las características sociodemográ- ficas de nuestra sociedad. Sujetos y métodos. Este estudio se enmarca dentro del proyecto multicéntrico Normacog, mediante el cual se administró el TCPS a 700 participantes, con edades comprendidas entre 18 y 90 años. Se analizó el efecto de variables sociodemográficas, como la edad, el nivel educativo o el sexo, sobre el rendimiento cognitivo en el TCPS, y se crearon los percentiles y las puntuaciones escalares ajustadas por edad y nivel educativo. Resultados. Los resultados mostraron un efecto significativo de la edad y del nivel educativo sobre las variables analizadas del TCPS (respuestas correctas y errores del TCPS-3 y TCPS-6), y la edad fue la que mayor porcentaje de varianza explicaba sobre el rendimiento del TCPS-3 (47%) y el TCPS-6 (45%). A mayor edad y menor nivel educativo, el número de respuestas correctas disminuía y se realizaba mayor cantidad de errores. Conclusión. El presente estudio presenta por primera vez los baremos normativos del TCPS para población española teniendo en cuenta las características sociodemográficas del país, que confirman la influencia de la edad y el nivel educativo sobre el rendimiento en el test. Como para el resto de pruebas del proyecto Normacog, se presentan las instrucciones de administración y corrección del TCPS (AU)

Introduction. The Salthouse Perceptual Comparison Test (SPCT) assesses the processing and perceptual speed. Although this test is widely used in neuropsychology, it has not normative data adapted to Spanish population. Aim. To normalize and standardize the SPCT in Spanish population taking into account the sociodemographic characteristics of our society. Subjects and methods. This study is part of the multisite Normacog project. Seven hundred participants from 18 to 90 years old were assessed using the SPCT. The effect of sociodemographic characteristics such as age, level of education and sex, were analyzed on the SPCT performance, and percentiles and scalar scores adjusted by age and level of education were created. Results. The effect of age and level of education on the SPCT variables analyzed (correct answers and errors of the SPCT-3 and SPCT-6) was statistically significant. Age explained the higher percentage of the variance in SPCT (SPCT-3: 47%; SPCT-6: 45%). The older participants with lower level of formal education obtained worse performance in the number of correct answers and higher number of errors. Conclusion. The present study reports the first normative data of the SPCT for Spanish population taking into account the sociodemographic characteristics of Spain which confirm the influence of age and level of education on the performance of the SPCT. As part of the Normacog project, this study presents the administration and correction instructions (AU)

Perception of Ethical Misconduct by Neuropsychology Professionals in Latin America.

To date, extremely limited research has focused on the ethical aspects of clinical neuropsychology practice in Latin America. The current study aimed to identify the frequency of perceived ethical misconduct in a sample of 465 self-identified neuropsychology professionals from Latin America in order to better guide policies for training and begin to establish standards for practitioners in the region. Frequencies of neuropsychologists who knew another professional engaging in ethical misconduct ranged from 1.1% to 60.4% in the areas of research, clinical care, training, and professional relationships. The most frequently reported perceived misconduct was in the domain of professional training and expertise, with nearly two thirds of participants knowing other professionals who do not possess adequate training to be working as neuropsychologists. The least frequently reported perceived misconduct was in the domain of professional relationships. Nearly one third of participants indicated that they had never received formal training in professional ethics.

Utilidad de los nuevos criterios diagnósticos y la introducción de los biomarcadores en el continuum de la enfermedad de Alzheimer / Usefullness of new diagnosis criteria and introduction of biomarkers in Alzheimer’s disease continuum

Objetivos: los nuevos criterios diagnósticos de enfermedad de Alzheimer (EA) y deterioro cognitivo leve (DCL) apoyan la utilización de los biomarcadores. Valoramos la utilidad de añadir los biomarcadores en la práctica clínica habitual para confirmar y/o modificar el grado de certeza en el diagnóstico de EA y DCL. Pacientes y métodos: presentamos 40 pacientes en los que de forma consecutiva se realizó la determinación de biomarcadores en líquido cefalorraquídeo (LCR) (amilode, tau y p-tau) y evaluación neuropsicológica según los criterios establecidos en nuestra unidad. Resultados: presentamos las características demográficas de los pacientes. En el 52 % de los pacientes los biomarcadores permitieron modificar el grado de certeza del diagnóstico. La mayor aportación es poder reclasificar a los pacientes con DCL en pacientes con DCL y alto riesgo de EA (7), riesgo intermedio (6) o riesgo bajo (12). En dos casos de inicio rápidamente progresivo, los biomarcadores fueron compatibles con EA. Además, su determinación basal ayuda a predecir el riesgo de progresión a EA tras 2 años de seguimiento. Conclusiones: la utilización de los biomarcadores en la práctica clínica habitual ayuda a modificar el grado de certeza del diagnóstico clínico y, por tanto, el pronóstico de los pacientes, especialmente en fase prodrómica y en presentaciones atípicas (AU)

Background: The new diagnostic criteria for Alzheimer's disease (AD) and mild cognitive impairment (MCI) supports the use of biomarkers. We appreciate the value of adding biomarkers to routine clinical practice to confirm and/or modify the degree of certainty in the diagnosis of AD and MCI. Methods: We present 40 patients consecutively determining CSF biomarkers (amyloid, tau and p-tau) and neuropsychological evaluation was performed according to the criteria set out in our unit. Results: We present the demographic characteristics of the patients. In 52% of patients allowed biomarkers modify the degree of certainty of the diagnosis. The greatest contribution is to reclassify patients with MCI in MCI patients at high risk of AD (7), intermediate risk (7) or low risk of AD (12). In both cases of rapidly progressive onset biomarkers were consistent with AD. Besides, basal CSF biomarkers are useful to predict progression to AD after two years follow-up. Conclusion: The use of biomarkers in clinical practice helps to modify the degree of certainty of the clinical diagnosis, and therefore the prognosis of patients, especially in prodromal phase and atypical presentations (AU)