Diminished effect of age and education on neuropsychological test performances of older children with learning disabilities

Previous research has shown that age and education have a significant effect on neuropsychological test scores among normals, but that these effects are sharply diminished, or perhaps totally obliterated, among adults with brain damage and children with brain damage. These findings would have their major practical clinical significance in limiting the use of age and/or education adjustments of raw scores for subjects with brain damage, especially if the adjustments were based on data derived from the study of normal subjects. The present investigation studied the effects of age and education on the Neuropsychological Deficit Scale (NDS) for Older Children scores of children with learning disabilities, aged 9 through 14 years. No significant effects among age and education variables and NDS scores were found. In fact, younger and older subgroups as well as lower- and higher-educated subgroups earned mean NDS scores that were not significantly different. It appears that the neuropsychological consequences of learning disabilities override the effects of age and education in the 9- through 14-year age range.     

Normative data on a battery of neuropsychological tests in the Han Chinese population

In order to develop normative data of a battery of neuropsychological tests in the mainland Chinese population, we examined the performance of 15 neuropsychological tests in 465 healthy subjects (231 males and 234 females) in a population‐based cohort study. The years of education were ranged between 1 and 23 years, and ages were ranged between 16 and 75 years old. The 15 neuropsychological tests cover five domains of neurocognitive functions including attention and speed of information processing, memory and learning, verbal function, visual constructive abilities, and executive function. We also assessed the effects of gender, age, educational attainment on the performance of these neuropsychological tests. The results showed that, as expected, educational attainment and age are the two main factors affecting performance in these tests. Educational attainment has the strongest predictive effect on all tests, while the majority of tests selected in this study are also affected by age at examination to varying degrees. The presented normative data will be useful for future studies in related clinical research, and be of value in transcultural neuropsychological studies.     

Neuropsychological test norms controlled for physical health: Does it matter?

The objective of the present study was to investigate the effects of physical health on neuropsychological test norms. Medical and neuropsychological data from 118 healthy volunteer controls, aged 26–91 years, were collected during five recruitment occasions. The examinations included a clinical investigation, brain neuroimaging, and a comprehensive neuropsychological test battery. Test‐specific statistical regression‐weights for age, education and gender were calculated to establish preliminary test norms. Hierarchical regression analyses demonstrated that control in addition for physical health moved best performance from age 60 to 65 for abstraction; replaced a plateau above age 70 for verbal fluency, with a continued rise in performance; eliminated significant negative influences of age on auditory learning, spatial reasoning and complex copying; reduced them on wordlist recall, psychomotor speed, visual scanning and mental shifting; and slightly reduced negative influences of low education on most verbal tests, several memory tests, and psychomotor speed, indicating rises in normative scores of up to 0.8 SD at age 80 and 0.4 SD at age 60. No differences were found at age 40. Although the sample size is not adequate to be used for normative data, the findings indicate that norms uncontrolled for health overestimate the negative influence of advanced age and low education, implying a risk of drawing false diagnostic conclusions.     

Issues associated with repeated neuropsychological assessments

Distinguishing practice effects from other factors in repeated neuropsychological assessments are discussed in the context of research studies and clinical/forensic assessments. Potential methodological procedures for reducing the impact of practice effects in research settings are outlined. In contrast, the potential clinical utility and interpretation of practice effects in clinical assessments and forensic evaluations are highlighted.     

Cognitive outcomes of pediatric stroke

A limited number of longitudinal studies have investigated long-term neuropsychological development in the pediatric stroke population. This study retrospectively examines cognitive outcomes in 41 children with a history of stroke, with reference to age at stroke, laterality, region and mechanism of stroke. In the course of recovery, neuropsychological measures of intellectual functioning and memory were administered at two time points, whilst executive functioning, attention and academic skills were administered at one time point. As predicted, children with stroke performed significantly worse compared to normative expectations on all neuropsychological measures. Up to two thirds of children scored in the borderline impaired and impaired ranges on at least one domain of cognition. Performance on intellectual and memory assessment remained relatively stable over time. Younger age at stroke was found to be associated with poorer intellectual functioning. No effects of laterality of stroke on neuropsychological performance over time were found. Children with subcortical stroke demonstrated a greater improvement in immediate memory over time than children with cortical stroke. These findings reveal that children with stroke display long-term cognitive difficulties that typically remain stable over time. Attention and academic skills are particularly vulnerable to impairment. Further evidence that age at stroke is a significant factor in terms of cognitive outcome is provided, in support of the “early vulnerability” position.     

Fitness to drive following cerebral pathology: The Rookwood Driving Battery as a tool for predicting on‐road driving performance

The use of neuropsychological testing to determine fitness to drive in people with neuropathology is likely to be an increasingly attractive alternative to on‐road testing for many candidates for assessment. The Rookwood Driving Battery has been shown to have good predictive value for determining some who are likely to fail an on‐road test in early studies. This study replicated earlier research by examining the predictive value and theoretical validity of the battery on a larger sample of 391 participants, as well as extending earlier analysis by examining the effect of older age (over 70 years) and the interaction between age and pathology on battery and on‐road performance. The battery demonstrated good positive and negative predictive values for predicting on‐road performance. There were significant effects of older age on both the Rookwood Battery performance and the on‐road test, with older adults performing significantly poorer on both. There was no interaction between age and pathology on the Rookwood Battery but on‐road age interacted with some pathologies to produce significantly poorer performances. Furthermore, correlation and regression analysis indicate that the battery is a powerful instrument that encompasses tests of core neuropsychological functions needed for driving.     

Neuropsychological, learning and psychosocial profile of primary school aged children with the velo-cardio-facial syndrome (22q11 deletion): evidence for a nonverbal learning disability?

In this exploratory study, the neuropsychological and learning profile of nine primary school age children with velo-cardio-facial syndrome (VCFS) was studied by systematic neuropsychological testing. In five out of nine children, the following profile was found: a VIQ-PIQ discrepancy (in favor of the VIQ), significantly better scores (.05 level) for reading (decoding) and spelling compared to arithmetic, deficient tactile-perceptual skills (difficulties mainly on the left side of the body), weak but not deficient visual-perceptual abilities, deficient visual-spatial skills, extremely poor psychomotor skills (gross motor skills more deficient than fine motor skills), problems with processing of new and complex material, poor visual attention, good auditory memory and relatively good language skills. These findings correspond to the pattern of neuropsychological assets and deficits that has been described for the syndrome of nonverbal learning disabilities (NLD) (Rourke, 1987, 1988, 1989, 1995). The psychosocial profile of all nine children with VCFS also correspond to that of children with NLD. Further studies on the relationship between cognitive function, behavior, psychiatric disorder and abnormalities in brain anatomy in young people with VCFS will be needed. In clinical practice, it is worthwhile exploring in greater depth the neuropsychological functions of children with VCFS to rule out NLD, since they may benefit from specific remediation following the learning principles of the NLD-treatment.     

Working Memory Interference Control Deficit in Children Referred by Teachers for ADHD Symptoms

In this exploratory study, the neuropsychological and learning profile of nine primary school age children with velo-cardio-facial syndrome (VCFS) was studied by systematic neuropsychological testing. In five out of nine children, the following profile was found: a VIQ-PIQ discrepancy (in favor of the VIQ), significantly better scores (.05 level) for reading (decoding) and spelling compared to arithmetic, deficient tactile-perceptual skills (difficulties mainly on the left side of the body), weak but not deficient visual-perceptual abilities, deficient visual-spatial skills, extremely poor psychomotor skills (gross motor skills more deficient than fine motor skills), problems with processing of new and complex material, poor visual attention, good auditory memory and relatively good language skills. These findings correspond to the pattern of neuropsychological assets and deficits that has been described for the syndrome of nonverbal learning disabilities (NLD) (Rourke, 1987, 1988, 1989, 1995). The psychosocial profile of all nine children with VCFS also correspond to that of children with NLD. Further studies on the relationship between cognitive function, behavior, psychiatric disorder and abnormalities in brain anatomy in young people with VCFS will be needed. In clinical practice, it is worthwhile exploring in greater depth the neuropsychological functions of children with VCFS to rule out NLD, since they may benefit from specific remediation following the learning principles of the NLD-treatment.     

Neuropsychological sequelae following pediatric stroke: A nonlinear model of age at lesion effects

Aim: The distribution and quality of brain recovery following pediatric arterial ischemic stroke remains controversial. The literature suggests that age at stroke may be an important modulator of neuropsychological outcome, with reports inferring either greater vulnerability or plasticity in the nascent brain. Our aim was to investigate neuropsychological outcomes following pediatric stroke in a clinical sample with reference to age at lesion, lesion laterality, elapsed time from stroke to assessment, and persistent neurological sequelae.

Methods: Using comprehensive neuropsychological assessment batteries, we investigated retrospectively a large (n?=?44) and evenly distributed group of children who had ischemic stroke during “infancy” (1 month to 1 year), “early childhood” (1 to 6 years), and “late childhood” (6 to 16 years).

Results: Children who suffered a stroke performed significantly worse on a range of neuropsychological measures when compared to a normative sample. However, children who suffered a stroke between 1 and 6 years old demonstrated better preserved neuropsychological profiles than either the earlier (before age 1) or later (after age 6) age groups. In addition, those children suffering a left hemisphere lesion performed more poorly on a range of neuropsychological measures than did children with right hemisphere lesions.

Interpretation: Age at stroke is an important determinant of recovery following insult and may modulate neuropsychological and cognitive outcome.     

Neuropsychological correlates of psychopathology in an unselected cohort of young adolescents

Members of a birth cohort were assessed for psychopathology and neuropsychological dysfunction at age 13. Ss who met DSM-III criteria for a single disorder, multiple disorders, and no disorder were compared on 5 composite neuropsychological measures. The multiple disorders group performed significantly worse than did the nondisordered group on the Verbal, Visuospatial, Verbal Memory, and Visual-Motor Integration factors. They also showed the highest rate of neuropsychological impairment. The attention-deficit disorder group performed significantly worse than did the nondisordered group on the Verbal Memory and Visual-Motor Integration factors, and the anxiety disorder group performed significantly worse than did the nondisordered group on the Visual-Motor Integration factor. Results suggest that neuropsychological dysfunction is more often associated with multiple rather than single, psychiatric disorders in adolescents. The problem of comorbidity in studies of neuropsychological function in childhood and adolescent psychopathology is highlighted.     

Neuropsychological correlates of hypertension: review and methodologic considerations.

Essential hypertension is a chronic disorder having many potential physical and behavioral sequelae. This article evaluates the impact of hypertension on neuropsychological test performance. First, cross-sectional and longitudinal studies that examine the neuropsychological correlates of hypertension are reviewed. In general, hypertensives are found to perform more poorly than normotensives, particularly on tests of memory, attention, and abstract reasoning, and less consistently on tests of perception, constructional ability, mental flexibility, and psychomotor speed. Next, the influence of variables that may moderate relationships between hypertension and neuropsychological performance--such as age, education, and medication usage--are examined. Finally, potential mechanisms, both physiological and psychological, underlying associations between hypertension and neuropsychological performance are discussed.     

The effect of cognitive testing and feedback on older adults’ subjective age

Subjective age, or how old a person feels, is an important measure of self-perception that is associated with consequential cognitive and health outcomes. Recent research suggests that subjective age is affected by certain situations, including cognitive testing contexts. The current study examined whether cognitive testing and positive performance feedback affect subjective age and subsequent cognitive performance. Older adults took a series of neuropsychological and cognitive tests and subjective age was measured at various time points. Participants also either received positive or no feedback on an initial cognitive task, an analogies task. Results showed that participants felt older over the course of the testing session, particularly after taking a working memory test, relative to baseline. Positive feedback did not significantly mitigate this subjective aging effect. Results suggest that subjective age is malleable and that it can be affected by standard cognitive and neuropsychological test conditions.     

Neuropsychological dysfunction in asthmatic children

Neuropsychological dysfunction associated with pediatric asthma is reviewed. Significant methodological confounds associated with clinical research, including problems with the objective measure of asthma, are prevalent in many studies. Most evidence does not support the belief that asthma alone results in homogeneous neuropsychological compromise. Studies of adverse reactions to asthma medications indicate medication-specific effects including slight improvements in some aspects of neuropsychological functioning, such as attention, and deficiencies in other aspects of neuropsychological functioning, such as memory. The acute neuropsychological effects of various medication regimens appears to be reversible with cessation of the asthma medication under suspicion, although no data yet exist regarding the long-term effects of therapeutic dosages of asthma medications upon a developing nervous system. The hypothetical effects of asthma on school performance have been related to non-neuropsychological variables such as a child's socioeconomic status, though there is also evidence suggesting that poorly controlled asthma is related to learning problems. Implications for pediatric neuropsychologists are discussed.     

Neuropsychological profile of children with cryptogenic localization related epilepsy.

Up to one third of the epilepsy population consists of children with cryptogenic localization related epilepsy (CLRE). Unfortunately, the effect of CLRE on the development is still unclear. Behavioral and academic problems have been reported, but no conclusive study concerning the impact of CLRE on neuropsychological functioning is yet published. This study was a systematic cross-sectional open clinical and nonrandomized investigation, which included 68 children with CLRE. Several neuropsychological tests were analyzed and age-related normative values were used as reference. Differences between CLRE and reference values were tested with Paired-Samples t-tests. Z scores were computed to compare the different neuropsychological tests and to inspect whether a characteristic neuropsychological profile exists for CLRE. The Independent-Samples t-test was used to explore which epilepsy factors (seizure type, seizure frequency, age at onset, duration of epilepsy, and drug load) were influencing the cognitive profile of CLRE. There seems to be a characteristic cognitive profile for children with CLRE; children with CLRE experience cognitive difficulties on a wide range of areas-in particular, alertness, mental speed, and memory. Seizure type, seizure frequency, duration of epilepsy, and drug load do not influence this neuropsychological profile. Age at onset was an important risk factor; the earlier the age at onset, the worse the cognitive performance. In spite of the influence of age at onset, the revealed profile can be seen as a stable, independent of temporary factors, neuropsychological profile for children with CLRE.     

The Neuropsychology of Heading and Head Trauma in Association Football (Soccer): A Review

Association Football (soccer) is the most popular and widespread sport in the world. A significant proportion of the injuries suffered in football are head injuries involving trauma to the brain. In normal play, head trauma frequently arises from collisions, but some researchers have claimed that it also may arise as a consequence of heading the ball. Although assessments based on biomechanical analyses are equivocal on the potential for brain injury due to football heading, a growing literature seems to support the claim that neuropsychological impairment results from general football play and football heading in particular. However, this review suggests a distinction is required between the neuropsychological effects of concussive and subconcussive head trauma and that all of the neuropsychological studies conducted so far suffer from methodological problems. At best, a few of these studies may be regarded as exploratory. The review concludes that presently, although there is exploratory evidence of subclinical neuropsychological impairment as a consequence of football-related concussions, there is no reliable and certainly no definitive evidence that such impairment occurs as a result of general football play or normal football heading. The neuropsychological consequences of football-related subconcussive effects await confirmatory investigation.     

The interactive effects of age,education, and BMI on cognitive functioning

We examined the moderating effects of age and cognitive reserve on the relationship between body mass index (BMI) and processing speed, executive function, and working memory based on the literature suggesting that obese individuals perform more poorly on measures of these abilities. Fifty-six healthy, dementia-free community-dwelling older (mean age 65.72 ± 7.40) and younger (mean age 21.10 ± 2.33) adults completed a neuropsychological battery and reported height and weight. Mixed effects models were used to evaluate the interactive effects of age, education (a proxy for cognitive reserve), and BMI on cognitive scores. Higher education was protective for executive deficits in younger, but not older adults. Age differences in executive functions were reduced at higher education levels but increased in individuals with higher BMI. Results suggest the inter-relationships between cognitive reserve – as measured by education – and BMI differ across age, and that obesity may accelerate the cognitive aging process.     

A Two-Year Longitudinal Study of Neuropsychological and Cognitive Performance in Relation to Behavioral Problems and Competencies in Elementary School Children

Despite interest in early neuropsychological status as a possible contributor to children's behavioral development, prospective longitudinal investigations of neuropsychological measures in relation to later behavioral outcomes in childhood are few. A 2-year longitudinal study in a nonselected childhood sample is reported. The study tested the influence of early neuropsychological performance (verbal fluency, mental inhibitory control, and visual spatial ability) on later childhood behavioral problems and social competency. Regular education children (n = 235) were assessed at three time points 1 year apart. To control for autocorrelation of outcome measures, Time 1 behavior was partialed while testing the effects of Time 1 neuropsychological scores on Time 3 outcome. To control for autocorrelation of neuropsychological scores, Time 2 scores were partialed while testing the predictive effect of Time 1 scores on Time 3 outcome. Both sets of regression models suggested modest but statistically significant effects for inhibitory control and verbal fluency, but not IQ, reading, or visual spatial ability, on behavioral outcome. Study results are consistent with a modest causal effect of selected neuropsychological skills on later behavioral adjustment. The findings support theories that implicate subtle neuropsychological dysfunction in the development of behavioral problems in childhood.     

Neuropsychological mediators of the links among age, chronic illness, and everyday problem solving

Reductions in everyday problem solving (EPS) are often reported in older age, although the underlying mechanisms remain unclear. The authors examined the role of 2 variables predicted to mediate (neuropsychological abilities and health status) or moderate (health status) the relationship between age and EPS performance. Toward these ends, they compared EPS and neuropsychological performance in 50 functionally independent adults with chronic kidney disease (CKD) and 64 control participants matched on age and education. Both older age and CKD were associated with worse performance on measures of EPS and memory/executive abilities. Neuropsychological abilities were positively associated with EPS performance. In both the full sample and control participants only, memory/executive functioning mediated the association between presence of chronic illness and EPS. Furthermore, memory/executive functioning partially mediated the link between age and EPS. Findings indicate that relations among age, health status, and EPS are not straightforward. Although performance on neuropsychological measures appeared to underlie EPS declines in chronic illness, increasing age remained independently associated with reduced EPS. The authors discuss implications for models of adult developmental changes in everyday cognition.     

Clinical significance of test refusal among young children.

The present study describes the incidence of test refusal at neuropsychological assessment, investigates its correlates, and its stability. The participants were 124 children aged 3.5 years whose development has been followed from birth in the Jyv?skyl? Longitudinal Study of Dyslexia (JLD). The frequency of test refusal on the Finnish version of the NEPSY was analyzed with respect to the children's concurrent and earlier cognitive and language skills, assessed using tests and parental ratings. Refusal during test-taking was found to be relatively common at this age, and high frequency of refusal at an earlier age was associated with similar tendency at a later age. High test refusal was associated with compromised neuropsychological and linguistic test scores. Missing data due to refusal were more common in neuropsychological tasks requiring verbal production. It is concluded that test refusals reflect a child's poor underlying skills and an attempt to avoid failure, rather than noncompliant or oppositional behavior.     

Time Perception in Boys With Attention-Deficit/Hyperactivity Disorder According to Time Duration,Distraction and Mode of Presentation

The present study describes the incidence of test refusal at neuropsychological assessment, investigates its correlates, and its stability. The participants were 124 children aged 3.5 years whose development has been followed from birth in the Jyväskylä Longitudinal Study of Dyslexia (JLD). The frequency of test refusal on the Finnish version of the NEPSY was analyzed with respect to the children's concurrent and earlier cognitive and language skills, assessed using tests and parental ratings. Refusal during test-taking was found to be relatively common at this age, and high frequency of refusal at an earlier age was associated with similar tendency at a later age. High test refusal was associated with compromised neuropsychological and linguistic test scores. Missing data due to refusal were more common in neuropsychological tasks requiring verbal production. It is concluded that test refusals reflect a child's poor underlying skills and an attempt to avoid failure, rather than noncompliant or oppositional behavior.