Association rule learning in neuropsychological data analysis for Alzheimer’s disease

Efficient methods of analysis readily available for clinicians continue to be limited within neuropsychological assessment at the raw data level. Here, a novel approach for generating predictive response patterns and analysing neuropsychological raw data is offered. In order to assess the usefulness of association rule learning as an analysis tool for neuropsychological raw data, Frequent Pattern Growth (FP-Growth) was used to mine patterns from the Consortium to Establish a Registry for Alzheimer’s Disease Neuropsychological Battery (CERAD-NB) database. Complete assessment data for 84 post-mortem confirmed Alzheimer’s disease (AD) cases and 294 age, race, and education matched controls were analysed across baseline and one-year follow-up using FP-Growth, for the purpose of assessing the clinical utility of a finer analysis at the raw data level and the feasibility of predicting response patterns for clinical/control groups. Output from FP-Growth, in terms of the number of frequent itemsets retained across both evaluation timepoints, was discernable between controls, mild, and moderate to severe Alzheimer’s disease cases (p < .001, and η² = .488). Patterns within raw data scores, both in terms of frequent itemsets and predictive association rules, appear to be differentiable across groups within neuropsychological analysis, which indicates that FP-Growth is applicable as a supplementary analysis tool for neuropsychological assessment by means of offering an additional level of data analysis, predictive item response capabilities, and aiding in clinical decision making.     

The Suicide (SPI) and Violence Potential Indices (VPI) from the Personality Assessment Inventory: A Preliminary Exploration of Validity in an Outpatient Psychiatric Sample

Assessing risk of harm to self and others is an important component of psychological assessment, although methods for risk assessment vary considerably. The Personality Assessment Inventory (PAI) is frequently administered to evaluate general psychological functioning, as well as to provide information about suicide and violence risk. The purpose of this study was to evaluate the construct validity of the PAI Suicide (SPI) and Violence Potential (VPI) indices in a sample of 158 psychiatric outpatients referred for psychological and neuropsychological assessment within a large northeastern academic medical center between 2007 and 2011. Results generally supported the convergent and divergent validity of both SPI and VPI when evaluating groups with and without a history of suicide and violence risk, and effect sizes were moderate to large even after controlling for other covariates. SPI and VPI scores were also found to vary significantly across different psychiatric groups in ways that would be expected. Finally, we explored the relationship between SPI and VPI, and executive functioning impairment??a neuropsychological variable found to be associated with impulsive self and other-harming behaviors. Consistent with prior research, SPI and VPI were found to be significantly elevated in groups demonstrating executive dysfunction. The implications of these findings and specifically the utility of using SPI and VPI in the assessment of risk are discussed.     

Cognitive Event-Related Potentials in Neuropsychological Assessment

Neuropsychology is a behavioral approach to studying the brain, and an integration of neuropsychology with on-line processing measures of brain function is important for advancing the understanding of brain–behavior relationships. Cognitive event-related potentials (ERPs) are on-line processing measures that are of interest to neuropsychologists because they are linked to familiar neuropsychological test paradigms and because they have reached a degree of standardization sufficient to make them applicable in individual assessment. A selective review of cognitive ERPs is given, focusing on studies of attention in the oddball paradigm and arguing that an adequate assessment of attention is basic in understanding higher order cognitive functions. General principles for using ERP data to supplement and clarify neuropsychological analysis are discussed, and available evidence on dementia and traumatic head injury is reviewed. It is concluded that ERPs are a useful supplement to neuropsychological assessment. Although diagnostic use of ERPs must be guarded because of limited standardization and validation, information-processing analysis with ERPs may aid significantly in interpretation of behavioral data.     

Legal and psychological implications in the assessment of sexual consent in the cognitively impaired population

The question of competency to consent to sexual activity in the cognitively impaired population continues to be a difficult assessment issue. Problems center on inconsistent legal and clinical criteria, current inadequate methods of psychological assessment, and the need to promote basic human rights, while protecting people from harm. The purpose of this study was twofold. First, the problems inherent in the psychological assessment of competency to consent to sexual activity are discussed with an emphasis on problems defining consent competency. Second, the utility of a neuropsychological test battery in assisting with the assessment of the ability to consent to sexual activity was examined. Findings indicated that executive measures of neuropsychological assessment were primarily associated with competency to consent to sexual activity. It is important that these neuropsychological measures were more accurate in categorizing competent and noncompetent individuals than methods currently in use. This suggests that sexual consent assessments in the forensic arena should include neuropsychological testing and that current methods are insufficient.     

The Role of Neuropsychological Assessment in the Functional Outcomes of Children with ADHD

The value of evidence-based services is now recognized both within clinical communities and by the public at large. Increasingly, neuropsychologists must justify the necessity of often costly and time-consuming neuropsychological assessments in the diagnosis and treatment of common childhood disorders, such as Attention-deficit/Hyperactivity Disorder (ADHD). Published medical guidelines and prominent researchers, however, have argued against the need for formal neuropsychological assessment of ADHD. The present review examines the literature on developmental outcomes in childhood ADHD, with emphasis on the utility of formal neuropsychological assessment among children diagnosed and treated in primary care settings. The review yields three central findings: 1) adherence to published diagnostic guidelines for ADHD is poor among pediatric and primary care physicians; 2) ADHD most often co-exists with other disorders, thus diagnoses made without formal psychometric assessment can be incomplete or incorrect, ultimately increasing treatment costs; and, 3) untreated children with ADHD, and those who have untreated comorbidities, are at greater risk for poor outcomes in social, academic, vocational, and practical settings. The available literature suggests that neuropsychological assessment provides information that can potentially reduce risks for poor outcomes and improve quality of life among children with ADHD. Controlled studies directly examining the impact of neuropsychological assessments in improving outcomes among children with ADHD are needed.     

Repeated assessment of cognition in children and the measurement of performance change.

There is limited understanding of the problems associated with repeated neuropsychological assessment in children, including the statistics used to guide decisions about cognitive change. This study investigated the utility of a computerized assessment battery that was specifically designed for the repeated assessment of cognitive function in children. Eighty-seven participants aged 8 to 12 years completed the battery four times within a 2-hour testing session. The results support the application of this assessment battery for measuring cognitive change in children. A novel method for calculating measurement error is employed, and its use in the detection of cognitive change in individual children is discussed. An estimate of the measurement error within each of the tests is provided, and recommendations are made regarding the application of this assessment battery for measuring cognitive change in children.     

Referrers' Perceived Utility and Outcomes of Clinical Neuropsychological Assessment in an Adolescent and Young Adult Public Mental Health Service

Despite frequent informal or anecdotal acknowledgement of the usefulness of neuropsychological services within various settings, including mental health settings, few studies have formally investigated the satisfaction, perceived utility, or outcomes associated with such a service. This survey‐based study evaluated referring clinicians’ (n = 35) perceptions of the usefulness and outcomes associated with the provision of clinical neuropsychological assessment and feedback within an adolescent and young adult public mental health service in Melbourne, Australia. The results suggest that referrers perceive the neuropsychological service, including formal neuropsychological assessment report and verbal and written feedbacks, as a highly useful adjunct to their clinical practice. In addition, referrers frequently reported clinically meaningful outcomes in association with the neuropsychological service, including diagnostic changes or additions (11% of clients referred), changes to approaches in treatment (52% of clients referred), and increased or appropriate access to services, education, or work (33% of clients referred). Referrers also reported that almost 60% of neuropsychological assessment reports were forwarded to other services or clinicians involved in the client's care. The findings suggest that mental health settings are likely to benefit from routine inclusion of specialist neuropsychology services. However, future research should also examine client and family perceptions regarding the satisfaction and usefulness of neuropsychological services.     

基于神经生理学的疼痛测量

疼痛是一种受多重因素影响的复杂主观感受。临床上,疼痛测量主要依赖于患者的主观评价。然而,这种传统的疼痛测量方法具有多方面的局限。近年来,研究者借助生理记录、脑电和功能磁共振等技术,揭示疼痛的神经生理、心理机制,挖掘与疼痛相关的神经生理指标,进而构建有效、客观和精确的疼痛评价体系。在基础研究和临床实践中,这些技术有望弥补传统疼痛测量方法的不足,从而极大推动疼痛测量及其治疗等相关领域研究的发展。     

Psychometrics of a simple method for scoring organizational approach on the Rey‐Osterrieth complex figure

The Rey‐Osterrieth Complex Figure (ROCF) is a commonly used neuropsychological measure that assesses visuospatial processing, planning and visuomotor integration. Using samples of clinically referred (N=20) and non‐clinical (N=44) adults, the present study examines the psychometric properties of a simple method of scoring organizational approach to the ROCF. Developed by Savage et al. (1999) and refined by Deckersbach et al. (2000) , this simple 5‐point organizational scoring system allows for the quick and accurate assessment of organizational quality. Results suggest that this system is internally consistent and can be scored reliably. Correlations with measures of visuomotor integration and accuracy of rendition after a delay provide evidence of convergent validity. Organization scores were independent of both Verbal and Performance IQ estimates. However, discriminant validity analyses found that high‐functioning patients referred for a neuropsychological assessment did not score significantly different from a non‐clinical sample, raising questions about the diagnostic utility of this measure with less impaired populations. Implications for clinical practice are discussed, as are directions for future research.     

Neuropsychological Assessment of HIV-Infected Populations in International Settings

Resource-limited regions of the world represent the areas most affected by the global HIV epidemic. Currently, there are insufficient data on the neurocognitive effects of HIV in these areas and neuropsychological studies that have been carried out thus far are marked by inconsistent methods, test batteries, and rating systems for levels of cognitive impairment. These differences in methods, along with genetic variability of both virus and host, differences in co-infections and other co-morbidities, differences in language and culture, and infrastructural deficiencies in many international settings create challenges to the assessment of neurocognitive functioning and interpretation of neuropsychological data. Identifying neurocognitive impairment directly attributable to HIV, exploring relationships between HIV-associated neurocognitive impairment, disease variables, and everyday functioning, evaluating differences in HIV-1 subtype associated neuropathology, and determining implications for treatment remain complicated and challenging goals. Endeavors to establish a more standardized approach to neurocognitive assessments across international studies in addition to accumulating appropriate normative data that will allow more accurate rating of neuropsychological test performance will be crucial to future efforts attempting to achieve these goals.     

Examining the Test Of Memory Malingering Trial 1 and Word Memory Test Immediate Recognition as screening tools for insufficient effort

Assessing effort level during neuropsychological evaluations is critical to support the accuracy of cognitive test scores. Many instruments are designed to measure effort, yet they are not routinely administered in neuropsychological assessments. The Test of Memory Malingering (TOMM) and the Word Memory Test (WMT) are commonly administered symptom validity tests with sound psychometric properties. This study examines the use of the TOMM Trial 1 and the WMT Immediate Recognition (IR) trial scores as brief screening tools for insufficient effort through an archival analysis of a combined sample of mild head-injury litigants ( N = 105) who were assessed in forensic private practices. Results show that both demonstrate impressive diagnostic accuracy and calculations of positive and negative predictive power are presented for a range of base rates. These results support the utility of Trial 1 of the TOMM and the WMT IR trial as screening methods for the assessment of insufficient effort in neuropsychological assessments.     

A data-driven approach to neuropsychological features in isolated REM behaviour disorder: A latent class analysis

Recent evidence demonstrated that neuropsychological assessment may be considered a valid marker of neurodegeneration in idiopathic REM sleep behaviour disorder (iRBD). However, little is known about the possible neuropsychological heterogeneity within the iRBD population. This retrospective study aimed to identify and describe different neuropsychological phenotypes in iRBD patients by means of a data-driven approach using latent class analysis. A total of 289 iRBD patients underwent a neuropsychological assessment evaluating cognitive domains: global cognition, language, short- and long-term memory, executive functions and visuospatial abilities. The presence of mild cognitive impairment (MCI) was also assessed. Latent class analysis was carried out to identify iRBD subtypes according to neuropsychological scores. The most parsimonious model identified three latent classes. Groups were labelled as follows: Class 2 “severely impaired” (n = 83/289): mean pathological scores in different tests, a high percentage of MCI multiple-domain and impairment in all neuropsychological domains. Class 1 “moderately impaired” (n = 44/289): mean neuropsychological score within the normal value, a high percentage of MCI (high risk to phenoconversion) and great impairment in the visuospatial domain. Class 3 “slightly impaired” (n = 162/289): no deficit worthy of attention except for short- and long-term memory. Our results suggest three different clinical phenotypes within the iRBD population. These findings may be relevant in the future for predicting the clinical trajectories of phenoconversion in iRBD.     

Neuropsychological,Cognitive, and Theoretical Considerations for Evaluation of Bilingual Individuals

As the number of bilinguals in the USA grows rapidly, it is increasingly important for neuropsychologists to be equipped and trained to address the unique challenges inherent in conducting ethical and competent neuropsychological evaluations with this population. Research on bilingualism has focused on two key cognitive mechanisms that introduce differences between bilinguals and monolinguals: (a) reduced frequency of language-specific use (weaker links), and (b) competition for selection within the language system in bilinguals (interference). Both mechanisms are needed to explain how bilingualism affects neuropsychological test performance, including the robust bilingual disadvantages found on verbal tasks, and more subtle bilingual advantages on some measures of cognitive control. These empirical results and theoretical claims can be used to derive a theoretically informed method for assessing cognitive status in bilinguals. We present specific considerations for measuring degree of bilingualism for both clients and examiners to aid in determinations of approaches to testing bilinguals, with practical guidelines for incorporating models of bilingualism and recent experimental data into neuropsychological evaluations. This integrated approach promises to provide improved clinical services for bilingual clients, and will also contribute to a program of research that will ultimately reveal the mechanisms underlying language processing and executive functioning in bilinguals and monolinguals alike.     

The functional state of the central nervous system in chemical stress

The psychosocial and physical factors, including chemical ones, which affect the human organism are considered by some authors to be stress factors which affect the functional state (FS) of the central nervous system (CNS). We calculated correlations among the clinical, psychological/psychometric, and quantitative electropsychological (QEEG) variables of the functional changes of the CNS in chemical stress. These data were based on occupational contact with lead as experienced by 402 workers, with styrene by 96, with shale-oil products by 252, with organic solvents by 77 workers, and a control group of 145 workers in different age groups. The QEEG data of 77 patients were analyzed to determine the chronic neurotoxic effects of industrial chemical substances by diagnosing the functional changes at the syndrome level. We concluded that occupational chemical factors impact the functional state of the CNS. During chemical stress -activity and total cerebral bioelectrical activity (BA) decreases. The use of psychometric/ psychological and QEEG methods makes it possible to diagnose the changes of the CNS as hypersthenic, hyposthenic, and organic psychosyndromes.     

The classification of neuropsychological deficit

The study involves classification of neuropsychiatric patients on the basis of neuropsychological and intelligence test performance. One hundred twenty-five hospitalized male neuropsychiatric patients with various diagnoses were administered the Halstead-Reitan and Luria-Nebraska neuropsychological test batteries, as well as the Wechsler Adult Intelligence Scale. A cluster analysis was performed for each of those three procedures utilizing Ward's method. It was found in all cases that clusters were determined on the basis of level rather than pattern of performance. Relationships were found between cluster membership and age, education, and presence or absence of structural brain damage but were not found for diagnoses of schizophrenia or alcoholism. Schizophrenic and alcoholic patients were found in all clusters in the case of all three test procedures. Differences in clustering among the three test procedures were noted, with the WAIS being relatively more sensitive to educational differences while the Halstead-Reitan was more sensitive to age differences. The clinical utility of classifying patients on the basis of neuropsychological and cognitive test performance was discussed.Acknowledgement is made to the Veterans Administration for support of this research.     

Comparisons of the BRIEF parental report and neuropsychological clinical tests of executive function in Fetal Alcohol Spectrum Disorders: data from the UK national specialist clinic

Extant literature is sparse with regards to the relationship between caregiver reports and neuropsychological tests of executive functioning in Fetal Alcohol Spectrum Disorders (FASD). The goal of this paper was determining the clinical utilities of executive functioning measures used in the United Kingdom national FASD clinic. We examined relationships between outcomes on the Behavior Rating Inventory of Executive Function (BRIEF) and the Delis-Kaplan Executive Function System (D-KEFS), as part of an ongoing service evaluation. Profiles of executive functioning measures were reported in order to contribute to delineating a profile of executive dysfunction in FASD. Caregivers of 49 people with FASD completed the Parent BRIEF, and 61 people with FASD were administered the D-KEFS. Pearson’s Correlations between all 11 BRIEF scales and the 18 selected D-KEFS subscales showed little relationship. The BRIEF showed a profile of clinically significant elevations in all three Index scores and seven out of the eight Scale scores. Several D-KEFS tests showed below average executive functioning. Both executive function measures have separate clinical utility in demonstrating executive function deficits in FASD. The sample population used in this study also show a similar pattern to FASD populations internationally, suggesting a similar neuropsychological profile is seen in the United Kingdom. However, caregiver reports display little relationship to neuropsychological tests. These measures likely monitor different aspects of executive functioning in different settings. Future research should focus on identifying tests that better relate findings from clinical settings to behavior in daily life.     

Case illustration of a boy with nonverbal learning disorder and Asperger's features: neuropsychological and personality assessment

I present a case study of a latency-age boy referred for assessment of a nonverbal learning disability/disorder (NLD) who also had features of Asperger's syndrome (AS). I review NLD terminology, presumed brain-behavior relationship, neuropsychological profile, and diagnosis/classification issues. I discuss the challenge of differentiating NLD from AS in relation to the client's pattern of visual-spatial, communication, social-emotional, and behavioral NLD correlates. I integrate neuropsychological and personality assessment data with interviews, observations, prior testing, and input from teacher and therapist in formulating a diagnostic impression. I discuss Rorschach (Exner, 2003) and neuropsychological consultations in relation to subtle language and interpersonal features of the client's communication style. I provide parent feedback at 18 and 24 months posttesting. I discuss implications relative to a model of school neuropsychological assessment that includes the Rorschach test.     

Spanish Applications of Luria's Assessment Methods

Luria's neuropsychology has been particularly influential in the Spanish-speaking world. Its impact is observed with regard to not only assessment, but also rehabilitation, and, especially, neuropsychological theorization. In this article, Luria's approach to neuropsychological assessment is examined. A distinction between Luria's neuropsychological tests and Luria's neuropsychological approach is introduced. It is pointed out that, according to Luria, the specific tests used in the neuropsychological assessment are secondary; the theory supporting the neuropsychological testing is of primary importance. The development of neuropsychology in the Spanish-speaking world is briefly presented, and the use of Luria's neuropsychological assessment procedures in Latin America and Spain is analyzed. Finally, neo-Lurianism in the Spanish-speaking world is considered.     

Relative absence of neuropsychological deficit in patients with low grade astrocytomas

Given the current accuracy and precision of modern brain imaging technology, there is presumed to be little utility in neuropsychological assessment procedures in patients with brain tumors. The primary exposure of many clinical neuropsychologists to patients with brain tumors is during their training, in the form of didactic classroom activities, such as reviewing the brain tumor cases of early investigators in the field. Historically, these brain tumors were the more aggressive and destructive tumors, such as grade III and IV astrocytomas, that could be identified with pre CT and pre MRI technology. With current imaging technology, low grade tumors that might previously have gone undiagnosed for years can be detected and patients followed over time. This series of cases represents documentation of the very unique neuropsychological status of patients with relatively slow growing, infiltrative brain tumors classified as grade II astrocytomas. The potential relevance of neuropsychological assessment for such cases is discussed.