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.     

Neuropsychological testing: evolution and emerging trends

Neuropsychological (NP) test batteries have evolved as an amalgam of intelligence tests, various individual measures of "biological" cognition, and sensory and motor testing. The early emphasis of NP testing was to identify "organicity" and central nervous system lesion localization. More recent approaches have emphasized the profiling of performance across individual neurocognitive domains (eg, attention, memory, and language) to facilitate diagnosis and treatment planning. However, the field is still hampered by the use of many tests that are antiquated, excessively long, or of dubious psychometric quality. Some of these problems may have contributed to the current under-utilization of NP testing in diagnostic workups of neuropsychiatric disorders. This paper reviews some of the recent changes in the field that hold promise for substantially shortening assessments, improving diagnostic reliability, and making NP testing more cost-effective and practical.     

Neuropsychological rehabilitation after brain injury: Scientific and professional issues

Neuropsychological rehabilitation after acquired brain injury is an important contribution to our health-care system. Despite a growing database which supports its clinical utility, the insurance coverage for this form of care is now being threatened. This paper addresses some of the professional and scientific issues that psychologists need to face in order to continue to provide these services.Invited Address, President's Mini-Convention To Your Health: Psychology Through the Life Span, American Psychological Association Convention, New York, August 12, 1995.     

Neuropsychological assessment of learning disabilities: a discriminant analysis

The neuropsychological test scores of 23 learning disabled children were compared with those of a matched population of normal children in the 9-1 to 13-1 age range. All children were administered the Wechsler Intelligence Scale for Children-Revised (WISC-R), a dichotic listening task involving both free and directed recall conditions, a handedness inventory, the Tactile Performance Test and the Category Test from the Halstead-Reitan Neuropsychological Test Battery. A multivariate analysis of variance resulted in a significant separation between groups (p less than .001) using these procedures. A stepwise discriminant function analysis revealed that both of the directed dichotic tasks contributed the most of all 13 measures to the significant group separation. In addition, other cognitive tasks found to discriminate normal from learning disabled children include general verbal processes, concept formation, and tactile memory. These findings suggest that the directed dichotic listening procedure and the WISC-R Verbal IQ measure are reasonably valuable clinical tools in the classification of learning disabilities.     

Psychological testing and psychological assessment. A review of evidence and issues

This article summarizes evidence and issues associated with psychological assessment. Data from more than 125 meta-analyses on test validity and 800 samples examining multimethod assessment suggest 4 general conclusions: (a) Psychological test validity is strong and compelling, (b) psychological test validity is comparable to medical test validity, (c) distinct assessment methods provide unique sources of information, and (d) clinicians who rely exclusively on interviews are prone to incomplete understandings. Following principles for optimal nomothetic research, the authors suggest that a multimethod assessment battery provides a structured means for skilled clinicians to maximize the validity of individualized assessments. Future investigations should move beyond an examination of test scales to focus more on the role of psychologists who use tests as helpful tools to furnish patients and referral sources with professional consultation.     

The incremental validity of psychological testing and assessment: conceptual, methodological, and statistical issues

There has been insufficient effort in most areas of applied psychology to evaluate incremental validity. To further this kind of validity research, the authors examined applicable research designs, including those to assess the incremental validity of test instruments, of test-informed clinical inferences, and of newly developed measures. The authors also considered key statistical and measurement issues that can influence incremental validity findings, including the entry order of predictor variables, how to interpret the size of a validity increment, and possible artifactual effects in the criteria selected for incremental validity research. The authors concluded by suggesting steps for building a cumulative research base concerning incremental validity and by describing challenges associated with applying nomothetic research findings to individual clinical cases.     

Neuropsychological assessment in illiterates: visuospatial and memory abilities

A basic neuropsychological battery of visuospatial and memory abilities was administered to extreme educational groups (illiterates and professionals). Subjects were matched according to sex and age. The following visuospatial tasks were included: figure copy (cube, house, and Rey-Osterrieth complex figure), telling time, recognition of superimposed figures, recognition of a map, and drawing of the plan of the room. The following memory tasks were used: basic information, digit retention (forward and backward), memory curve, delayed verbal recall, sentence repetition, logical memory, delayed logical memory, immediate recall of the Rey-Osterrieth complex figure, immediate reproduction of a cube, visuospatial memory, and sequential memory. In visuospatial tasks all differences between the two groups were statistically significant. Five of the seven visuospatial tasks (all but telling time and recognition of superimposed figures) showed differences between age groups with a better performance found in the younger groups and four of the tasks (cube, house, Rey-Osterrith complex figure copying, and telling time) were significant between sexes with a better performance in men. In memory tasks, with the exception of the immediate memory of sentences, all tasks showed statistically significant differences between educational groups. Eight of the 13 memory tasks (digits forward and backward, delayed memory of words, immediate and delayed logical memory, Rey-Osterrieth immediate memory, cube immediate memory, and sequential memory) showed significant differences for age while 4 of the tasks (digits backward, memory curve, Rey-Osterrieth immediate memory, and cube immediate memory) were significant for sex. Results are analyzed with regard to current theories in cognitive psychology and anthropology. Emphasis is placed on the finding that cognitive skills usually examined by neuropsychological tests represent learned and highly trained abilities.     

Factors predictive of a fetal alcohol spectrum disorder: Neuropsychological assessment

A variety of neurodevelopmental impairments related to fetal alcohol spectrum disorder (FASD) diagnoses have been consistently documented. However, it is not clear whether such variables are predictive of a diagnosis. The purpose of the present study is to use logistic regressions to identify predictors of FASD in neuropsychological assessment. Charts of 180 children and adolescents with prenatal alcohol exposure (PAE) who underwent psychological and diagnostic assessment for FASD were retrospectively reviewed. A total of 107 received an FASD diagnosis (the PAE-FASD group) and 73 did not (the PAE group). Following preliminary analyses, direct logistic regressions were performed to assess the contribution of different neuropsychological testing measures on the likelihood of a child or adolescent receiving an FASD diagnosis. The results indicate that the classification accuracy of the PAE-FASD and PAE groups is clinically significant across models of intelligence, academic achievement, memory, and executive functioning. Classification rates across the various models range from 67.1% to 75.5%, with models incorporating 10 intelligence subtests or 3 academic subtests emerging as superior to those using broad indices of intelligence and/or individual subtests of memory or executive functioning. A “test battery” model incorporating verbal intelligence, verbal/auditory working memory (digit span), basic reading and spelling skills, math calculations, delayed story recall, and spatial planning and problem-solving yielded a classification rate of 74.7%. These results suggest that neuropsychological testing is a critical component of FASD assessment and help guide decisions to maximize the efficiency and efficacy of the diagnostic process and treatment recommendations.     

Neuropsychological evaluation in the assessment of personal injury

Neuropsychological evaluation offers unique potentials in the assessment of personal injury claims. Strengths and limitations of major approaches to testing are reviewed, and special attention is given to applications in the particular forensic areas of head injury, toxic environments, physical disease, and malpractice. The varieties of cognitive, emotional, and interpersonal damages which may occur with brain injury are described. Suggestions are provided for forensically appropriate neuropsychological assessment, as well as guidelines offered for discerning inappropriate practices. Issues of neurological malingering, credentialing of the expert, and forensic roles of the neuropsychologist in rehabilitation are discussed.     

Neuropsychological rehabilitation: microcomputer-assisted treatment of brain-injured adults.

This study was designed to investigate the contribution of cognitive rehabilitation therapy delivered by computer within an educationally based treatment program for brain-injured adults. The effectiveness of two forms of computer-assisted neuropsychological treatment was examined, 36 head-injured adults received the treatment targeting either attention and memory skills or reasoning and logical thinking skills. Both groups were assessed on three measures of attention and memory and three measures of reasoning before and after the 8-wk. treatment. Analysis indicated significant improvement on five of six measures by both groups. No differential effect was observed by treatment condition. These findings did not support the hypothesis that computer-assisted neuropsychological rehabilitation programs which differ in both content and focus can produce specific effects on cognitive functioning of brain-injured adults.     

Neuropsychological assessment in illiterates : II. Language and praxic abilities

A basic neuropsychological examination of language and praxic abilities was administered to extreme educational groups (100 illiterates and 100 professionals). Subjects were matched according to sex and age (16-25, 26-35, 36-45, 46-55, and 56-65). The following tasks were included: language comprehension, phonological discrimination, naming (objects, figures, and body parts), repetition of words, verbal fluency, calculation, buccofacial and ideomotor praxis, finger alternating movements, meaningless movements, cancellation task, coordinated movements with both hands, and motor impersistence tasks. All the differences between the two educational groups were statistically significant. Two of the eight language tests (phonological discrimination and naming figures) and three of the seven praxic tests (buccofacial praxis, coordinated movements, and cancellation task) showed differences between age groups with a better performance in the younger groups. Calculation tasks and ideomotor praxis showed differences between sexes with a better performance in males. Influence of educational factors in performing routine neuropsychological tests is analyzed.     

To drive or not to drive: Neuropsychological assessment for driver's license among stroke patients

Seventy-two stroke patients, 43 with right hemisphere (RHD) and 29 with left hemisphere damage (LHD), and 7 coronary infarct controls with no evidence of cerebral damage, were neuropsychologically tested as part of an assessment program for driver's license. Mean age in the group was 53 years. Stroke patients were tested on average 4 months post injury. The groups did not differ on major demographic variables except that RHD patients were more often hemiplegic than LHD patients. The test battery was factor analyzed into 4 valid principal components: (I) visual perception , (II) spatial attention , (III) visuospatial processing , and (IV) language/praxis. The presence of hemianopia (factor I) excludes driving. In addition, measures of neglect and reduced speed of mental processing from factor II, III and IV, were found to be the most discriminating variables when classifying patients for driving. Even though neglect was more frequently observed among RHD than LHD patients, the two hemisphere groups did not differ significantly in number of patients denied driving, 58% RHD compared to 41% LHD patients. The need for comprehensive neuropsychological assessment is underlined.     

Neuropsychological and neurophysiological effects of strengthening exercise for early dementia: a pilot study

Research demonstrates a positive effect of aerobic exercise on cognitive functioning in older adults. Unfortunately, aerobic exercise is often contraindicated for older adults due to cardiovascular and functional limitations. Low-intensity strengthening exercise may offer a practical alternative, but the neuropsychological benefits and potential neurophysiological mechanisms are less well understood. The current study evaluated the effects of a 10-week strengthening exercise intervention on cognitive functioning and EEG in a sample of 13 older adults with early dementia, and 9 normative controls. Results revealed beneficial effects of strengthening exercise on verbal memory coupled with frontal beta and delta power asymmetries and N200 amplitude asymmetry. Results point to increased cognitive efficiency following 10 weeks of strengthening exercise. The findings suggest it is feasible to conduct a strengthening intervention with early dementia patients, and to gather neuropsychological and neurophysiological data to evaluate outcomes. Strengthening exercise may serve as a useful alternative to aerobic exercise.     

Neuropsychological and neurophysiological effects of strengthening exercise for early dementia: A pilot study

ABSTRACT

Research demonstrates a positive effect of aerobic exercise on cognitive functioning in older adults. Unfortunately, aerobic exercise is often contraindicated for older adults due to cardiovascular and functional limitations. Low-intensity strengthening exercise may offer a practical alternative, but the neuropsychological benefits and potential neurophysiological mechanisms are less well understood. The current study evaluated the effects of a 10-week strengthening exercise intervention on cognitive functioning and EEG in a sample of 13 older adults with early dementia, and 9 normative controls. Results revealed beneficial effects of strengthening exercise on verbal memory coupled with frontal beta and delta power asymmetries and N200 amplitude asymmetry. Results point to increased cognitive efficiency following 10 weeks of strengthening exercise. The findings suggest it is feasible to conduct a strengthening intervention with early dementia patients, and to gather neuropsychological and neurophysiological data to evaluate outcomes. Strengthening exercise may serve as a useful alternative to aerobic exercise.     

Generating items during testing: Psychometric issues and models

On-line item generation is becoming increasingly feasible for many cognitive tests. Item generation seemingly conflicts with the well established principle of measuring persons from items with known psychometric properties. This paper examines psychometric principles and models required for measurement from on-line item generation. Three psychometric issues are elaborated for item generation. First, design principles to generate items are considered. A cognitive design system approach is elaborated and then illustrated with an application to a test of abstract reasoning. Second, psychometric models for calibrating generating principles, rather than specific items, are required. Existing item response theory (IRT) models are reviewed and a new IRT model that includes the impact on item discrimination, as well as difficulty, is developed. Third, the impact of item parameter uncertainty on person estimates is considered. Results from both fixed content and adaptive testing are presented.This article is based on the Presidential Address Susan E. Embretson gave on June 26, 1999 at the 1999 Annual Meeting of the Psychometric Society held at the University of Kansas in Lawrence, Kansas. —Editor     

Neuropsychological practice effects x age: a brief note.

This is a brief review of some literature on practice effects and age on neuropsychological testing. Research suggests that younger subjects show greater improvement when retested on intelligence tests than older persons. The implication is that the effects of neuropsychological practice may vary with the age of the person assessed. Suggestions for further research are discussed.     

Neuropsychological assessment of a case of early right hemiplegia: qualitative and quantitative analysis

Evidence for normal development of linguistic but poor visuo-perceptual skills has been obtained with the neuropsychological assessment of a case of early left-brain injury. Data suggest the transfer of linguistic functions from the left to the right hemisphere at the expense of visuo-perceptual capacities for which the right hemisphere is potentially specialized.     

Mandatory neurotechnological treatment: ethical issues

What if neurofeedback or other types of neurotechnological treatment, by itself or in combination with behavioral treatment, could achieve a successful “rewiring” of the psychopath’s brain? Imagine that such treatments exist and that they provide a better long-term risk-minimizing strategy compared to imprisonment. Would it be ethical to offer such treatments as a condition of probation, parole, or (early) prison release? In this paper, I argue that it can be ethical to offer effective, non-invasive neurotechnological treatments to offenders as a condition of probation, parole, or (early) prison release provided that: (1) the status quo is in no way cruel, inhuman, degrading, or in some other way wrong, (2) the treatment option is in no way cruel, inhuman, degrading, or in some other way wrong, (3) the treatment is in the best interests of the offender, and (4) the offender gives his/her informed consent.