Chronic Pain and Neuropsychological Functioning

This review article examines the effect of chronic pain on neuropsychological functioning. Primary attention is given to studies that include patient groups without a history of traumatic brain injury (TBI) or neurologic disorders. Numerous studies were identified that demonstrate neuropsychological impairment in patients with chronic pain, particularly on measures assessing attentional capacity, processing speed, and psychomotor speed. Despite suggestive findings, further studies are needed to clarify the variables that mediate the impact of pain on neuropsychological functioning and the unique role of various symptoms often associated with chronic pain.     

Neuropsychological predictors of conversion to probable Alzheimer disease in elderly with mild cognitive impairment

In the field of neuropsychology, it is essential to determine which neuropsychological tests predict Alzheimer's disease (AD) in people with mild cognitive impairment (MCI) and which cut‐off points should be used to identify people at greater risk for converting to dementia. The aim of the present study was to analyse the predictive value of the cognitive tests included in a neuropsychological battery for conversion to AD among MCI participants and to analyse the influence of some sociodemographic variables – sex, age, schooling – and others, such as follow‐up time and emotional state. A total of 105 participants were assessed with a neuropsychological battery at baseline and during a 3‐year follow‐up period. For the present study, the data were analysed at baseline. During the follow‐up period, 24 participants (22.85%) converted to dementia (2.79 ± 1.14 years) and 81 (77.14%) remained as MCI. The logistic regression analysis determined that the long delay cued recall and the performance time of the Rey figure test were the best predictive tests of conversion to dementia after an MCI diagnosis. Concerning the sociodemographic factors, sex had the highest predictive power. The results reveal the relevance of the neuropsychological data obtained in the first assessment. Specifically, the data obtained in the episodic verbal memory tests and tests that assess visuospatial and executive components may help to identify people with MCI who may develop AD in an interval not longer than 4 years, with the masculine gender being an added risk factor.     

Neuropsychological Functioning in Chronic Lyme Disease

Lyme disease is currently the most common vector-borne illness in the United States. The disease is multisystemic, and chronic disease, in particular, may be associated with neuropsychological deficits. However, to date, only a few empirical studies exist, which examine the neuropsychological sequelae associated with chronic Lyme disease. A review of the literature shows that the deficits observed in adults with chronic Lyme disease are generally consistent with the deficits that can be seen in processes with primarily frontal systems involvement. These observations are generally consistent with neuroradiologic findings. The clinical presentation in chronic Lyme disease and the nature of the neuropsychological deficits are discussed, as are several central issues in understanding neuropsychological functioning in chronic Lyme disease, such as the impact of chronic illness, response to treatment, and the relationship between neuropsychological performance and depression, fatigue, and neurological indicators of disease.     

Neuropsychological subgroups of adolescents with conduct disorder

Närhi, V., Lehto‐Salo, P., Ahonen, T. & Marttunen, M. (2010). Neuropsychological subgroups of adolescents with conduct disorder. Scandinavian Journal of Psychology, 51, 278–284. In group‐level studies adolescents with conduct disorder (CD) have been found to have deficiencies in verbal and executive functions. Teichner and Golden (2000) addressed the neuropsychological heterogeneity of CD, and hypothesized the existence of six neuropsychologically different subgroups. We used that theoretical basis to identify subgroups among 77 adolescents with CD and 48 controls. Among subjects with CD we identified subjects with no, diffuse, verbal and executive function deficits, but none with specific memory or visuo‐spatial deficits. In total, neuropsychological deficits altogether were more common among subjects with CD relative to controls, as were specific verbal deficits. Subgroups did not differ in gender distribution, comorbidity of psychiatric disorders, type or severity of CD, or number of psychosocial risk factors. Among subjects with CD, learning disabilities were common. CD is neuropsychologically a heterogeneous disorder, and neuropsychological deficits should be taken into account in assessing and planning interventions for adolescents with CD.     

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.     

Neuropsychological function in a group of patients 25 years after sustaining minor head injuries as children and adolescents

Previous studies suggest that neuropsychological impairment following mild to moderate pediatric head injury may become persistent and interrupt the normal course of intellectual development. In this study 45 subjects were assessed with a standardized neuropsychological test battery 25 years after sustaining mild to moderate head injury as children. Although the group scores in the normal range, significant relations between head injury severity and current neuropsychological function were found. The most important predictor of poor outcome was length of PTA at injury, EEG pathology, and loss of consciousness at injury. No significant influence of pre- and post-injury risk factors on current neuropsychological function was evident. The findings support the view that complicated mild and moderate paediatric head injury may heighten the risk of developing subtle neuropsychological problems later in life.     

Neuropsychological tools to predict conversion from amnestic mild cognitive impairment to dementia. The TREDEM Registry

Most of the studies about conversion from Mild cognitive impairment (MCI) to dementia have focused on amnestic MCI (aMCI) which is considered a preclinical phase of Alzheimer’s disease. The aim of the present study was to identify neuropsychological tools that would best predict conversion from aMCI to dementia. Fifty-five aMCI subjects on the Treviso Dementia Registry were investigated. They underwent a neuropsychological evaluation during their first assessment and again at follow-up. Cox proportional-hazard regression models were created to measure the association between the dependent variable (dementia diagnosis or MCI status maintenance) and the neuropsychological test scores at baseline. The sample (28 women and 27 men; mean age 76.82 ± 5.88 years; education 7.62 ± 3.99 years) was observed for an average time of 2.17 ± 1.25 years. A Cox backward stepwise regression showed that the Rey Auditory Verbal Learning Test, Delayed Recall (p = .041) and Semantic Verbal Fluency tests (p = .031) appear to be useful in predicting conversion to dementia.     

Quantitative Electroencephalography (QEEG) and Neuropsychological Syndrome Analysis

The ideographic, syndrome analysis and the nomothetic, standardized test battery approaches to neuropsychological assessment are compared and contrasted within the context of advances in noninvasive technology readily available for use within the examiner's office. By demonstrating the relative strengths and benefits of syndrome analysis, it is suggested that this approach provides a thorough and efficient method of neuropsychological assessment. Subsequently, the utility of an a priori hypothesis testing process approach as a critical technique in syndrome analysis will be supported. It will be proposed that QEEG procedures provide a useful method for further substantiating conclusions generated from a syndrome analysis approach to neuropsychological assessment. Two cases are described demonstrating the utility and flexibility of the QEEG as a confirmatory test of localization following syndrome analysis. In summary, the contributions that neuropsychologists make to the understanding of brain–behavior relationships may be strengthened by combining neuropsychological and neurophysiological assessment methods.     

Neuropsychological Functioning in Children with Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) has been associated with deficits in the areas of verbal memory and learning, executive functioning, working memory, and attention in adults. Findings have been less consistent in the few studies examining neuropsychological functioning in childhood PTSD, which are often limited by comparing children with PTSD to children without trauma histories, making it unclear whether observed neuropsychological deficits are related to trauma exposure or to PTSD symptomatology. In an ethnically diverse sample of 62 children who witnessed intimate partner violence (n = 27 PTSD+ and 35 PTSD?), children with PTSD exhibited slower and less effective learning, heightened sensitivity to interference, and impaired effect of rehearsal on memory acquisition on the California Verbal Learning Test – Children's Version, a word list learning task. Both groups performed in the below average range on measures of executive functioning, attention, and intellectual ability.     

A taxonomy of neurobehavioral functions applied to neuropsychological assessment after head injury

Neuropsychological dysfunctions after traumatic brain injury are classified into a taxonomy to plan a comprehensive examination, and organize and report findings for diagnosis and treatment: consciousness, information processing, sensorimotor, neurophysiological, cerebral personality disorders, intelligence, memory, language, stress, psychodynamic, identity and weltanschauung, adaptation, complex adaptive functions, and development of children. Widerange sampling enhances the detection of acute and late-developing dysfunctions, and diagnosis of complex syndromes. Historical, personality, and injury data are components of the assessment. Issues discussed include underestimation of brain injury, malingering, interaction of symptoms, symptom persistence, and noncerebral lesional contributors to impairment after mild head injury.     

Clinical Implications and Methodological Challenges in the Study of the Neuropsychological Correlates of Cannabis,Stimulant, and Opioid Abuse

Chronic consumption of several drugs of abuse (cannabis, stimulants, opioids) has been associated with the presence of neuropsychological impairments in a broad range of functions. Nevertheless, in recent years neuropsychological research on substance abuse has focused on the study of impairments in the executive functions linked to the prefrontal cortex and their influence on the personality, cognitions, and behaviors of the substance abusers. The aim of our review is, first, to summarize the main neuropsychological impairments shown by classic studies, as well as these new discoveries in executive functioning; second, to consider the mediating role of neuropsychological status on treatment outcomes and analyze the impact of these impairments in clinical practice with drug addicts; and third, to review the principal methodological challenges associated with research in the field of the neuropsychology of substance abuse. We also highlight the convenience of intervening in those functions most relevant to the abusers' persistence in consumption and risk of relapse.     

Neuropsychological changes in children with cancer: The treatment of missing data in longitudinal studies

Researchers conducting longitudinal studies with children or adults are inevitably confronted with problems of attrition and missing data. Missing data in longitudinal studies is frequently handled by excluding from analyses those cases for whom data are incomplete. This approach to missing data is not optimal. On the one hand, if data are missing at random, then dropping incomplete cases ignores information collected on those cases that could be used to improve estimates of population parameters (e.g., means, variances, covariances, and growth rates) and improve the power of significance tests of statistical hypotheses. On the other hand, if data are not missing at random, then dropping incomplete cases leads to biased parameter estimates and hypothesis tests that may be internally and externally invalid. This study uses three years of follow-up data from a longitudinal investigation of neuropsychological outcomes of cancer in children to demonstrate the problems presented by missing data in repeated measures designs and some solutions. In evaluating potential biasing effects of attrition, the study extends previous research on neuropsychological outcomes in pediatric cancer by inclusion of patients whose disease had relapsed, and by comparison of surviving and nonsurviving patients. Although the data presented have specific relevance to the study of neuropsychological outcome in pediatric cancer, the problems of missing data and the solutions presented are relevant to a wide variety of diseases and conditions of interest to researchers in child and adult neuropsychology.     

Emotional disturbances and their interaction with neuropsychological deficits

The interaction and relationships between neuropsychological tests (which are principally oriented to intellectual and cognitive abilities) and tests of personality and emotional status are complex, but nevertheless important in the clinical assessment of brain-damaged persons. Are indications of emotional disturbances to be expected as a direct consequence of brain damage? If so, how can the indications of emotional disturbances be differentiated from results obtained with psychiatrically disturbed (non-brain-damaged) subjects? Some authors have presumed that emotional disturbances, such as depression, acute anxiety, etc., in their own right cause impaired performances on neuropsychological tests, whereas other authors have proposed that brain damage predisposes the individual to demonstrate evidence of emotional disturbances. If emotional disturbances cause impairment on neuropsychological tests, why is it that so many emotionally disturbed persons without brain damage tend to perform normally on neuropsychological tests? This review of relevant publications considers (1) different general approaches to these questions and their implications for neuropsychology, (2) evidence of differential sensitivity to brain damage of neuropsychological and emotional instruments, (3) the sensitivity and specificity of self-assessments and complaints of head-injured subjects, (4) MMPI findings among head-injured subjects and in interaction with neuropsychological measurements, and (5) principles and guidelines that may be of value in clinical application of findings reported in the literature.     

Quantitative EEG Assessment During Neuropsychological Task Performance in Adults with Attention Deficit Hyperactivity Disorder

This study evaluated the neuropsychological performance of adults with and without Attention Deficit Hyperactivity Disorder (ADHD) during the Paced Auditory Serial Addition Test (PASAT), Wisconsin Card Sorting Test: Computerized Version 3 (WCST), and the Integrated Visual and Auditory Continuous Performance Test (IVA). Quantitative electroencephalographic (QEEG) data were also collected during task performance to examine differences in cortical activity between groups and tasks. Results suggest that adults with ADHD demonstrated lower levels of performance on the PASAT and IVA, tasks that involve working memory and processing speed, and sustained attention, respectively. Adults with ADHD also had more upper alpha activity during the IVA. Lastly, for the ADHD group, an increased theta/beta ratio during the IVA was significantly related to poorer attentional performance. The current results support reinforcing specific types of cortical activity though EEG operant conditioning (neurofeedback) as a treatment option in adults with ADHD. This paper is based largely in part on a dissertation by J. Noland White in partial fulfillment of the requirements of his doctoral program at The University of Tennessee. Portions of this study have been presented in summary form at several professional conferences.     

轻度认知损伤的语义记忆研究述评

轻度认知损伤（Mild cognitive impairment,MCI）是介于正常老化与痴呆之间的过渡阶段,表现为与年龄和教育程度不相称的认知功能减退。本文回顾了近期有关MCI语义记忆的研究,分析比较了各研究的实验任务及结果,得出MCI患者存在一定程度的由多种原因造成的语义记忆损伤,语义记忆测验对MCI的早期筛查和转归预测有重要作用。最后指出将来的研究需要将包括语义记忆成分在内的多种认知测验相结合,以便及早发现有可能发展为痴呆的危险个体并开展相应干预。     

Executive Functioning in Children and Adolescents with Major Depressive Disorder

The present investigation examined neurocognitive functioning, focusing on executive functioning (EF), in 39 children and adolescents with Major Depressive Disorder (MDD) and 24 healthy control subjects all ages 8 to 17 years. The Wechsler Intelligence Scale for Children-Third Edition along with several measures of executive functioning including the Wisconsin Card Sorting Task, Trail Making Test, Controlled Oral Word Association Test, and the Stroop Color Word Test were administered. The neurocognitive profiles for the group of depressed children and adolescents were grossly intact as most scores on intellectual and EF measures fell within the average range and did not differ from the comparison group. Mental processing speed was decreased in the MDD versus normal control group and 27% of the depressed group performed below average on the Trail Making Test. This investigation provided a good base from which to compare future literature on EF in outpatients with early-onset MDD.     

Neuropsychological profiles of six children with anoxic brain injury

Anoxic brain injury (ABI) often results in severe memory impairment and other cognitive and behavioral deficits, although limited information is available regarding pediatric cases. This study reported the neuropsychological outcomes in six children and adolescents who sustained ABI. Profiles were compared by mechanism of injury (ischemic vs. hypoxemic) and three cases were evaluated more than once. Severe intellectual, attention, memory, and behavioral impairments were observed in all six cases although academic achievement, internalizing behavioral problems, and visuospatial deficits were in general less severe than other cognitive and behavioral deficits. The longitudinal case studies varied but showed steady increases in memory and intellectual performance in the younger children with strongest improvement in nonverbal abilities and little change in parent-reported behavior. This study raises several possible hypotheses about specific cognitive and behavioral outcomes observed in pediatric ABI.