The Role of Neurocognitive Tests in the Assessment of Adult Attention-Deficit/Hyperactivity Disorder

Despite widespread recognition that attention-deficit/hyperactivity disorder (ADHD) is a lifelong neurodevelopmental disorder, optimal methods of diagnosis among adults remain elusive. Substantial overlap between ADHD symptoms and cognitive symptoms of other mental health conditions, such as depression and anxiety, and concerns about validity in symptom reporting have made the use of neuropsychological tests in ADHD diagnostic assessment appealing. However, past work exploring the potential diagnostic utility of neuropsychological tests among adults has often relied on a relatively small subset of tests, has failed to include symptom and performance validity measures, and often does not include comparison groups of participants with commonly comorbid disorders, such as depression. The current study examined the utility of an extensive neuropsychological measure battery for diagnosing ADHD among adults. Two hundred forty-six participants (109 ADHD, 52 depressed, 85 nondisordered controls) completed a multistage screening and assessment process, which included a clinical interview, self, and informant report on behavior rating scales, performance and symptom validity measures, and an extensive neuropsychological testing battery. Results indicated that measures of working memory, sustained attention, response speed, and variability best discriminated ADHD and non-ADHD participants. While single test measures provided performed poorly in identifying ADHD participants, analyses revealed that a combined approach using self and informant symptom ratings, positive family history of ADHD, and a reaction time (RT) variability measure correctly classified 87% of cases. Findings suggest that neuropsychological test measures used in conjunction with other clinical assessments may enhance prediction of adult ADHD diagnoses

Unimpaired Neuropsychological Performance and Enhanced Memory Recall in Patients with Sbma: A Large Sample Comparative Study.

Peculiar cognitive profile of patients with SBMA has been described by fragmented literature. Our retrospective study reports the neuropsychological evaluations of a large cohort of patients in order to contribute towards the understanding of this field. We consider 64 neuropsychological evaluations assessing mnesic, linguistic and executive functions collected from 2013 to 2015 in patients attending at Motor Neuron Disease Centre of University of Padova. The battery consisted in: Digit Span forwards and backwards, Prose Memory test, Phonemic Verbal fluency and Trail making tests. ANCOVA statistics were employed to compare tests scores results with those obtained from a sample of healthy control subjects. Multiple linear regressions were used to study the effect on cognitive performance of CAG-repeat expansion, the degree of androgen insensitivity and their interaction to cognitive performance. Statistical analyses did not reveal altered scores in any neuropsychological tests among those adopted. Interestingly, patients performed significantly better in the Prose Memory test's score. No relevant associations were found with genetic, hormonal or clinical patients' profile. Results inconsistent with previous studies have been interpreted according to the phenomenon of somatic mosaicism. We suggest a testosterone-related and the mood state-dependant perspectives as two possible interpretations of the enhanced performances in the Prose Memory test. Further studies employing more datailed tests batteries are encouraged

Low myo-inositol and high glutamine levels in brain are associated with neuropsychological deterioration after induced hyperammonemia

The neuropsychological effect of hyperammonemia is variable. This study tests the hypothesis that the effect of ammonia on the neuropsychological function in patients with cirrhosis is determined by the ability of the brain to buffer ammonia-induced increase in glutamine within the astrocyte by losing osmolytes like myo-inositol (mI) and not by the magnitude of the induced hyperammonemia. Fourteen cirrhotic patients with no evidence of overt hepatic encephalopathy were given a 75-g amino acid (aa) solution mimicking the hemoglobin molecule to induce hyperammonemia. Measurement of a battery of neuropsychological function tests including immediate memory, ammonia, aa, and short-echo time proton magnetic resonance spectroscopy were performed before and 4 h after administration of the as solution. Eight patients showed deterioration in the Immediate Memory Test at 4 h. Demographic factors, severity of liver disease, change in plasma ammonia, and as profiles after the as solution were similar in those that showed a deterioration compared with those who did not. In patients who showed deterioration in the memory test, the mI-to-creatine ratio (mI/Cr) was significantly lower at baseline than those that did not deteriorate. In contrast, the glutamate/glutamine-to-Cr ratio was significantly greater in the patients that deteriorated. The observation that deterioration in the memory test scores was greater in those with lower mI/Cr supports the hypothesis that the neuropsychological effects of induced hyperammonemia is determined by the capacity of the brain to handle ammonia-induced increase in glutamine

Neuropsychological Tests for developmental Disorders

注意欠陥/多動性障害や広汎性発達障害などの発達障害をともなう子どもへの適切な教育を行う特別支援教育のための個々のニーズの適切な実態把握が必要とされている。本論文では客観的な評価手法の1つとして子どもへの適用が検討されているウィスコンシンカード分類テストやストループテストなどの各種神経心理学的検査について,その諸特性と本邦での動向を概観した。わが国の各検査の子どもにおける標準化は未だ十分ではなく,臨床応用には発達的変化の検討や標準値の作成が進められることが課題と考えられた

How Valuable are Clinical Neuropsychological Assessments? A Meta-analysis of Neuropsychological Tests with Comparison to Common Medical Tests and Treatments

There has been a general decrease in neuropsychological assessments at a time when medical diagnostic technology and treatments have expanded, leading to a faulty assumption that medical tests and healthcare treatments provide more reliable or valid data than psychological assessments. A landmark report from the American Psychological Association’s (APA) Psychological Assessment Work Group (PAWG) found that validity coefficients for many psychological tests were indistinguishable from those of medical tests (Meyer et al., 2001). An updated systematic review of the advancement in neuropsychological testing is essential to the continued advancement of the value of neuropsychological assessment in healthcare. This meta-analysis sought to (1) summarize effect sizes of neuroimaging to diagnose dementia, medications to treat chronic diseases, and neuropsychological tests to diagnose dementia and TBI, (2) determine the differences (if any) in effect sizes between medical domains, and (3) determine the differences (if any) in effect sizes between medical domains and neuropsychological tests. EBSCO networks were searched for original research examining the efficacy of neuroimaging for Alzheimer’s Disease (AD),neuropsychological tests for AD and traumatic brain injury (TBI), and medication to treat memory impairment and cardiovascular events between clinical and control samples. Studies were coded using a complex multi-comparison, outcome, and subgroup schema. Data were analyzed under random-effects modeling. Of 6,668 studies identified, 78 were retained for primary and ancillary meta-analyses (715 effect sizes extracted; 35,810 clinical and 42,964 control participants represented). Primary results indicated a significant difference between domains, such that neuroimaging (g = -1.603) and neuropsychological tests (g = -1.591) both yielded greater effect sizes than medication studies (g = -0.009]. Secondary results indicated the AD neuropsychological test effect size [g = -2.213) was significantly different than the TBI neuropsychological test efficacy [g = -0.649; Q(1) = 42.821, p = 0.000]. Additionally, results indicated nonsignificant effect sizes for both memory impairment medications (g = -.052) and aspirin for cardiovascular events (g = .017). CONCLUSIONS: The diagnostic efficacy of neuroimaging and neuropsychological tests were both substantial and non-significantly different from one another. These findings provide clinicians and consumers with convincing evidence that neuropsychological tests are a reliable diagnostic tool for people with acquired and neurodegenerative brain disorders

An investigation into the relationship between performance on tests neuropsychological function and performance on three everyday problem-solving tasks

This study set out to examine the relationship between performance on neuropsychological tests and performance on everyday-problem solving tasks. Three everyday problem-solving tasks covering three domains of daily life were developed, and a battery of neuropsychological tests known to have an executive function component was selected. A within participants design was used and tasks and tests were administered to a group of thirty-two individuals (hospital inpatients and outpatients) with non-progressive brain- injuries. Correlations between individual tests and everyday problem-solving tasks were examined and three multiple regressions (one for each of the everyday problem-solving tasks) carried out. Comparison of performances on individual neuropsychological tests with those on the three everyday problem-solving tasks showed: (a) Performance on the Six Elements Test, an executive function test considered to have high ecological validity, correlated well with performance on the three problem- solving tasks, (b) The pattern of significant relationships between individual problem-solving tasks and individual neuropsychological tests suggested that there was a degree of specificity to each of the three everyday problem-solving tasks designed, (c) In some participants a dissociation between performance on everyday problem-solving tasks and on neuropsychological tests of executive function was observed. The multiple regression analyses, carried out to explore the explanatory value of performance on the battery of neuropsychological tests for performance on the everyday problem-solving tasks, showed that, depending on the task, between one quarter and one third of overall performance were explained by the group of neuropsychological tests administered. The study is best regarded as a pilot project on which to base further exploration of the association between performance on pure tests of neuropsychological functioning and performance on tasks of everyday problem-solving

How Valuable are Clinical Neuropsychological Assessments? A Meta-analysis of Neuropsychological Tests with Comparison to Common Medical Tests and Treatments

There has been a general decrease in neuropsychological assessments at a time when medical diagnostic technology and treatments have expanded, leading to a faulty assumption that medical tests and healthcare treatments provide more reliable or valid data than psychological assessments. A landmark report from the American Psychological Association’s (APA) Psychological Assessment Work Group (PAWG) found that validity coefficients for many psychological tests were indistinguishable from those of medical tests (Meyer et al., 2001). An updated systematic review of the advancement in neuropsychological testing is essential to the continued advancement of the value of neuropsychological assessment in healthcare. This meta-analysis sought to (1) summarize effect sizes of neuroimaging to diagnose dementia, medications to treat chronic diseases, and neuropsychological tests to diagnose dementia and TBI, (2) determine the differences (if any) in effect sizes between medical domains, and (3) determine the differences (if any) in effect sizes between medical domains and neuropsychological tests. EBSCO networks were searched for original research examining the efficacy of neuroimaging for Alzheimer’s Disease (AD), xi neuropsychological tests for AD and traumatic brain injury (TBI), and medication to treat memory impairment and cardiovascular events between clinical and control samples. Studies were coded using a complex multi-comparison, outcome, and subgroup schema. Data were analyzed under random-effects modeling. Of 6,668 studies identified, 78 were retained for primary and ancillary meta-analyses (715 effect sizes extracted; 35,810 clinical and 42,964 control participants represented). Primary results indicated a significant difference between domains, such that neuroimaging (g = -1.603) and neuropsychological tests (g = -1.591) both yielded greater effect sizes than medication studies (g = -0.009]. Secondary results indicated the AD neuropsychological test effect size [g = -2.213) was significantly different than the TBI neuropsychological test efficacy [g = -0.649; Q(1) = 42.821, p = 0.000]. Additionally, results indicated nonsignificant effect sizes for both memory impairment medications (g = -.052) and aspirin for cardiovascular events (g = .017). CONCLUSIONS: The diagnostic efficacy of neuroimaging and neuropsychological tests were both substantial and non-significantly different from one another. These findings provide clinicians and consumers with convincing evidence that neuropsychological tests are a reliable diagnostic tool for people with acquired and neurodegenerative brain disorders