Neuropsychological functioning in mid-life treatment-seeking adults with obesity: a cross-sectional study

Objective: To compare cognitive functioning between treatment-seeking individuals with obesity and healthy-weight adults. Design and Methods: Sixty-nine bariatric surgery candidates (BMI>30kg/m2) and 65 healthy-weight control participants (BMI 18.5-25kg/m2) completed a neuropsychological battery and a self-report psychosocial questionnaire battery. Results: Hierarchical regression analyses indicated that obesity was predictive of poorer performance in the domains of psychomotor speed (p=.043), verbal learning (p<.001), verbal memory (p=.002), complex attention (p=.002), semantic verbal fluency (p=.009), working memory (p=.002), and concept formation and set-shifting (p=.003), independent of education. Obesity remained a significant predictor of performance in each of these domains, except verbal memory, following control for obesity-related comorbidities. Obesity was not predictive of visual construction, visual memory, phonemic verbal fluency or inhibition performance. Individuals with obesity also had significantly poorer decision making compared to healthy-weight controls. Conclusions: Findings support the contribution of obesity to selective aspects of mid-life cognition after controlling for obesity-related comorbidities, while addressing limitations of previous research including employment of an adequate sample, a healthy-weight control group, and stringent exclusion criteria. Further investigation into the functional impact of such deficits, the mechanisms underlying these poorer cognitive outcomes, and the impact of weight-loss on cognition is required

The experience and acceptability of smartphone reminder app training for people with acquired brain injury : A mixed methods study

Smartphones are useful compensatory memory aids, yet training on how to use them is seldom offered as part of rehabilitation for acquired brain injuries (ABIs). We aimed to explore the experience and acceptability of a smartphone training intervention in 26 people with ABI who participated in a pilot randomized controlled trial comparing three skills training approaches. Participants completed questionnaire ratings and a semi-structured interview, six weeks post-training. Most participants rated the training as enjoyable (80.8%) and reasonable in duration (88.5%). Others reported that more than one training session was needed to learn the app (34.6%). Five themes were identified from qualitative data through thematic analysis: (1) Attitudes and pre-existing factors, (2) Experiencing the intervention, (3) Tailoring the intervention to the individual, (4) Facilitators and barriers to implementation and (5) Enhancing smartphone use in everyday life. These themes were juxtaposed with a theoretical framework of acceptability, which indicated that some elements (e.g., having a structured session and a supportive trainer) contributed to the acceptability of the intervention by minimizing training burden and increasing self-efficacy. Tailoring the training to the individual’s technological skills and lifestyle, providing post-training resources and involving family members were identified as factors that could improve intervention acceptability

General and domain-specific effectiveness of cognitive remediation after stroke: Systematic literature review and meta-analysis

Cognitive remediation (CR) has been shown to improve cognitive abilities following a stroke. However, an updated quantitative literature review is needed to synthesize recent research and build understanding of factors that may optimize training parameters and treatment effects. Randomized controlled trials of CR were retrieved from seven electronic databases. Studies specific to adult stroke populations were included. Treatment effects were estimated using a random effects model, with immediate and longer-term follow-up outcomes, and moderator effects, examined for both overall and domain-specific functioning. Twenty-two studies were identified yielding 1098 patients (583 in CR groups). CR produced a small overall effect (g = 0.48, 95% CI 0.35–0.60, p < 0.01) compared with control conditions. This effect was moderated by recovery stage (p < 0.01), study quality (p = 0.04), and dose (p = 0.04), but not CR approach (p = 0.63). Significant small to medium (g = 0.25–0.75) post-intervention gains were evident within each individual outcome domain examined. A small overall effect (g = 0.27, 95% CI 0.04–0.51, p = 0.02) of CR persisted at follow-up (range 2–52 weeks). CR is effective and efficient at improving cognitive performance after stroke. The degree of efficacy varies across cognitive domains, and further high-quality research is required to enhance and sustain the immediate effects. Increased emphasis on early intervention approaches, brain-behavior relationships, and evaluation of activity and participation outcomes is also recommended

Comparing performance across in-person and videoconference-based administrations of common neuropsychological measures in community-based survivors of stroke

Objective: Neuropsychological assessment via videoconference could assist in bridging service access gaps due to geographical, mobility, or infection control barriers. We aimed to compare performances on neuropsychological measures across in-person and videoconference-based administrations in community-based survivors of stroke. Method: Participants were recruited through a stroke-specific database and community advertising. Stroke survivors were eligible if they had no upcoming neuropsychological assessment, concurrent neurological and/or major psychiatric diagnoses, and/or sensory, motor, or language impairment that would preclude standardised assessment. Thirteen neuropsychological measures were administered in-person and via videoconference in a randomised crossover design (2-week interval). Videoconference calls were established between two laptop computers, facilitated by Zoom. Repeated-measures t tests, intraclass correlation coefficients (ICCs), and Bland–Altman plots were used to compare performance across conditions. Results: Forty-eight participants (26 men; Mage = 64.6, SD = 10.1; Mtime since stroke = 5.2 years, SD = 4.0) completed both sessions on average 15.8 (SD = 9.7) days apart. For most measures, the participants did not perform systematically better in a particular condition, indicating agreement between administration methods. However, on the Hopkins Verbal Learning Test – Revised, participants performed poorer in the videoconference condition (Total Recall Mdifference = −2.11). ICC estimates ranged from .40 to .96 across measures. Conclusions: This study provides preliminary evidence that in-person and videoconference assessment result in comparable scores for most neuropsychological tests evaluated in mildly impaired community-based survivors of stroke. This preliminary evidence supports teleneuropsychological assessment to address service gaps in stroke rehabilitation; however, further research is needed in more diverse stroke samples

Comparing face-to-face and videoconference completion of the Montreal Cognitive Assessment (MoCA) in community-based survivors of stroke

Introduction Videoconferencing may help address barriers associated with poor access to post-stroke cognitive screening. However, the equivalence of videoconference and face-to-face administrations of appropriate cognitive screening tools needs to be established. We compared face-to-face and videoconference administrations of the Montreal Cognitive Assessment (MoCA) in community-based survivors of stroke. We also evaluated whether participant characteristics (e.g. age) influenced equivalence. Methods We used a randomised crossover design (two-week interval). Participants were recruited through community advertising and use of a stroke-specific database. Both sessions were conducted by the same researcher in the same location. Videoconference sessions were conducted using Zoom. A repeated-measures t-test, intraclass correlation coefficient (ICC), Bland–Altman plot and multivariate regression modelling were used to establish equivalence. Results Forty-eight participants (26 men, Mage = 64.6 years, standard deviation (SD) = 10.1; Mtime since stroke = 5.2 years, SD = 4.0) completed the MoCA face-to-face and via videoconference on average 15.8 (SD = 9.7) days apart. Participants did not perform systematically better in a particular condition, and no participant variable predicted difference in MoCA performance. However, the ICC was low (0.615), and the Bland–Altman plot indicated wide limits of agreement, indicating variability between sessions. Discussion Our findings provide preliminary evidence to support the use of videoconference to administer the MoCA following stroke. However, further research into the test–retest reliability of scores derived from the MoCA is needed in this population. Administering the MoCA via videoconference holds potential to ensure that all stroke survivors undergo cognitive screening, in line with recommended clinical practice

The use of videoconferencing in clinical neuropsychology practice : A mixed methods evaluation of neuropsychologists' experiences and views

Objective Videoconference technology may be a means of improving access to neuropsychological services. We investigated the use of, and views on, videoconference for clinical purposes among neuropsychologists in Australia. Method An online survey was completed by a convenience sample of neuropsychologists (i.e., registered psychologists working in clinical neuropsychology roles) between March and June 2018, recruited through a profession‐based email group and word‐of‐mouth. Quantitative data were analysed descriptively and open‐ended responses summarised using thematic analysis. Results Among 90 eligible respondents (77 female; Mage = 39.9-years, SD = 9.6, range: 25–69; Mexperience = 9.3-years, SD = 6.3, range: 1–26), only 25 (27.8%) had used videoconference in their clinical practice. The majority of these respondents had only used it once or less than monthly. Use was particularly scarce for history taking interviews (n = 6) and assessments (n = 6). Those who had not used videoconference were less willing to try it for clinical assessments in comparison to other areas of service delivery. Five themes characterised clinicians' views on videoconference in neuropsychology: tradition, practical and resource‐related considerations, quality of the clinical service, improved service resource use and clinician convenience, and client convenience, comfort and access. Conclusions Currently, few neuropsychologists use videoconferencing for client consultations. Positive and negative perceptions were reported. Education, training, and directions for future research were recommended to address barriers and increase uptake of the use of videoconference in clinical neuropsychology practice