Pediatric epilepsy surgery: neuroimaging, neuropsychology, and anticonvulsants

Neuroimaging and the neuropsychological evaluation are important components of the presurgical evaluation for epilepsy surgery. Advances in neuroimaging over the last decade, to a large part, underlie improvements in pediatric epilepsy surgery outcomes. The neuropsychological evaluation plays an important role in the evaluation of the older child and adolescent, particularly in the evaluation of mesial temporal sclerosis. However, its role in the young child being considered for surgery remains to be defined. This section reviews the definition of medical intractability, issues related to medication withdrawal during video-EEG monitoring, recent neuroimaging advances, and the neuropsychological evaluation.     

Myths of neuropsychology: intelligence, neurometabolism, and cognitive ability

Recently, Dodrill (1999) revised a previously described "Myth of neuropsychology" (1997) to state: "Just as below average performances on neuropsychological tests are found when intelligence is below average, to that same degree above average performances on neuropsychological tests are expected when intellectual abilities are above average." This study addresses the relationship between intellectual and neuropsychological performance in the context of Magnetic Resonance Spectroscopy (MRS) measurements of the neurometabolite N-acetylaspartate (NAA). When subjects were stratified by Full Scale IQ (Average, High Average, Superior) they differed significantly in terms of total neuropsychological performance [F(2,47) = 17.63; p <.001] and the neuronal marker NAA [F(2,47) = 3.25; p <.05]. Regression analysis across groups demonstrated that FSIQ and NAA were independently related to Total z-score [F(1,47) = 29.43; p <.0001] and accounted for over half the variance (r(2) of model =.56). The concurrent relationship of FSIQ and NAA to total neuropsychological performance suggests that the relationship between measures sensitive to intellectual ability and neuropsychological performance is real, and does not reflect arbitrary psychometric or scaling properties of the WAIS-III.     

Meta-analysis in neuropsychology: basic approaches, findings, and applications

This article is a broad review of the approaches, findings, and applications of meta-analyses on clinical neuropsychological topics. The review is divided into four sections: basic characteristics of meta-analysis; the value of meta-analysis for neuropsychological investigations; illustrative findings from various meta-analyses on neuropsychological topics demonstrating the type of questions that can be answered; and problems and limitations of meta-analysis with a focus on future directions. The article is not intended to exhaustively review all the relevant literature nor detail the technical aspects of meta-analytic techniques, but rather it is designed to provide a basic, conceptual introduction for the general reader, particularly the clinician, to aid in comprehension of the now burgeoning literature that uses meta-analysis. Throughout, illustrative examples are developed and references are made to the practice of clinical neuropsychology.     

Entry into clinical neuropsychology: Graduate,undergraduate, and beyond

Abstract

Psychologists at all levels of training have become interested in entering the field of clinical neuropsychology. The issues and obstacles pertaining to entry at various professional levels are discussed. Training and credentialing issues surrounding the question of minimal levels of competence have direct bearing on the protection of the discipline of neuropsychology and the population who receive neuropsychological services.     

认知神经心理学——认知研究领域的新生儿?

认知科学的核心学科是人工智能和人工神经网络 ;神经科学包括脑损害定位、分子生物学、脑神经构像技术等。但二者面对科学王冠上的明珠———人类大脑智能奥秘的研究都显得力不从心 ,两者结合孕育出科学的新秀———认知神经科学 ,认知神经科学是上述两大科学体系相结合的 2 0世纪 90年代的新生儿。认知科学可看作是认知神经科学之父 ,神经科学可看作是其母。认知神经科学包括 :认知神经心理学、认知心理生理学、认知生理心理学、认知神经生物学、计算神经科学。意在发展跨学科、多层次的理论研究 ,合力攻克大脑智能之谜。一、认知科学 (ｃ…     

The challenge of forgetting: Neurobiological mechanisms of auditory directed forgetting

Directed forgetting (DF) is considered an adaptive mechanism to cope with unwanted memories. Understanding it is crucial to develop treatments for disorders in which thought control is an issue. With an item‐method DF paradigm in an auditory form, the underlying neurocognitive processes that support auditory DF were investigated. Subjects were asked to perform multi‐modal encoding of word‐stimuli before knowing whether to remember or forget each word. Using functional magnetic resonance imaging, we found that DF is subserved by a right frontal‐parietal‐cingulate network. Both qualitative and quantitative analyses of the activation of this network show converging evidence suggesting that DF is a complex process in which active inhibition, attentional switching, and working memory are needed to manipulate both unwanted and preferred items. These results indicate that DF is a complex inhibitory mechanism which requires the crucial involvement of brain areas outside prefrontal regions to operate over attentional and working memory processes. Hum Brain Mapp 39:249–263, 2018. © 2017 Wiley Periodicals, Inc.     

Encephalitis in children: a clinical neuropsychology perspective

Encephalitis is an inflammation of brain tissue that can result from a number of viruses and can be contracted at any age, with prevalence in children exceeding adult incidence. In order to illustrate specific cognitive, behavioural and service provision issues related to post-encephalitis rehabilitation of children, this paper examines the pattern of referrals to a specialist regional paediatric neuropsychology service in the United Kingdom. Three case vignettes are presented to demonstrate the wide range of presentations encountered in our service ranging from mild (10%) to moderate (65%) and severe (25%) impairment with 80% of referrals relating to behaviour and educational concerns. On average 13 new referrals are received annually resulting in a cumulative case-load due to the need for serial assessment. The implications for patient care are discussed.     

Cytokines, neurophysiology, neuropsychology, and psychiatric symptoms

Recent research has overcome the old paradigms of the brain as an immunologically privileged organ, and of the exclusive role of neurotransmitters and neuropeptides as signal transducers in the central nervous system. Growing evidence suggests that the signal proteins of the immune system - the cytokines - are also involved in modulation of behavior and induction of psychiatric symptoms. This article gives an overview on the nature of cytokines and the proposed mechanisms of immune-to-brain interaction. The role of cytokines in psychiatric symptoms, syndromes, and disorders like sickness behavior, major depression, and schizophrenia are discussed together with recent immunogenetic findings.     

Classification in neuropsychology: a theoretical framework and research paradigm

Classification research is not well understood in neuropsychology. A major purpose of classification research is to establish and investigate inclusion and exclusion criteria for group formation. Therefore, classification represents the foundations of clinical assessment as well as traditional contrasting groups research designs in neuropsychology. Null results in neuropsychological research do not pinpoint the basis for the absence of group differences. The most frequent research focuses on the original theory or the validity of the dependent variables. Classification research focuses on a third potential problem area, which has received little attention: poor subject classifications (invalid independent variables). The purpose of this paper is to describe a general theoretical framework and outline a set of decisions for conducting classification research in neuropsychology.     

Coalescence of psychiatry, neurology, and neuropsychology: from theory to practice

In a climate of renewed interest in the synergy between neurology and psychiatry, practitioners are increasingly recognizing the importance of exchange and collaboration between these two disciplines. However, there are few working models of interdisciplinary teams that freely share expertise in real time, while providing clinical and academic training to future physicians who specialize in the central nervous system. Over the past 11 years, the McLean Hospital Neuropsychiatry and Behavioral Neurology service has provided proof-of-principle for such collaboration, demonstrating that a team comprising psychiatrists, neurologists, and neuropsychologists can function effectively as a unit while maintaining the autonomy of these three disciplines and also synthesizing their combined knowledge. In addition to delivering enhanced patient care and promoting medical research, this clinical service has provided enriched cross-specialty training for fellows, residents, and medical students. The practical functioning of the team is described, and case vignettes are presented to illustrate the team's collaborative synergism in practice.     

The neuropsychology of borderline personality disorder: a meta-analysis and review

The neuropsychological profile of borderline personality disorder (BPD) is unclear. Past investigations have produced seemingly inconsistent results concerning precisely what neuropsychological deficits characterize the patient with BPD. A meta-analysis of 10 studies was conducted comparing BPD and healthy comparison groups on selected neuropsychological measures comprising six domains of functioning: attention, cognitive flexibility, learning and memory, planning, speeded processing, and visuospatial abilities. BPD participants performed more poorly than controls across all neuropsychological domains, with mean effect sizes (Cohen's d) ranging from − 0.29 for cognitive flexibility to − 1.43 for planning. The results suggest that persons with BPD perform more poorly than healthy comparison groups in multiple neurocognitive domains and that these deficits may be more strongly lateralized to the right hemisphere. Although neuropsychological testing appears to be sensitive to the neurocognitive deficits of BPD, the clinical utility of these results is limited. Implications of these findings for future neurocognitive investigations of BPD are discussed.     

Toward a cognitive neuropsychology of awareness: implicit knowledge and anosognosia

Although a systematic cognitive neuropsychology of awareness has not yet emerged, a number of phenomena reported in the literature provide an empirical basis for developing it. The present discussion focusses on two such phenomena: implicit knowledge, which refers to knowledge that is expressed in task performance unintentionally and with little phenomenal awareness; and anosognosia, which refers to unawareness of neuropsychological deficits. Two types of theoretical accounts of these phenomena are discussed. A first order theoretical account entails postulating damage to, or disconnection of, a system or process that generates awareness across multiple domains. A second-order account does not postulate disruption of a cross-domain awareness mechanism, but instead appeals to difficulties in gaining access to particular kinds of domain-specific information that are associated with aware expressions of knowledge in individual domains. Instances of first- and second-order accounts are illustrated with examples from studies of memory and amnesia. The relation between implicit knowledge and anosognosia is also discussed.     

Clinical neuropsychology in Israel: history,training, practice and future challenges

Objective: This is an invited paper for a special issue on international perspectives on training and practice in clinical neuropsychology. We provide a review of the status of clinical neuropsychology in Israel, including the history of neuropsychological, educational, and accreditation requirements to become a clinical neuropsychologist and to practice clinical neuropsychology. Method: The information is based primarily on the personal knowledge of the authors who have been practicing clinical neuropsychology for over three decades and hold various administrative and academic positions in this field. Second, we conducted three ad hoc surveys among clinical and rehabilitation psychologists; heads of academic programs for rehabilitation and neuropsychology; and heads of accredited service providers. Third, we present a literature review of publications by clinical neuropsychologists in Israel. Results: Most of the clinical neuropsychologists are graduates of either rehabilitation or clinical training programs. The vast majority of neuropsychologists are affiliated with rehabilitation psychology. The training programs (2–3 years of graduate school) provide solid therapeutic and diagnostic skills to the students. Seventy-five percent of the participants in this survey are employed at least part-time by public or state-funded institutions. Israeli neuropsychologists are heavily involved in case management, including vocational counseling, and rehabilitation psychotherapy. Conclusions and future goals: Although clinical neuropsychologists in Israel are well educated and valued by all health professionals, there are still several challenges that must be addressed in order to further advance the field and the profession. These included the need for Hebrew-language standardized and normalized neuropsychological tests and the application of evidence-based interventions in neuropsychological rehabilitation.     

Aphasia and dementia: Steps towards a new era in neuropsychology

Abstract

Once the victim of comparative neglect, the study of language in patients with dementia is beginning to flourish. It is important for both practical and theoretical reasons. Language dysfunction can be prominent in patients with dementia and indeed may be the presenting symptom (e.g. Pogacar and Williams 1984, Wechsler, Verity, Rosenschein, Fried and Scheibel 1982). The presence or absence of language impairment has come to occupy a key role in relation to a number of nosological and nosographic issues. These include the controversial classification of the dementias into cortical and subcortical types and the distinction between so-called early- and late-onset types of Alzheimer's disease, the most common cause of dementia. Furthermore, it has been suggested that impairment of language in patients with dementia may be a useful index of severity and can have prognostic implications (Bayles and Boone 1982, Kaszniak, Fox, Gandell, Garron, Huckman and Ramsay 1978, Skelton-Robinson and Jones 1984). Impaired communicative abilities undoubtedly contribute to the burden of caring which falls largely upon the shoulders of relatives (Gilleard, Boyd and Watt 1982).