tag:blogger.com,1999:blog-46048588487331412952024-03-14T05:54:23.087-04:00The Cortex UnfoldedA neuropsychology blog focused on research and news relevant to brain-behavior relationshipsAnonymoushttp://www.blogger.com/profile/10965118499171942070noreply@blogger.comBlogger12125tag:blogger.com,1999:blog-4604858848733141295.post-36593194633877736322015-11-17T22:23:00.000-05:002015-11-17T22:23:47.802-05:00The Psychology of Anti-Refugee Attitudes, Part 1<div class="MsoNormal">
As a psychology 101 instructor whose students are largely
non-psychology majors, I generally introduce the course objectives by stating,
“You are going to forget most of what I teach you in this class.” Although that
may sound like a pessimistic way to begin a semester, there is a reason for
this statement. Those students that elect not to major in psychology will
likely forget about schedules of reinforcement, the functions of the parietal
lobe, and the specifics of Piaget’s stages, and that’s ok.<span style="mso-spacerun: yes;"> </span>What I expect them to take from my course is
an ability to think critically about issues that they will face in the future,
whether they be personal, political, or otherwise – a skill that will be useful
to them throughout their lives, no matter their chosen career. Throughout the
course, we discuss a number of psychological phenomena that affect critical
thinking abilities. What follows is a breakdown of a number of these phenomena,
using the current debate surrounding the Syrian refugee crisis as a framework.
These phenomena include biases in thinking as well as social psychological
principles. For the sake of brevity, I will divide this into two posts: the
first discussing thinking biases, and the second addressing social
psychological concepts. <o:p></o:p></div>
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First, I want to discuss critical thinking briefly. While
there are multiple theories regarding stages/levels of critical thinking, the
one we focus on in my course was developed by King and Kitchener (2004), who
proposed several levels of critical thinking divided into 3 categories:<o:p></o:p></div>
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<!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">1)<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><i style="mso-bidi-font-style: normal;">Pre-reflective
thinkers</i> tend to assume that a correct answer always exists and that it can
be obtained through the senses or from authorities. So, in thinking about the
refugee crisis, pre-reflective thinkers are likely to base their opinions on
what they hear from whatever politicians, media, or other “authority figures”
believe. Certainly we are all influenced by this, but pre-reflective thinkers
take no other steps to think for themselves. They are also uncomfortable with
nuance or a lack of certainty, believing a clear solution is always available.
These individuals will assume that some action (bombing Syria, putting troops
on the ground, impeaching the president, refusing refugees, etc.) will solve
the problem of ISIS.<o:p></o:p></div>
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<div class="MsoListParagraphCxSpFirst" style="margin-left: .75in; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -.25in;">
<!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">2)<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]--><i style="mso-bidi-font-style: normal;">Quasi-reflective
thinkers</i> recognize that some things cannot be known with absolute certainty
and that judgments should be supported by evidence, yet they pay attention only
to evidence that fits what they already believe. On the positive side, they are
able to acknowledge that a clear correct solution may not always exist. The
issue of ISIS is a perfect example. How can we get rid of them? Should we put
boots on the ground and stomp them out, likely being forced to occupy
indefinitely to keep the peace? Should we bomb from afar? Should we stay out of
the Middle East completely? There are no easy answers here. <span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>On the
other hand, quasi-reflective thinkers ignore evidence that goes against their
beliefs - another powerful psychological concept referred to as “confirmation
bias” – something I am certainly not immune to despite being aware of. Those
who do not want to allow Syrian refugees into the U.S. are likely to only pay
attention to the information that Syrians are dangerous, only read articles criticizing
the Obama administration, and ignore conflicting evidence/perspectives. Thus, a
conservative individual may obtain his news only from Fox News Channel, which
confirms the individual’s beliefs and results in making them even stronger.
Those on the other side are equally likely to pay attention only to evidence
that would support the acceptance of Syrian refugees. <o:p></o:p></div>
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<!--[if !supportLists]--><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">3)<span style="font: 7.0pt "Times New Roman";">
</span></span></span><!--[endif]-->Those who use <i style="mso-bidi-font-style: normal;">reflective judgment </i>acknowledge that some things can never be known
with certainty, but some judgments are more valid than others. These
individuals also use <i style="mso-bidi-font-style: normal;">dialectical
reasoning</i>, which involves considering and comparing opposing points of view
in order to resolve differences (essentially what juries are supposed to do in
deciding a case). Most people show no evidence of reflective judgment until their
middle or late 20s, if ever. <o:p></o:p></div>
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Before we move on, I want to make an additional point about
confirmation bias. Have you ever tried arguing with someone about something you
both feel strongly about? Have you ever successfully changed someone’s mind on
that issue? Probably not, and confirmation bias is one of the main reasons why.
Let me tell you about a recent study that explained how this works. Researchers
at UCLA divided adults whom were skeptical of the safety of vaccinations into
three groups. One group was provided information from the CDC explaining that
the Measles, Mumps, & Rubella (MMR) vaccine is safe. The second group read
materials that described the dangers of those diseases and viewed images of
children with the diseases, as well as information on how vaccines can prevent
the diseases. The third group was a control that read a statement unrelated to
MMR vaccines. The researchers found that explaining the dangers of the diseases
was the only approach that increased support for vaccination - presenting
evidence of the safety of vaccines had no effect (Home, Powell, Hummel, &
Holyoak, 2015). <o:p></o:p></div>
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That evidence doesn’t change people’s minds is no surprise.
Other research has found that not only do people ignore disconfirming evidence,
but when people have strong beliefs, such evidence can sometimes serve to make
people even more entrenched in their views (Nyhan & Reifler, 2010).<o:p></o:p></div>
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In addition to confirmation bias, we use certain shortcuts,
known as <i>heuristics</i>, to help us
quickly process information and make decisions (Myers & DeWall, 2014).
These heuristics are useful most of the time, but can sometimes lead us astray.
One such example is <i>affect heuristic</i>,
in which we judge the goodness of a situation based on how it makes us feel.
This is sort of like “going with your gut” and can be adaptive in many
situations. If you are in a situation and feel frightened, you are likely to
try to escape the situation, which could possibly save your life. At a more
mundane level, think about how you choose what cereal you are going to buy at
the store. You may go through each box, examining the nutrition content and
analyzing the taste, texture, price, and smell of each one; however, this would
probably waste a lot of time. Instead, you probably just see one that you feel positively
about, pull it off of the shelf, and move on with your day.</div>
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<o:p></o:p></div>
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However, the affect heuristic can have other effects –
something media outlets know well. Using fearmongering techniques, media can
manipulate our emotions surrounding an issue, which affects how we feel about
it. Those who do not want to accept refugees have a strong fear of a terrorist
attack and likely Muslims in general. Others have an emotional reaction of
“empathy,” which outweighs their fear and influences them to welcome refugees. <o:p></o:p></div>
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The final concept I want to mention is another heuristic
called <i style="mso-bidi-font-style: normal;">availability heuristic.</i>
Basically, we tend to judge the probability of an event occurring based on how
easy it is to think of instances of that event. Whenever there is a terrorist
attack, we hear about it on the news, making that information very available in
our minds. What we do not hear about are stories about Muslim people who are
peaceful citizens and not terrorists. That information is not newsworthy.
Because it’s easier for us to recall examples of Muslims being terrorists than
examples of them being peaceful, we may overestimate the probability of a
Muslim refugee being a potential terrorist.<o:p></o:p></div>
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In part 2, I’ll talk about some of the social psychological
principles that are influencing people’s perceptions of whether refugees should
be welcomed into our country. <o:p></o:p></div>
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References<o:p></o:p></div>
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Home, Z., Powell, D., Hummel, J. E., & Holyoak, K. J.
(2015). Countering antivaccination attitudes. <i style="mso-bidi-font-style: normal;">PNAS, 112, </i>10321-10324.<o:p></o:p></div>
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Hyhan, B., & Reifler, J. (2010). When corrections fail:
The persistence of political misperceptions. <i style="mso-bidi-font-style: normal;">Political Behavior, 32, </i>303-330.<o:p></o:p></div>
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King, P. M., & Kitchener, K. S. (2004). Reflective
judgment: Theory and research on the development of epistemic assumptions
through adulthood. <i style="mso-bidi-font-style: normal;">Educational
Psychologist, 39, </i>5-18. <o:p></o:p></div>
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Myers, D. G., & DeWall, C. N. (2014). Psychology in
everyday life. New York: Worth.<o:p></o:p></div>
Anonymoushttp://www.blogger.com/profile/10965118499171942070noreply@blogger.com0tag:blogger.com,1999:blog-4604858848733141295.post-56980262288887717842015-02-01T15:10:00.002-05:002015-02-01T15:10:49.676-05:00Welcome Back to the Blog!After quite a long hiatus, Cortex Unfolded is back, and we're excited to get back to work! Sometimes classes, teaching, practicums, and research get in the way, but we now have a renewed commitment to setting aside time to update you all in the latest neuropsychology-related news and research. While we may not post a blog every week (although we'll try), expect to see regular tweets @cortexunfolded. The main focus will remain on topics related to clinical neuropsychology; however, you are also likely to see some occasional posts addressing issues in forensic psychology due to Brian's changed interests. <div>
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Also, we would love to have some guest posts! If you come across or are working on some interesting research or other information that you would like to share with us, let us know, and we'll be happy to post it.</div>
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Now, what's the over-under on the amount of concussed players in the Super Bowl whom are allowed to return to the game? <br /><div>
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Anonymoushttp://www.blogger.com/profile/10965118499171942070noreply@blogger.com0tag:blogger.com,1999:blog-4604858848733141295.post-1725145191213790272014-03-09T17:25:00.000-04:002014-03-09T17:25:13.122-04:00A New Trail Making TestThe Trail Making Test (TMT) is an oldie but a goodie. The paper-and-pencil neuropsychological measure consists of two parts: TMT-A is composed of numbers enclosed in circles, and the examinee is asked to simply connect the numbered circles in ascending order as quickly as possible. Part B has both letters and numbers, and examinees must connect "1" to "A," "A" to "2," "2" to "B," and so on. TMT-B has been considered one of the most sensitive indicators of overall brain impairment due to the multiple abilities it taps into (e.g., psychomotor speed, attention, working memory, visual scanning, mental flexibility).<br />
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On the other hand, the inclusion of the English alphabet has limited the use of the test to Western populations. Citing this along with evidence that individuals with less-education/MCI do not perform well on the TMT, researchers devised an alternative version of the TMT (Kim, Baek, & Kim, 2014). The TMT-B&W (black and white) replaces the letters of the original with a second, identical set of numbers which are enclosed in black circles instead of white ones. Instead of alternating between numbers and letters, examinees connect a white-circled number with it's black counterpart before moving onto the next number (see below). Part A is similar to the original TMT-A, but with all of the even numbers enclosed in black circles.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFfhGtwIYkwS6eCljvHCL2LOrUiKAQnqz2hqREGOCa4W8RR7lE1aX-MDYBGZzjcUBrdEAjujUdLmBDeeqluFlOyA4hehh8NaazP5WKze1XTUcoh_wvdaE030XBpJtgoeHdfhW2tGPbP7s/s1600/Screen+Shot+2014-03-09+at+4.31.27+PM.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFfhGtwIYkwS6eCljvHCL2LOrUiKAQnqz2hqREGOCa4W8RR7lE1aX-MDYBGZzjcUBrdEAjujUdLmBDeeqluFlOyA4hehh8NaazP5WKze1XTUcoh_wvdaE030XBpJtgoeHdfhW2tGPbP7s/s1600/Screen+Shot+2014-03-09+at+4.31.27+PM.png" height="191" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">(from Kim, et al., 2014)<br /><br /><br /><br /><br /></td></tr>
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The authors administered the TMT-B&W and the original TMT (and some other neuropsych measures) to three groups of participants in South Korea, including a control group, patients diagnosed with mild cognitive impairment, and individuals with Alzheimer's Disease. Overall, a higher rate of individuals completed the TMT-B&W relative to the TMT (participants with lower education especially struggled to complete the TMT). Another interesting finding was that TMT-B performance only distinguished the AD group from the control group, while the TMT-B&W was able to distinguish between all three groups (i.e., control, MCI, and AD).<br />
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The latter result suggests the new version of the TMT may be more sensitive than the older one. However, it is unclear if this finding is due only to the struggles of the Korean participants to complete the original TMT (the control and MCI groups may have performed equally poorly due to not understanding the English alphabet). One would intuitively think this test would be less sensitive than the original TMT, because it appears easier. Specifically, the working memory demands of the TMT-B&W seem less demanding, given that examinees only have to remember the number that they just connected, rather than having to keep both numbers and letters in mind. I'd be interested in a factor analysis to see if the two measures are tapping into the exact same constructs.<br />
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The authors' goal was to provide a version of the TMT that could be used for non-Western and illiterate populations. The TMT-B&W certainly shows promise in this regard, as participants tolerated the test well and correlations with the original TMT and other measures demonstrated evidence of good construct validity. However, participants level of English fluency was not measured or described, so it's impossible to tell how much of a role this played in the study. Even in Western populations, the test may be useful with illiterate/poorly-educated individuals. A comparison of the two versions of the TMT in an English-speaking population would provide further information on whether this is the case.<br />
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<span style="color: red;">Kim, H. J., Baek, M. J., & Kim, S. (2014). Alternative type of the Trail Making Test in nonnative English speakers: The Trail Making Test: Black & White. <i>PloS One 9 </i>(2), 1-6. </span><br />
<br />Anonymoushttp://www.blogger.com/profile/10965118499171942070noreply@blogger.com0tag:blogger.com,1999:blog-4604858848733141295.post-32960079875373133042014-02-07T16:38:00.001-05:002014-02-08T15:17:09.067-05:00Learn More, Care More?<div>
<span style="font-size: small;"><span style="font-family: inherit;"><span style="letter-spacing: 0px;">Cognitive reserve has been linked to apathy for the first time, according to a new article in <i>Archives of Clinical Neuropsychology</i> (Shapiro, Mahoney, Peyser, Zingman, & Verghase, 2014). Cognitive reserve refers to the brain’s ability to demonstrate resilience to brain damage that results from problems such as Alzheimer’s Disease. As an example, Individuals with a high amount of cognitive reserve may experience few memory problems despite Alzheimer’s pathology existing in the brain. Factors that may help build cognitive reserve include education, higher intelligence, and regular engagement in both mental and physical activities throughout the lifespan (For those interested in cognitive reserve in general, check out the fascinating video below on the Nun study).</span></span></span></div>
<span style="font-family: Times,"Times New Roman",serif;"><span style="font-size: small;"><span style="font-size: small;"><span style="font-family: inherit;"><iframe allowfullscreen="" frameborder="0" height="315" src="//www.youtube.com/embed/nw2lafKIEio?rel=0" width="420"></iframe></span></span><br /></span></span>
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<span style="font-size: small;"><span style="font-family: inherit;"><span style="letter-spacing: 0px;">The protective effects of cognitive reserve have generally been examined in relation to neurocognitive domains such as memory. Shapiro and colleagues wanted to see if cognitive reserve would also be protective against the effects of apathy. More specifically, they investigated individuals diagnosed with Human Immunodeficiency Virus (HIV), a disorder which is often associated with neurocognitive and neuropsychiatric symptoms including apathy. Cognitive reserve was measured through a composite score consisting of participants’ highest level of educational attainment and scores on the Wechsler Test of Adult Reading (WTAR), while apathy was measured using a brief self-report measure. Researchers accounted for possible confounding variables such as age, gender, disease duration, markers of disease severity, and scores on the Beck Depression Inventory.</span></span></span></div>
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<span style="font-size: small;"><span style="font-family: inherit;"><span style="letter-spacing: 0px;">31% of participants demonstrated clinically significant apathy based on the self-report measure. The authors stated that cognitive reserve significantly predicted apathy overall (<i>p </i>= .02), but the method section indicated that an alpha level of .01 was used for all analyses. Therefore, this main effect should not have been significant. In any case, there was a significant interaction between cognitive reserve and a marker of the stage of advancement of the disease (nadir CD4 counts). Specifically, individuals with greater cognitive reserve experienced less apathy than those with lower amounts of it, <i>but only</i> for those participants who were in a later stage of HIV infection (<i>p </i>< .001). For those participants in an earlier stage of infection, cognitive reserve did not significantly predict apathy. The authors hypothesize that this protective effect against apathy is a result of “more efficient neural processing and more effective compensation.”</span></span></span><br />
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<span style="font-family: Times,"Times New Roman",serif;"><span style="font-size: small;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjd3eU6xhCJ1MouaSQPkfEkd4a79Jm7irvL3peInEow3rja7k7aqqFHxbqsTw24_C5nFcarl1NfpdT65w3mW30IJJwtOvuO1fSysgmiMh1FoHGqt0oDQt9SCM89LjksT0DdtYwn_rtlXWs/s1600/photo-2.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjd3eU6xhCJ1MouaSQPkfEkd4a79Jm7irvL3peInEow3rja7k7aqqFHxbqsTw24_C5nFcarl1NfpdT65w3mW30IJJwtOvuO1fSysgmiMh1FoHGqt0oDQt9SCM89LjksT0DdtYwn_rtlXWs/s1600/photo-2.JPG" height="320" width="240" /></a></span></span></div>
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<span style="font-size: small;"><span style="font-family: inherit;"><span style="letter-spacing: 0px;">This paper is interesting in that it was able to find a link between cognitive reserve and apathy possibly for the first time; however, this link was found only in individuals with more advanced HIV. It’s not clear why this was the case. The study also has some limitations which were noted by the researchers, including the lack of a healthy control group and an inability to determine causality. Another possible problem that is not addressed is the fact that the overall mean word reading test scores fell in the borderline range. Therefore, these results may not generalize to the general population in which the mean should fall in the average range.</span></span></span></div>
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<span style="font-family: Times,"Times New Roman",serif;"><span style="color: red; font-size: small;">Shapiro, M. E., Mahoney, J. R., Peyser, D., Zingman, B. S., & Verghese, J. (2014). Cognitive reserve protects against apathy in individuals with Human Immunodeficiency Virus. <i>Archives of Clinical Neuropsychology, 29</i>, 110-120.</span></span></div>
Anonymoushttp://www.blogger.com/profile/10965118499171942070noreply@blogger.com0tag:blogger.com,1999:blog-4604858848733141295.post-31361799926277828392014-01-27T16:18:00.000-05:002014-02-08T15:17:25.704-05:00DSM-5 Neurocognitive Disorders and Implications for Forensic Evaluations<span style="font-family: 'Times New Roman', serif; font-size: 12pt;">As you’re probably well-aware, the latest
edition of the DSM has been met with much criticism.</span><span style="font-family: 'Times New Roman', serif; font-size: 12pt;"> </span><span style="font-family: 'Times New Roman', serif; font-size: 12pt;">Concerns of over-diagnosis have been loudly
expressed by individuals such as Allen Frances, M.D.</span><span style="font-family: 'Times New Roman', serif; font-size: 12pt;"> </span><span style="font-family: 'Times New Roman', serif; font-size: 12pt;">Despite receiving less attention than some
other categories (i.e., personality and neurodevelopmental disorders), the
changes to the diagnostic criteria for neurocognitive disorders have not
escaped controversy.</span><span style="font-family: 'Times New Roman', serif; font-size: 12pt;"> </span><br />
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">An article by Izabela Z. Schultz
(2013) in <i style="mso-bidi-font-style: normal;">Psychological Injury and Law</i>
discussed how the updated criteria for neurocognitive disorders may affect
forensic situations.<span style="mso-spacerun: yes;"> </span>Even with the focus
on forensic applications, many of the concerns she raises apply to any type of neuropsychological
evaluation (it should be noted that she also has positive things to say about
the changes; I am focusing on her criticisms here).<span style="mso-spacerun: yes;"> </span>Below I outline and respond to some of these
concerns.<span style="mso-spacerun: yes;"> </span></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">In DSM-5, Major and Minor
Neurocognitive Disorder diagnoses depend on the presence (or absence) of both a
decline from previous functioning and inference with independence in activities
of daily living.<span style="mso-spacerun: yes;"> </span>The former consists of
both concern from an individual (i.e., client, clinician, or family member)
along with objective cognitive impairment, generally determined by neuropsychological
testing.<span style="mso-spacerun: yes;"> </span>Schultz cites problems with the
assessment of ADLs and with the use of neuropsychological tests in this
context.<span style="mso-spacerun: yes;"> </span>First, she claims that
psychologists may not have the skills to assess ADLs, given that this is
primarily the domain of occupational therapists.<span style="mso-spacerun: yes;"> </span>Although OTs specialize in ADL assessment, I’m
confident psychologists are also capable of assessing ADLs through interviews
and measures such as the Texas Functional Living Scale.</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Schultz’s complaints about the
use of neuropsychological testing for the purposes of determining cognitive
impairment include:</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Arbitrary
cut-off values (in standard deviations from the mean) may result in
overdiagnosis of mild neurocognitive disorder and underdiagnosis of major
neurocognitive disorder.</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Neuropsychological
measures may have psychometric problems and be prone to biases, errors, and
limitations with regard to certain populations who experience barriers to
assessment.<span style="mso-spacerun: yes;"> </span></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Neuropsychologists
administer several tests, and there is no standard rule for how to determine
the overall level of impairment when test scores vary.<span style="mso-spacerun: yes;"> </span>In forensic settings, this could lead to consciously or unconsciously-biased diagnostic decision making.</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">DSM-5
does not stress a multi-method approach involving qualitative methods in
addition to quantitative ones.</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Related to Schultz’s first point
is another criticism: lack of a “moderate neurocognitive disorder”
diagnosis.<span style="mso-spacerun: yes;"> </span>Schultz is concerned that in
forensic settings, individuals who have serious functional problems may only be
diagnosed with the mild disorder, which could detrimentally affect case
outcomes.<span style="mso-spacerun: yes;"> </span>She raises a valid point when
she discusses the fact that DSM-5 acknowledges mild, moderate, and severe TBI
when there is no option to diagnose a moderate neurocognitive disorder.<span style="mso-spacerun: yes;"> </span>On the other hand, the cut-off values for
establishing cognitive impairment (1 or 2 standard deviations for minor and
major neurocognitive disorder respectively), are indeed somewhat arbitrary.<span style="mso-spacerun: yes;"> </span>Adding a moderate diagnosis would reduce the
range between the cut-off values, likely blurring the lines between the
disorders even more.<span style="mso-spacerun: yes;"> </span>Despite there being
no option to diagnose a moderate neurocognitive disorder, I am not overly
concerned about overdiagnosis of the mild form.<span style="mso-spacerun: yes;">
</span>These diagnoses are not based solely on neuropsychological test scores –
they also take decline from previous functioning and independence in ADLs into
account.<span style="mso-spacerun: yes;"> </span>Therefore, someone will not be
diagnosed with a disorder based solely on scoring a standard deviation below
the mean on a neuropsychological measure.</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Schultz’s second and fourth
points above appear to be less a problem with diagnostic criteria and more of
an issue of neuropsychologists’ ethics.<span style="mso-spacerun: yes;">
</span>Neuropsychologists are ethically obligated to choose tests that are valid
for the purpose they are testing and for the individuals whom they are
testing.<span style="mso-spacerun: yes;"> </span>Therefore, the responsibility
is on the psychologist to consider the psychometric properties of each measure.<span style="mso-spacerun: yes;"> </span>Similarly, DSM-5’s lack of emphasis on
qualitative assessment methods is not a problem.<span style="mso-spacerun: yes;"> </span>Any competent psychologist knows that test
scores must be interpreted in light of other factors such as premorbid
functioning, clinical interview data, medical records, etc.</span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">The third potential issue with
neuropsychological testing could certainly bring about some problems.<span style="mso-spacerun: yes;"> </span>It appears to be left up to individual
clinicians to determine how to judge overall severity when multiple measures
are administered with varying results.<span style="mso-spacerun: yes;">
</span>For example, should an individual with one test that is two standard
deviations below the mean, with the rest being just one standard deviation
below the mean be diagnosed with major or minor neurocognitive disorder?<span style="mso-spacerun: yes;"> </span>A standard rule does seem to be indicated
here.<span style="mso-spacerun: yes;"> </span>At the least, neuropsychologists
should apply their own rule and use it consistently to avoid bias in forensic
situations.</span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: normal;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Another point of contention to
the DSM-5 changes brought up in the article is the choice of specifiers for
individual sources of cognitive impairment. <span style="mso-spacerun: yes;"> </span>Schultz points out that rare diseases such as
prion disease are included, while other sources such as Multiple Sclerosis and
electrical injury are left out, relegated to the “due to another medical
condition” specifier.<span style="mso-spacerun: yes;"> </span>In forensic
settings, it seems that use of “due to another medical condition” specifier
shouldn’t be a problem, howeverm as the psychologist could discuss what that
medical condition is probably causing the problem (e.g., an electrical
injury).<span style="mso-spacerun: yes;"> </span>Admittedly, I’m not a forensic
psychologist, so maybe someone well-versed in that field could clear up this
question.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: normal;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Finally, Schultz mentions that ADLs
are considered in the diagnostic criteria, but not other domains of impairment,
such as vocational or social impairment.<span style="mso-spacerun: yes;">
</span>I agree that these should be part of the criteria, especially
considering that functional impairment can be independent of other indicators
such as neuropsychological test scores.<span style="mso-spacerun: yes;">
</span>As an example, an individual with a 1 standard deviation decline in
cognitive functioning due to a TBI may experience more functional problems if
that individual has a cognitively demanding job as opposed to a job that
requires only manual labor.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: normal;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: normal;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Overall, I believe this category is
one of the few which improved with the new edition of the DSM.<span style="mso-spacerun: yes;"> </span>However, only time will tell how the updated
criteria will affect neuropsychological evaluations in forensic and other
settings.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: normal;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: normal;">
<span style="color: red;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">American Psychiatric Association.
(2013). <i style="mso-bidi-font-style: normal;">Diagnostic and statistical manual
of mental disorders (5<sup>th</sup> ed.). </i>Arlington, VA: American
Psychiatric Publishing.</span></span></div>
<span style="color: red;">
</span><br />
<div class="MsoNormalCxSpMiddle" style="line-height: normal;">
<br /></div>
<span style="color: red;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US;">Schultz, I. Z. (2013). DSM-5 neurocognitive
disorders: Validity, reliability, fairness, and utility in forensic
applications. <i style="mso-bidi-font-style: normal;">Psychological Injury and
Law, 6</i>, 299-306.</span></span>Anonymoushttp://www.blogger.com/profile/10965118499171942070noreply@blogger.com0tag:blogger.com,1999:blog-4604858848733141295.post-43139105659560112502014-01-12T14:09:00.000-05:002014-01-12T20:12:36.364-05:00Can Neuropsychology Detect Psychosis Before it Ever Occurs?<div class="MsoNormal">
Over the last several years, interest in detecting
schizophrenia (and other psychotic disorders) in its prodromal phase (before
the appearance of any psychotic symptoms have manifested) has been rapidly
increasing. Detecting one’s vulnerability to acute psychosis before suffering a
first event has many theoretical and practical advantages. Evidence suggests
that the length and severity of untreated psychosis is directly related to an
individual’s long-term outcome. If psychosis can be delayed, reduced, or ideally,
altogether prevented by targeted interventions, the morbidity of the illness
should be greatly improved (Eastvold, Heaton, & Cadenhead, 2007; Hawkins et
al., 2004). </div>
<div class="MsoNormal">
</div>
<div class="MsoNormal">
In the past, attempts at diagnosing prodromal psychosis have
relied upon criteria that included transient psychotic symptoms, and/or a
family history of psychosis combined with a marked decline in functioning;
however, this method is marred by a 50% or higher false positive rating in most
studies, and most people identified as at risk do not go on to develop
psychosis, at least not over the duration of the studies that are monitoring
them (Haroun, Dunn, Haroun, & Cadenhead, 2006). This high rate of false
positives and low rate of conversions to psychotic states raises ethical concerns
about if and how to treat those identified as having a high risk of developing
a psychotic illness (Haroun, Dunn, Haroun, & Cadenhead, 2006).</div>
<div class="MsoNormal">
</div>
<div class="MsoNormal">
The above has led to a desire to develop a more accurate way
of identifying those most at risk of having a psychotic episode. The
neurodevelopmental model provides strong evidence that cognitive abnormalities
related to abnormal brain maturation is a core feature of psychotic illnesses
(Lencz et al., 2006; Eastvold, Heaton, & Cadenhead, 2007). These neurocognitive
deficits are well established in schizophrenia, span multiple domains, and
include motor abilities, executive functions, language, general intelligence,
learning/memory, and spatial abilities (Eastvold, Heaton, & Cadenhead,
2007). </div>
<div class="MsoNormal">
</div>
<div class="MsoNormal">
Similar neurocognitive dysfunction, especially those related
to visuospatial processing impairment and working memory deficits, has been
detected in first degree relatives of family members of psychotic patients and
those with schizotypal disorder who are known to be at greater risk of
developing psychosis (Brewer et al, 2005). Because these neurocognitive
features are present prior to the onset of any psychotic symptoms, they may be
a trait marker for schizophrenia. This has raised the very interesting
possibility of identifying those at high risk of developing psychosis by using
neuropsychological assessments such as the Wechsler Memory Scales-R (WMS-R),
the Wisconsin Card Sorting Test, the Vocabulary and Block Design subtests of
the WAIS IV, and others (Brewer et al, 2005; Eastvold, Heaton, & Cadenhead,
2007; Lencz et al., 2006). </div>
<div class="MsoNormal">
</div>
<div class="MsoNormal">
These findings represent very exciting developments in the
field of psychological assessment. While the current research is very
promising, most studies call for continued research with larger cohorts to
further define and validate the neurocognitive profile that best indicates
future psychotic symptoms, as well as to validate the cognitive deficits as a
true trait marker for psychotic vulnerability. </div>
<div class="MsoNormal">
</div>
<div class="MsoNormal">
Another problem to be addressed is the high degree of
variability presently found within the composition of the neuropsychological
batteries being tested for detecting prodromal psychosis by various
researchers. This is part of the process of developing a standardized test
battery, but presently we are without any general consensus about which tests
to use and what results to look for, causing the utility of neuropsychological assessments as an identifier for those at risk of psychosis
to remain quite limited. </div>
<div class="MsoNormal">
</div>
<div class="MsoNormal">
I find the prospect of being able to assess for prodromal
psychosis to be tantalizing. As a student of clinical psychology, this could
potentially be an important part of my future. I think that being able to
reliability detect psychotic disorders before they strike would be a wonderful
development for clients, their families, and the field of clinical psychology.
It could potentially prevent much personal and economic devastation; it is
noninvasive, relatively brief to administer (at least in regard to the enormity
of possibly preventing disorders as severe as these from manifesting), and is
potentially much more reliable than what is presently available. </div>
<div class="MsoNormal">
</div>
<div class="MsoNormal">
Of course, even with all of the obvious benefits, that are
certainly potential problems to address. Aside from further validating the
neurocognitive trait marker and assessment batteries, I can see ethical
concerns looming as perhaps the largest potential challenge. Determining who
should be screened, when they should be screened, and who pays for said
screening are among the first concerns. What will the threshold be for a
positive screening, and what, if anything, should be done for those deemed at
only moderate risk for developing a psychotic state are all questions in need
of answers. </div>
<div class="MsoNormal">
</div>
<div class="MsoNormal">
Perhaps the biggest ethical dilemma will be reserved for
those that are deemed to be highly likely to develop a psychotic illness.
Presently, most interventions for psychosis involve antipsychotic medications,
which come with a host of unpleasant and potentially dangerous side effects
(although in this regard they are little different from other pharmaceuticals).
Would it be ethical to recommend a client be prescribed these drugs in
perpetuity if one was not 100% sure they were needed? The line between
pragmatic risk prevention and unnecessary risk is a thin one indeed, and our
accuracy in detecting prodromal psychosis will need to improve before we are
informed enough to make such profound decisions.</div>
<div class="MsoNormal">
</div>
<div class="MsoNormal">
It also seems likely that psychologists will face issues
informing client’s that they have been found likely to develop psychosis. This
knowledge, like the genetic knowledge that one will almost certainly develop
cancer, could be very beneficial in reducing morbidity, but it is not without
considerable stress. Knowing one’s vulnerability to psychosis could have both
long and short term negative effects on one’s psychological health. It is even
possible that the sheer anxiety caused by this information could increase the
chances of a vulnerable person having a first psychotic event, and/or increase the
chances of them developing other mental illnesses. This problem is magnified if
we do not have any palatable and efficacious interventions to offer them at the
time the prognosis is delivered. </div>
<div class="MsoNormal">
</div>
<div class="MsoNormal">
Ultimately, I think that using neuropsychological assessments
to detect prodromal psychotic disorders will become a valued part of what
clinical neuropsychologists provide. Before that can happen, it is paramount
that the neurocognitive deficits being assessed are validated and then
quantified in such a way that they can very reliably predict the future onset
of psychotic illness. The ethical concerns described above will also need to be
addressed before any widespread adoption of a neuropsychological battery used
for the detection of potential psychotic illnesses should occur. Finally, while
I feel that the development of these test batteries should proceed as rapidly
as possible, the benefits of detection will be blunted by our present lack of
quality preventative interventions. In some cases, early detection could cause
potentially damaging anxiety, precisely because of our present dearth of safe
and proven options for preventing psychosis from developing. This downside is
likely outweighed by the fact that at the very least, those identified as at
high risk could be carefully monitored and provided with proper medications at
the very first signs of an initial psychotic break, greatly improving their
long-term outcomes. </div>
<div class="MsoNormal">
<br />
References </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Brewer, W. J., Francey, S. M., Wood, S. J., Jackson, H. J.,
Pantelis, C., Phillips, L. J., ... & McGorry, P. D. (2005). Memory
impairments identified in people at ultra-high risk for psychosis who later
develop first-episode psychosis.American Journal of Psychiatry, 162, 71-78.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Eastvold, A. D., Heaton, R. K., & Cadenhead, K. S.
(2007). Neurocognitive deficits in the (putative) prodrome and first episode of
psychosis. Schizophrenia research, 93, 266-277.</div>
<div class="MsoNormal">
<br />
Haroun, N., Dunn, L., Haroun, A., & Cadenhead, K. S. (2006). Risk and
protection in prodromal schizophrenia: ethical implications for clinical
practice and future research. Schizophrenia bulletin, 32, 166-178.</div>
<div class="MsoNormal">
<br />
Hawkins, K. A., Addington, J., Keefe, R. S. E., Christensen, B., Perkins, D.
O., Zipurksy, R., ... & McGlashan, T. H. (2004). Neuropsychological status
of subjects at high risk for a first episode of psychosis. Schizophrenia
research,67, 115-122.</div>
<div class="MsoNormal">
</div>
<div class="MsoNormal">
<br />
Lencz, T., Smith, C. W., McLaughlin, D., Auther, A., Nakayama, E., Hovey, L.,
& Cornblatt, B. A. (2006). Generalized and specific neurocognitive deficits
in prodromal schizophrenia. Biological psychiatry, 59, 863-871.</div>
Anonymoushttp://www.blogger.com/profile/15761602181353512995noreply@blogger.com0tag:blogger.com,1999:blog-4604858848733141295.post-80954308969377228582014-01-05T20:21:00.001-05:002014-01-05T20:21:48.204-05:00Toward a Modern Neuropsychology<div class="MsoNormal">
Are neuropsychology’s current syndromes and assessment
measures out-dated? Ardila (2013) argues
that this may be the case in his commentary in the journal <i>Archives of Clinical Neuropsychology</i>. Ardila contends that some classic
neuropsychological syndromes (e.g., aphasia, alexia, prosopagnosia) may need
updated, considering the changes in technological and social conditions that
have taken place over the last 100 years.
Because of these changes, tasks are often performed in different ways
then they used to be, thus potentially requiring the use of different brain
areas. The author specifically refers to
cognitive abilities including spoken language, written language, numerical
abilities, spatial orientation, people recognition, memory, and executive
functions.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Written language is one of the more interesting areas addressed
in this article. Much writing is now
done using a keyboard and word processor rather than pen-and-pencil. Although an understanding of language is
necessary for both, typing and handwriting require differing demands from the
individual. For example, handwriting
requires individuals to construct letters using fine motor skills, while also
keeping the letters spaced properly.
Typing, on the other hand, merely requires the press of buttons rather
than construction of letters; however, typists must use both hands to type
letters in the correct order. To do this
quickly and accurately, a well-functioning corpus callosum is needed to
facilitate communication between the two cerebral hemispheres. The argument is that because modern written
language involves much typing, we need to learn more about the brain structures
involved (as opposed to those involved in handwriting) and develop new ways to
assess for impairment in typing ability that is due to brain dysfunction. This same concept applies to the other
functional domains addressed in the article.
For example, societal changes over time may affect how our brain is
organized for the recognition of people, as we are now compelled to remember more
faces than we were when neuropsychology was a new field due to exposure to
television, the internet, and other media.
</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The author concludes that our century-old neuropsychological
syndromes (and measures used to test for them) need re-assessed. In any field, it is important to take time to
examine practices to see if they are out-dated or could be improved upon, and
neuropsychology is no different. On the
other hand, is it necessary to declare the existence of new syndromes based on modern
tasks that did not exist previously?
Ardila suggests one such new syndrome could be “acomputeria” – an
inability to use computers. He goes on
to list potential specific subtypes of acomputeria. I wonder if a better solution would be to
classify problems based on their underlying causes, rather than inventing a new
syndrome for each new modern task. For
example, one’s inability to use a computer may not be a syndrome in and of
itself, but the result of memory problems (the individual is unable to learn
new information), executive dysfunction (the individual may be unable to
problem solve and continue to perform unsuccessful actions), or something else. In this case, traditional neuropsychological
measures may be effective in determining the underlying problem. Either way, the issues addressed in the
commentary are certainly worth thinking about further, and, most importantly,
testing empirically.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Here is a link to the abstract: <a href="http://www.ncbi.nlm.nih.gov/pubmed/23702677" target="_blank">Ardila 2013</a></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-size: 12pt; text-indent: 0.5in;">Ardila, A. (2013). A new neuropsychology for the XXI
century. </span><i style="font-size: 12pt; text-indent: 0.5in;">Archives of Clinical Neuropsychology,
28</i><span style="font-size: 12pt; text-indent: 0.5in;">, 751-762.</span></div>
Anonymoushttp://www.blogger.com/profile/10965118499171942070noreply@blogger.com0tag:blogger.com,1999:blog-4604858848733141295.post-9460299658626115862013-11-25T22:41:00.002-05:002013-11-25T22:44:31.577-05:00Computerized Neurocognitive Testing in Sport Concussion Management: What Are the Problems? <div class="MsoNormal">
In a recent post, I gave a brief overview of the use of
computerized neurocognitive tests in the management of sports-related
concussions. I mentioned that while
these tests are standard practice, they are far from perfect. Now, I’ll expand on that statement.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
As I discussed before, these tests are used to identify
subtle problems that can’t be detected using standard neuroimaging techniques
or medical exams. The thinking is that
if we can identify these impairments, we can decrease risk of subsequent (and
potentially more serious) injuries.
However, factors relating to the tests we use, the athletes who we
administer them to, and characteristics of the injuries themselves can severely
impair these tests’ abilities to correctly identify individuals who are still
suffering from the effects of concussions. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
In terms of tests such as ImPACT, studies have generally
found low-to-moderate test-retest reliability, suggesting that athletes tend
not to perform consistently when they take the test multiple times (see Broglio,
Ferrara, Macciocchi, Baumgartner, & Elliott, 2011;<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";"> </span>Elbin, Schatz, & Covassin, 2011). This is a major problem, considering that the
tests are designed to be administered to the same athlete multiple times. One contributor to this issue is the presence
of practice effects, whereby athletes improve their performance due simply to
having taken the test before. Another
factor hampering reliability may be that the construct itself (i.e., impairment
due to sports concussion) can’t be reliably measured due to its often subtle
and transient nature.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The way in which the tests are used can also hurt their
validity. An advantage of these tests is
their ability to be administered to groups of athletes, saving organizations
time and money. In fact, most baseline
testing is done in groups. On the other
hand, post-injury testing is done on an individual basis. Given evidence that group testing may result
in poorer performance than individual testing (Moser, Schatz, Neidzwski, & Ott,
2011), comparisons of performance on baseline testing (group setting) to
post-injury testing (individual setting) may not be accurate.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Athletes are generally expected to play through injury. As a result, they may purposefully distort
results by engaging in “sandbagging.” Sandbagging is when someone purposefully
performs poorly on the baseline test, which resulting in a low score that is
easier to equal on post-injury testing (Peyton Manning has <a href="http://www.nfl.com/news/story/09000d5d81f83fbc/article/manning-admits-underperforming-on-baseline-concussion-tests"><b>admitted
to doing this</b></a>). The computerized
tests do have ways of identifying this; however, little research has been done
to determine if they work.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Finally, it remains to be seen if the baseline testing model
is effective in reducing the risk of either subsequent concussions or more
serious long-term effects. One study
found that a symptom-free waiting period did not reduce the risk of sustaining
another concussion (McCrea et al., 2009). <o:p></o:p></div>
<div class="MsoNormal">
<br />
Although computerized neurocognitive tests are far from
perfect, it is important to remember that they are just one tool in making
return-to-play decisions after athletes suffer concussions. Physical exams, self-reported symptoms, and
balance testing are also used.
Furthermore, as objective measures go, these tests are the best we
currently have. Consequently, their use
will continue to be widespread until something better comes along.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
References<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Broglio, S. P., Ferrara, M. S., Macciocchi, S. N.,
Baumgartner, T. A., & Elliott, R. (2007). Test-retest reliability of
computerized concussion assessment programs. <i>Journal of Athletic Training, 42</i>, 509-514.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Elbin, R. J., Schatz, P., & Covassin, T. (2011).
One-year test-retest reliability of the online version of ImPACT in high school
athletes. <i>The American Journal of Sports
Medicine, 39</i>, 2319-2324.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
McCrea, M., Guskiewicz, K., Randolph, C., Barr, W. E., Hammeke, T. A., Marshall, S. W., & Kelly, J. P. (2009). Effects of a symptom-free waiting period on clinical outcome and risk of reinjury after sport-related concussion. Neurosurgery, 65, 876-883.</div>
<br />
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Moser, R. S., Schatz, P., Neidzwski, K., & Ott, S. D.
(2011). Group versus individual administration affects baseline neurocognitive
test performance. <i>American Journal of
Sports Medicine, 39</i>, 2325-2330.</div>
<div class="MsoNormal">
<o:p></o:p></div>
Anonymoushttp://www.blogger.com/profile/10965118499171942070noreply@blogger.com0tag:blogger.com,1999:blog-4604858848733141295.post-64032455984438430092013-11-11T10:03:00.001-05:002013-11-11T10:03:22.617-05:00Free Neuropsychology LecturesThe website for the 4th UK Paediatric Neuropsychology Symposium has uploaded a series of free lectures from last year's symposium. These lectures include "Effects of Institutionalization on Brain Development and Behaviour" from Charles Nelson, a talk on acquired brain injury in childhood by Vicki Anderson, "Development of Executive Functions During Early Childhood and their Modulation by Genes and the Environment" from Adele Diamond, and a discussion of early symptomatic syndromes eliciting neurodevelopmental clinical examinations, from Christopher Gillberg. This year's conference will take place May 19-23, 2014. The theme is "Atypical Developmental Pathways."<br />
<br />
The lectures can be found <a href="http://www.ucl.ac.uk/neuropsych/4th_InternationalSymposia" target="_blank"><strong>here</strong></a>.Anonymoushttp://www.blogger.com/profile/10965118499171942070noreply@blogger.com0tag:blogger.com,1999:blog-4604858848733141295.post-33827221980756994342013-11-08T18:06:00.004-05:002013-11-08T18:08:56.458-05:00ImPACT: What It Is and Why We Use ItIt's that time of the year again: concussion season. The major sports with the highest incidence of head injuries are all in full swing, including football, hockey, and european soccer. Many fans have heard sports news anchors saying a certain concussed athlete passed or failed an ImPACT test, but few may understand what that really means. What are we actually testing, and why do we need to do it?<br />
<br />
The basic idea behind testing concussed athletes before they are allowed to return to play is that concussions are thought to put the brain in a vulnerable state. Consequently, sustaining another concussion before recovering from the first may put the athlete at risk for further and more serious injury. Determining recovery from concussion is very difficult, however. We can't rely solely on athletes reporting symptoms they are experiencing for a couple of reasons. First, they are often motivated (and pressured by coaches and teammates) to minimize symptoms so they can get back into the game. Second, subtle neuropsychological difficulties may still be present in the absence of physiological symptoms. Thus, objective measures are needed to assess the presence of any subtle problems resulting from concussions. This is where ImPACT and other similar tests come in. <br />
<br />
Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT; ImPACT applications) is a brief, computerized test battery designed to measure domains often impaired in concussed individuals, including memory, processing speed, and reaction time (anyone who is interested in getting a sense of what the test is like can try a demo <a href="https://www.impacttestonline.com/impacttestdemo/" target="_blank"><b>here</b></a>). The test is not "pass or fail", despite how some refer to it on the news. Athletes typically take the test when healthy to establish a baseline score. After suffering a concussion, they take the test again, and the results are then compared to their baseline scores. If post-injury scores are significantly lower than baseline scores, then it is concluded that full recovery has not yet occurred.<br />
<br />
One important thing to note is that these tests do not diagnose concussions. What they are doing is essentially assessing for declines in neurocognitive functioning and attributing them to the effects of the concussion on the brain. Another fact to keep in mind is that these tests are far from perfect. The baseline-testing paradigm described here is standard practice across many sports and competition levels, but it is also quite controversial. There are a number of problems associated with this model, which I'll talk about in another post...Anonymoushttp://www.blogger.com/profile/10965118499171942070noreply@blogger.com0tag:blogger.com,1999:blog-4604858848733141295.post-7648894736556541852013-10-24T20:56:00.001-04:002013-10-24T20:56:37.959-04:00Cognitive Benefits of Mindfulness Meditation Practice<div dir="ltr" style="line-height: 1.15; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Recently, I developed an interest in mindfulness meditation. This was due primarily to my mom, who took up the practice and now doesn't go a day without meditating (Hi mom!). As a stressed-out graduate student, I decided to give it a shot as well. In addition to any positive effects meditation may have on psychological well-being, I began to wonder about its cognitive benefits. The idea of mindfulness is to focus on one thing at a time, so I thought maybe it would help me focus and subsequently retain more information from the countless textbook chapters and journal articles we are assigned to read. </span></div>
<b id="docs-internal-guid-0-18e72e-ed15-8274-540a-8847d7eb5525" style="font-weight: normal;"><br /><span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"></span></b>
<div dir="ltr" style="line-height: 1.15; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">I decided to research the idea and found a literature review summarizing the research on the neuropsychological effects of mindfulness meditation practice (Chiesa, Calati, & Serretti, 2011). The researchers included in the review 23 studies examining the relationship between mindfulness meditation and domains of cognitive functioning including attention, working memory, and executive functioning.</span></div>
<b style="font-weight: normal;"><br /><span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"></span></b>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">About half of the studies examining aspects of attention (i.e., selective, sustained, and attention switching) found that meditators performed significantly better than non-meditators on tasks. The majority of studies finding positive results were case-control designs, while the prospective studies were more likely to find null results. In terms of memory, mindfulness meditation did result in improvements in working memory capacity but not general memory. The review findings also indicated that mindfulness-based cognitive therapy may increase verbal fluency (our ability to produce words).</span></div>
<b style="font-weight: normal;"><br /><span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"></span></b>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">The review found somewhat conflicting results, as some studies found significant neuropsychological benefits of meditation, while others did not. One thing that was clear, however, was that the majority of the studies in the review that did show significant results involved either retreats of long duration or highly experienced meditators. This highlights the importance of being persistent when it comes to meditation. Although there are still many questions to answer regarding the neurocognitive benefits of the practice, it appears that, as with most things, results will only come with putting a significant amount of time into the activity. Maybe with some practice, I'll finally be able to focus on that chapter on Classical Test Theory (or not). </span></div>
<b style="font-weight: normal;"><br /><span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"></span></b>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br /></span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 15px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">References</span></div>
<br /><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;"></span><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">Chiesa, A., Calati, R., Serretti, A. (2011). Does mindfulness training improve cognitive abilities? A systematic review of neuropsychological findings. </span><span style="font-family: Arial; font-size: 15px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">Clinical Psychology Review, 31</span><span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">, 449-464.</span>Anonymoushttp://www.blogger.com/profile/10965118499171942070noreply@blogger.com0tag:blogger.com,1999:blog-4604858848733141295.post-40009780907137662162013-10-18T10:36:00.004-04:002013-10-18T10:39:26.703-04:00A Potential Cure for Alzheimer's?In my clinical neuropsychology course, our professor alerted us to a newly-published article with potentially huge implications. Anyone who has known someone with Alzheimer's Disease (AD)understands just how devastating it is. Currently, there are no known cures for neurodegenerative diseases such as AD and Parkinson's Disease (PD) - only drugs that can slow down the process of degeneration. An article published in the journal <em>Science Translational Medicine</em> by Moreno et al. (2013) may represent a huge step toward treatment of these diseases.<br />
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At a basic level, several neurodegenerative diseases are thought to be due to accumulations of misfolded proteins in brain cells, which result in the discontinuation of protein synethesis. If cells aren't producing protein, they die, resulting in neurodegeneration. Using this knowledge, researchers <br />
infected mice with prion disease (another neurodegenerative disease), and then orally administered a drug which inhibits the function of a protein kinase that mediates the process of shutting-down protein synthesis. Thus, the goal was not to get rid of the misfolded proteins, but to allow the synthesis of new proteins to continue despite their presence.<br />
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Amazingly, prion-infected mice treated at both early and later stages of the disease were completely free of confirmatory clinical signs of prion disease after treatment. Some of the mice did exhibit some early-indicator signs, however. Control mice, who were infected with prion but not treated, were all terminally sick at this point.<br />
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The drug did have some side effects. Most significantly, the treated mice experienced weight loss of 20% of their body mass. In addition, their blood sugar was elevated (but not to the point of diabetes). The authors note, however, that problems such as these are managed relatively routinely, and that any negative effects would need to be weighed against the potential benefits of protecting our brains. I certainly think most people would tolerate some weight loss and elevated blood sugar in order to keep their brains intact (although 20% weight loss is alarming).<br />
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These findings are extremely significant in that we now have a drug that is known to stop the process of neurodegeneration in mice and potentially humans as well. However, there are still many hurdles to jump before translating the treatment to humans. Researchers note that because long-term treatment would be needed in humans, fine-tuning of these drugs is crucial. Specifically, research is needed to determine when the drug needs to be administered to be most effective and how to minimize serious side effects. In addition, clinical trials on humans, once begun, will take years. Although there are still many challenges to overcome, these results suggest it is likely that 20-somethings like myself will see treatments for diseases such as AD and PD in our lifetimes. <br />
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References<br />
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Moreno, J. A., Halliday, M., Molloy, C., Radford, H. Verity, N., Axton, J. M., . . . Mallucci, G. R. (2013). Oral treatment targeting the unfolded protein response prevents neurodegeneration and clinical disease in prion-infected mice<em>. Science Translational Medicine, </em>5 (206),<em> </em>1-10.<br />
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<br />Anonymoushttp://www.blogger.com/profile/10965118499171942070noreply@blogger.com0