Faculty Bibliography

The ecological validity of neuropsychological instruments has become an important topic in recent decades, as neuropsychologists are asked to address real-world outcomes with increasing frequency. Although novel instruments that tap skills required for everyday functioning have been developed, it is unclear whether these instruments are migrating from research laboratories into the applied settings of clinical neuropsychologists. The current study surveyed assessment practices of neuropsychologists with regard to their utilization of instruments designed with ecological concerns in mind. Respondents included 747 North American, doctorate-level psychologists (40% usable response rate) affiliated with Division 40 of the American Psychological Association, National Academy of Neuropsychology, or the International Neuropsychological Society. Results indicated that approximately one-third of respondents reported use of ecologically oriented instruments (EOIs), and these instruments were generally utilized with much less frequency than traditional measures. Additionally, certain practice demographics affected usage rates of EOIs. Study findings are interpreted in the context of a growing body of literature that calls attention to the importance of developing and utilizing instruments that are able to handle the complex, real-world issues increasingly addressed during the neuropsychological assessment process

BACKGROUND:Surgery for intractable temporal lobe epilepsy usually controls seizures and improves health-related quality of life (HRQOL), but some patients experience continued seizures, memory decline, or both. The relative impact of these unfavorable outcomes on HRQOL has not been described. METHODS:We studied seizure control, memory change, and HRQOL among 138 patients in the Multicenter Study of Epilepsy Surgery (MSES), an ongoing, prospective study of epilepsy surgery outcomes. Seizure remission at 2 years and 5 years was prospectively determined based upon regularly scheduled follow-up calls to study patients throughout the follow-up period. HRQOL was assessed annually using the Quality of Life in Epilepsy Inventory (QOLIE-89). Memory decline was determined by change in verbal delayed recall from baseline to the 2- or 5-year follow-up. RESULTS:HRQOL improved in patients who were in remission at the 2-year or 5-year follow-up, regardless of memory outcome. Among those not in remission at both 2 and 5 years (25/138, 18%), HRQOL remained stable when memory did not decline (14/138, 10%), but HRQOL declined when memory did decline (11/138, 8%). These 11 patients had baseline characteristics predictive of poor seizure or memory outcome. Declines were most apparent on HRQOL subscales assessing memory, role limitations, and limitations in work, driving, and social activities. CONCLUSIONS:After temporal resection, health-related quality of life (HRQOL) improves or remains stable in seizure-free patients despite memory decline, but HRQOL declines when persistent seizures are accompanied by memory decline. These results may be useful in presurgical counseling and identifying patients at risk for poor psychosocial outcome following surgery.

The current study surveyed test-usage practices of clinical neuropsychologists to determine whether respondents varied their assessment batteries based on specific patient demographic characteristics. Respondents were 747 doctorate-level psychologists (40% usable response rate) affiliated with Division 40 of the American Psychological Association, National Academy of Neuropsychology, or the International Neuropsychological Society. Respondents read a vignette about a traumatic brain injury patient and subsequently reported the instruments they would utilize to assess this patient's memory, attention, executive functioning, and ability to return to work. There were three versions of the case study, which varied according to the patient's occupation and level of education. Results revealed that the reported proportion of only 9 of 516 instruments (1.7%) varied across classifications, indicating that some neuropsychologists slightly modified their test batteries based on patients' demographic characteristics. The implications of these findings are discussed in relation to enhancing predictions of real-world outcomes based on neuropsychological test data

False-positive (FP) errors during recognition memory testing often interfere with interpretation of Wada test results. This study examined which clinical and neuropsychological variables provide the best prediction of these errors. Fifty-six patients completed the Wada test and the California Verbal Learning Test (CVLT). Subjects with three or more FP errors on the recognition trials of the CVLT were nearly twice as likely to exhibit FP responding during the Wada test. Further analysis indicates that FP errors during the Wada test appear to be the primary result of a stable and liberal response-bias rather than a result of any other neurological or procedure-related factor