Faculty Bibliography

Neuropsychology has fallen reliant on outdated and labor intensive methods of data collection that are slow, highly inefficient, and expensive, and provide relatively data-poor estimates of human behavior despite rapid technological advance in most other fields of medicine. Here we present a brief historical overview of current testing practices in an effort to frame the current crisis, followed by an overview of different settings in which technology can and should be integrated. Potential benefits of laboratory based assessments, remote assessments, as well as passive and high-frequency data collection tools rooted in technology are discussed, along with several relevant examples and how these technologies might be deployed. Broader issues of data security and privacy are discussed, as well as additional considerations to be addressed within each setting. Some of the historical barriers to adoption of technology are also presented, along with a brief discussion of the remaining uncertainties. While by no means intended as a comprehensive review or prescriptive roadmap, our goal is to show that there are a tremendous number of advantages to technologically driven data collection methods, and that technology should be embraced by the field. Our predictions are that the comprehensive assessments of the future will likely entail a combination of lab-based assessments, remote assessments, and passive data capture, and leading the development of these efforts will cement the role of neuropsychology at the forefront of cognitive and behavioral science.

OBJECTIVE: The Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) is a self-report instrument, previously shown to differentiate patients with epileptic seizures (ES) and psychogenic non-epileptic seizures (PNES). At present, the odds of MMPI-2-RF scale elevations in PNES patients, as well as the diagnostic predictive value of such scale elevations, remain largely unexplored. This can be of clinical utility, particularly when a diagnosis is uncertain. METHOD: After looking at mean group differences, we applied contingency table derived odds ratios to a sample of ES (n=92) and PNES (n=77) patients from a video EEG (vEEG) monitoring unit. We also looked at the positive and negative predictive values (PPV, NPV), as well as the false discovery rate (FDR) and false omission rate (FOR) for scales found to have increased odds of elevation in PNES patients. This was completed for the overall sample, as well as the sample stratified by sex. RESULTS: The odds of elevations related to somatic concerns, negative mood, and suicidal ideation in the PNES sample ranged from 2 to 5 times more likely. Female PNES patients had 3-6 times greater odds of such scale elevations, while male PNES patients had odds of 5-15 times more likely. PPV rates ranged from 53.66% to 84.62%, while NPV rates ranged from 47.52% to 90.91%. FDR across scales ranged from 15.38% to 50%, while the FOR ranged from 9.09% to 52.47%. CONCLUSIONS: Consistent with prior research, PNES patients have greater odds of MMPI-2-RF scale elevations, particularly related to somatic concerns and mood disturbance. Female PNES patients endorsed greater emotional distress, including endorsement of suicide related items. Elevations of these scales could aid in differentiating PNES from ES patients, although caution is warranted due to the possibility of both false positives and the incorrect omissions of PNES cases.

BACKGROUND: Given that post-traumatic headache is one of the most prevalent and long-lasting post-concussion sequelae, causes significant morbidity, and might be associated with slower neurocognitive recovery, we sought to evaluate the use of concussion screening scores in a concussion clinic population to assess for post-traumatic headache. METHODS: This is a retrospective cross-sectional study of 254 concussion patients from the New York University (NYU) Concussion Registry. Data on the headache characteristics, concussion mechanism, concussion screening scores were collected and analyzed. RESULTS: 72% of the patients had post-traumatic headache. About half (56.3%) were women. The mean age was 35 (SD 16.2). 90 (35%) patients suffered from sport-related concussions (SRC). Daily post-traumatic headache patients had higher Sport Concussion Assessment Tool (SCAT)-3 symptom severity scores than the non-daily post-traumatic headache and the headache-free patients (50.2 [SD 28.2] vs. 33.1 [SD 27.5] vs. 21.6 SD23], p < 0.001). Patients with SRC had lower headache intensity (4.47 [SD 2.5] vs. 6.24 [SD 2.28], p < 0.001) and SCAT symptom severity scores (33.9 [SD 27.4] vs. 51.4 [SD 27.7], p < 0.001) than the other patients, but there were no differences in post-traumatic headache prevalence, frequency, and Standardized Assessment of Concussion (SAC) scores. CONCLUSION: The presence and frequency of post-traumatic headache are associated with the SCAT-3 symptom severity score, which is the most important predictor for post-concussion recovery. The SCAT-3 symptom severity score might be a useful tool to help characterize patients' post-traumatic headache.

Neuropsychologists regularly conduct sport-related concussion (SRC) evaluations, although research has not tracked these assessment practices. As part of a survey of neuropsychological test usage, we analyzed data from 215 neuropsychologists who conduct SRC evaluations. Only 15% reported conducting baseline assessments of athletes as part of a sports program and 92% evaluate athletes' post-concussion without baseline data. The majority of respondents use a full battery, considered the most reliable approach for assessing concussion symptoms in athletes. Only 6% use computerized tests exclusively (>50% ImPACT). We discuss the implications of these results and address challenges faced by neuropsychologists who perform SRC evaluations.

OBJECTIVES: The aim of this study was to evaluate the reliability and validity of three computerized neurocognitive assessment tools (CNTs; i.e., ANAM, DANA, and ImPACT) for assessing mild traumatic brain injury (mTBI) in patients recruited through a level I trauma center emergency department (ED). METHODS: mTBI (n=94) and matched trauma control (n=80) subjects recruited from a level I trauma center emergency department completed symptom and neurocognitive assessments within 72 hr of injury and at 15 and 45 days post-injury. Concussion symptoms were also assessed via phone at 8 days post-injury. RESULTS: CNTs did not differentiate between groups at any time point (e.g., M 72-hr Cohen's d=-.16, .02, and .00 for ANAM, DANA, and ImPACT, respectively; negative values reflect greater impairment in the mTBI group). Roughly a quarter of stability coefficients were over .70 across measures and test-retest intervals in controls. In contrast, concussion symptom score differentiated mTBI vs. control groups acutely), with this effect size diminished over time (72-hr and day 8, 15, and 45 Cohen's d=-.78, -.60, -.49, and -.35, respectively). CONCLUSIONS: The CNTs evaluated, developed and widely used to assess sport-related concussion, did not yield significant differences between patients with mTBI versus other injuries. Symptom scores better differentiated groups than CNTs, with effect sizes weaker than those reported in sport-related concussion studies. Nonspecific injury factors, and other characteristics common in ED settings, likely affect CNT performance across trauma patients as a whole and thereby diminish the validity of CNTs for assessing mTBI in this patient population. (JINS, 2017, 23, 293-303).

The differential contribution of medial-temporal lobe regions to verbal declarative memory is debated within the neuroscience, neuropsychology, and cognitive psychology communities. We evaluate whether the extent of surgical resection within medial-temporal regions predicts longitudinal verbal learning and memory outcomes. This single-center retrospective observational study involved patients with refractory temporal lobe epilepsy undergoing unilateral anterior temporal lobe resection from 2007 to 2015. Thirty-two participants with Engel Classes 1 and 2 outcomes were included (14 left, 18 right) and followed for a mean of 2.3 years after surgery (+/-1.5 years). Participants had baseline and postsurgical neuropsychological testing and high-resolution T1-weighted MRI scans. Postsurgical lesions were manually traced and coregistered to presurgical scans to precisely quantify resection extent of medial-temporal regions. Verbal learning and memory change scores were regressed on hippocampal, entorhinal, and parahippocampal resection volume after accounting for baseline performance. Overall, there were no significant differences in learning and memory change between patients who received left and right anterior temporal lobe resection. After controlling for baseline performance, the extent of left parahippocampal resection accounted for 27% (p = .021) of the variance in verbal short delay free recall. The extent of left entorhinal resection accounted for 37% (p = .004) of the variance in verbal short delay free recall. Our findings highlight the critical role that the left parahippocampal and entorhinal regions play in recall for verbal material.

Research Objectives: Examine gender differences in self-reported postconcussion symptoms among individuals referred for neuropsychological services. Research has shown female gender is associated with increased susceptibility to emotional, physiological, sensory, and cognitive symptom clusters (King, 2014). Few studies have demonstrated which symptom cluster females are more likely to endorse. This study evaluates gender differences in symptomatology subsequent to various causes of concussion as research has shown this has implications for outcomes. Design: Retrospective study of adult concussion patients. Setting: Outpatient concussion center in an urban medical center. Participants: 100 patients (female = 59; mean age = 40.69 years) diagnosed with concussion or Post-Concussion Syndrome (PCS). Falls (33%), motor vehicle injuries (24%), and struck by an object (21%) were the top causes of injury. Interventions: Neuropsychological or psychological assessment. Main Outcome Measure(s): Sport Concussion Assessment Tool (SCAT 3). Results: Results indicated female concussion patients endorsed more physiological and sensory symptoms including nausea/vomiting (t(85.83)=-2.02, p <.05), dizziness (t(91) = -2.17, p <.05), balance problems (t(85.94) = -2.33, p <.05), sensitivity to light (t(91) = -3.18, p <.01 ), and sensitivity to noise (t(91) = -2.30, p <.05) than males. Additionally, females reported experiencing higher total numbers of symptoms (t(54.45)=-2.03, p <.05) and symptom severity (t(91) = -2.29, p <.05 ) than males. No gender differences were found with regard to cognitive, emotional, and sleep symptoms. Conclusions: A gender effect was demonstrated on several physiological and sensory concussion symptoms suggesting females to be more symptomatic than males. Results are consistent with previous findings indicating female athletes reported increased somatic symptoms postconcussion than male athletes. These findings can provide insight for rehabilitation specialists to develop more gender-specific approaches for treating female non-sport concussion patients