Faculty Bibliography

The International League Against Epilepsy (ILAE) Diagnostic Methods Commission charged the Neuropsychology Task Force with the job of developing a set of recommendations to address the following questions: (1) What is the role of a neuropsychological assessment? (2) Who should do a neuropsychological assessment? (3) When should people with epilepsy be referred for a neuropsychological assessment? and (4) What should be expected from a neuropsychological assessment? The recommendations have been broadly written for health care clinicians in established epilepsy settings as well as those setting up new services. They are based on a detailed survey of neuropsychological assessment practices across international epilepsy centers, and formal ranking of specific recommendations for advancing clinical epilepsy care generated by specialist epilepsy neuropsychologists from around the world. They also incorporate the latest research findings to establish minimum standards for training and practice, reflecting the many roles of neuropsychological assessment in the routine care of children and adults with epilepsy. The recommendations endorse routine screening of cognition, mood, and behavior in new-onset epilepsy, and describe the range of situations when more detailed, formal neuropsychological assessment is indicated. They identify a core set of cognitive and psychological domains that should be assessed to provide an objective account of an individual's cognitive, emotional, and psychosocial functioning, including factors likely contributing to deficits identified on qualitative and quantitative examination. The recommendations also endorse routine provision of feedback to patients, families, and clinicians about the implications of the assessment results, including specific clinical recommendations of what can be done to improve a patient's cognitive or psychosocial functioning and alleviate the distress of any difficulties identified. By canvassing the breadth and depth of scope of neuropsychological assessment, this report demonstrates the pivotal role played by this noninvasive and minimally resource intensive investigation in the care of people with epilepsy.

OBJECTIVE: This study investigated the classification accuracy of the Minnesota Multiphasic Personality Inventory-2-Restructured Form validity scales in a sample of disability claimants and civil forensic litigants. METHOD: A criterion-groups design was used, classifying examinees as "Failed Slick Criteria" through low performance on at least two performance validity indices (stand-alone or embedded) and "Passed Slick Criteria." The stand-alone measures included the Test of Memory Malingering and the Dot Counting Test. The embedded indices were extracted from the Wechsler Adult Intelligence Scales Digit Span and Vocabulary subtests, the California Verbal Learning Test-II, and the Wisconsin Card Sorting Test. RESULTS: Among groups classified by primary complaints at the time of evaluation, those alleging neurological conditions were more frequently classified as Failed Slick Criteria than those alleging psychiatric or medical conditions. Among those with neurological or psychiatric complaints, the F-r, FBS-r, and RBS scales differentiated between those who Passed Slick Criteria from those who Failed Slick Criteria. The Fs scale was also significantly higher in the Failed Slick Criteria compared to Passed Slick Criteria examinees within the psychiatric complaints group. CONCLUSIONS: Results indicated that interpretation of scale scores should take into account the examinees' presenting illness. While this study has limitations, it highlights the possibility of different cutoffs depending on the presenting complaints and the need for further studies to cross-validate the results.

OBJECTIVE: For patients with medically intractable focal epilepsy, the benefit of epilepsy surgery must be weighed against the risk of cognitive decline. Clinical factors such as age and presurgical cognitive level partially predict cognitive outcome; yet, little is known about the role of cross-hemispheric white matter pathways in supporting postsurgical recovery of cognitive function. The purpose of this study is to determine whether the presurgical corpus callosum (CC) midsagittal area is associated with pre- to postsurgical change following epilepsy surgery. METHODS: In this observational study, we retrospectively identified 24 adult patients from an epilepsy resection series who completed preoperative high-resolution T1 -weighted magnetic resonance imaging (MRI) scans, as well as pre- and postsurgical neuropsychological testing. The total area and seven subregional areas of the CC were measured on the midsagittal MRI slice using an automated method. Standardized indices of auditory-verbal working memory and delayed memory were used to probe cognitive change from pre- to postsurgery. CC total and subregional areas were regressed on memory-change scores, after controlling for overall brain volume, age, presurgical memory scores, and duration of epilepsy. RESULTS: Patients had significantly reduced CC area relative to healthy controls. We found a positive relationship between CC area and change in working memory, but not delayed memory; specifically, the larger the CC, the greater the postsurgical improvement in working memory (beta = 0.523; p = 0.009). Effects were strongest in posterior CC subregions. There was no relationship between CC area and presurgical memory scores. SIGNIFICANCE: Findings indicate that larger CC area, measured presurgically, is related to improvement in working memory abilities following epilepsy surgery. This suggests that transcallosal pathways may play an important, yet little understood, role in postsurgical recovery of cognitive functions.

Focal cortical dysplasia (FCD) is a malformation of cortical development that is associated with high rates of cognitive morbidity. However, the degree to which specific irregularities of dysplastic tissue directly impact cognition remains unknown. This study investigates the relationship between blurring of the cortical gray and white matter boundary on magnetic resonance imaging (MRI) and global cognitive abilities in FCD. Gray-white blurring (GWB) is quantified by sampling the non-normalized T1 image intensity contrast above and below the gray and white matter interface along the cortical mantle. Spherical averaging is used to compare resulting GWB for patients with histopathologically verified FCD with matched controls. Whole-brain correlational analyses are used to investigate the relationship between blurring and general cognitive abilities, controlling for epilepsy duration. Results show that cognitive performance is reduced in patients with FCD relative to controls. Patients show increased GWB in bilateral temporal, parietal, and frontal regions. Furthermore, increased GWB in these regions is linearly related to decreased cognition and mediates group differences in cognitive performance. These findings demonstrate that GWB is a marker of reduced cognitive efficiency in FCD that can potentially be used to probe general and domain-specific cognitive functions in other neurological disorders.

Recent acceleration in development of computerized neuropsychological tests and test batteries has led to gains in sophistication, intuitiveness, and capability with concomitant opportunities for greater adoption among practitioners. Advantages attributed to computerized methods (e. g., standardization, large-scale screening, measurement of performance attributes inaccessible by traditional means) enhance prospects for growth. Despite technological improvement and potential benefit to neuropsychological assessment, the regularity with which neuropsychologists utilize computer-based methods remains unsettled. As part of a 10-year follow-up study of neuropsychological test usage practices, we surveyed neuropsychologists' utilization of computerized instruments and investigated practice-related factors that influence computerized test adoption. Respondents were 512 doctorate-level psychologists residing in the United States and Canada (26% usable response rate; 54% female) affiliated with the National Academy of Neuropsychology or the International Neuropsychological Society. Of the 693 distinct instruments reported by respondents, only 6% (n = 40) were computerized, and the average respondent reported rarely using computerized tests. We present the top-ranked computerized instruments and results of correlational analyses, which indicate that fewer years practicing and the youth of respondents associates with increased likelihood of computerized test utilization, along with increased utilization of neuropsychological tests with alternative or parallel forms. Implications for existing and emerging technologies in research and clinical settings are considered.

Despite the importance of diversity variables to the clinical practice of neuropsychology, little is known about neuropsychologists' multicultural assessment practices and perspectives. The current study was the first to survey issues related to neuropsychologists' assessment of minority populations, proficiency in languages other than English, approaches to interpreting the cognitive scores of minorities, and perceived challenges associated with assessing ethnic/racial minority patients. We also surveyed respondents with regard to their own demographic backgrounds, as neuropsychologists who identify as ethnic/racial minorities are reportedly underrepresented in the field. Respondents were 512 (26% usable response rate; 54% female) doctorate-level psychologists affiliated with the International Neuropsychology Society or the National Academy of Neuropsychology who resided in the United States or Canada. Overall, results suggest that lack of appropriate norms, tests, and referral sources are perceived as the greatest challenges associated with assessment of ethnic/racial minorities, that multicultural training is not occurring for some practitioners, and that some are conducting assessments in foreign languages despite limited proficiency. In addition, ethnic/racial minorities appear to be grossly underrepresented in the field of neuropsychology. Findings are discussed in relation to the need for appropriate education and training of neuropsychologists in multicultural issues and the provision of more valid assessments for ethnic/racial minority individuals.

The present study examined the relationship between various sociocultural factors (e.g., acculturation, education), neurological variables (e.g., epilepsy duration and seizure frequency) and nonverbal neuropsychological (NP) test performance in a sample of 305 Latino/a and Non-Latino/a White adults with and without epilepsy. All participants completed nonverbal NP measures of visuospatial skills, memory, executive functioning, and psychomotor speed. An acculturation scale was administered to Spanish-speaking epilepsy patients and controls. Education was strongly correlated with performance on all but one of the nonverbal measures across the entire sample. Among Spanish-speaking Latino/a patients with epilepsy, level of acculturation to U.S. culture was associated with a measure of behavioral inflexibility (p < .05) and with a composite measure of nonverbal NP test performance (p < .05). Finally, the results of hierarchical regression models showed that sociocultural factors accounted for a greater proportion of variance in nonverbal NP test performance than did neurological factors. These results provide further evidence that sociocultural factors are strong predictors of NP test performance in clinical populations, even on nonverbal tests. Assessment of acculturation may be as critical as assessment of disease factors in interpreting cognitive performance in Latino/a individuals.

Rationale: For patients with medically intractable focal epilepsy, the best option for achieving seizure control is often surgical resection. In surgical planning, the potential for seizure reduction must be weighed against the risk of cognitive loss. The role that clinical and demographic factors play in predicting cognitive outcome is well established; however, little is known about the role of crosshemispheric white matter in promoting functional reorganization after surgery. In this study we measured the midsagittal crosssectional area of the corpus callosum (CC) on pre-surgical MRI to investigate whether this property is related to changes in working memory following surgery. Methods: A pre- and post-surgical neuropsychological test battery was obtained in 15 patients (9 males/6 females) who underwent temporal (n = 9), frontal (n = 4), temporal and frontal (n = 1) or parietal lobe (n = 1) resective surgery at NYU Langone Medical Center. Pre-surgical whole-brain T1-weighted 3D MRIs were acquired on all participants from the same dedicated research scanner. The midsaggital CC cross-sectional area was delineated and measured automatically on the MRI using 'yuki' (www.nitrc.org/projects/art), an automatic CC segmentation algorithm, described by Ardekani et al. 2012 (Figure 1A). The Working Memory Index (WMI) from the Wechsler Adult Intelligence Scale was used to probe change in concentration/working memory abilities (postsurgical W

This study examined the degree to which anxiety contributed to inconsistent material-specific memory difficulties among 243 patients with temporal lobe epilepsy from the Multisite Epilepsy Study. Visual memory performance on the Rey Complex Figure Test (RCFT) was poorer for those with high versus low levels of anxiety but was not found to be related to the TLE side. The verbal memory score on the California Verbal Learning Test (CVLT) was significantly lower for patients with left-sided TLE than for patients with right-sided TLE with low anxiety levels but equally impaired for those with high anxiety levels. These results suggest that we can place more confidence in the ability of verbal memory tests like the CVLT to lateralize to left-sided TLE for those with low anxiety levels, but that verbal memory will be less likely to produce lateralizing information for those with high anxiety levels. This suggests that more caution is needed when interpreting verbal memory tests for those with high anxiety levels. These results indicated that RCFT performance was significantly affected by anxiety and did not lateralize to either side, regardless of anxiety levels. This study adds to the existing literature which suggests that drawing-based visual memory tests do not lateralize among patients with TLE, regardless of anxiety levels.