Clinical neuropsychology, functional neurosurgery, and restorative neurology in the next millennium: beyond secondary outcome measures

Ecological validity of the Meyers Neuropsychological Battery

Neuropsychologists are increasingly being asked to apply neuropsychological test results to real world functioning; however, neuropsychological tests are not usually constructed to do so, but instead are more concerned with diagnostic accuracy than with prediction of daily functioning. Using samples of 5,460 patients that did self-ratings and 2791 patients that had family ratings plus the Meyers Neuropsychological Battery (MNB), it was found that the family ratings were better predicted by neuropsychological test data than were self-ratings on the 38 item Patient Competency Rating Scale (PCRS). The R values for family ratings on the 36 regression equations ranged from .236 to .763. The results show that the ratings given patients by family members could be predicted by the neuropsychological test results. These findings can help the clinician to make broad statements regarding likely real-life functioning and also support the ecological validity of the tests that make up the MNB.

Acceptability and feasibility of a visual working memory task in an ecological momentary assessment paradigm

Neuropsychological performance has historically been measured in laboratory settings using standardized assessments. However, these methods may be inherently limited in generalizability. This concern may be mitigated with paradigms such as ecological momentary assessment (EMA). We evaluated the initial feasibility and acceptability of administering a visual working memory (VWM) task on handheld computers across 1 EMA study week among adolescents/young adults (N = 39). Participants also completed standardized laboratory neurocognitive measures to determine the extent to which EMA VWM performance mapped onto scores obtained in traditional testing environments. Compliance with the EMA protocol was high as participants responded to 87% of random prompts across the study week. As expected, EMA VWM performance was positively associated with laboratory measures of auditory and VWM, and these relationships persisted after adjusting for predicted intelligence. Further, discriminant validity tests showed that EMA VWM was not linked with laboratory scores of verbal abilities and processing speed. These data provide initial evidence on the convergent and discriminant validity of interpretations from this novel, ecologically valid neurocognitive approach. Future studies will aim to further establish the psychometric properties of this (and similar) tasks and investigate how momentary fluctuations in VWM correspond with contextual influences (e.g., substance use, mood) and clinical outcomes.

Use of Virtual Reality Tasks to Assess Prospective Memory: Applicability and Evidence

Virtual reality (VR) is a term used to describe computer-generated virtual environments that the patient can explore and interact with in real time. In this review, the use of VR to construct ecologically valid tasks for use in neuropsychological assessment and rehabilitation is discussed with particular reference to the measurement of prospective memory (PM) abilities. PM, the ability to act upon delayed intentions, is an example of an everyday ability requiring the coordination of a different cognitive processes that is ideally suited to research and rehabilitation using VR. Studies investigating PM and related abilities in patients with brain impairments are surveyed, and it is established that there is evidence for the utility of applying VR procedures to measure prospective remembering. Future research could usefully focus on the construction of a standardised testing procedure with credible psychometric characteristics. In particular, there needs to be evidence for the criterion validity of such tests. Another potential research avenue is the evaluation of VR platforms as tools to teach memory skills and awareness of impairments. It is concluded that difficulties in adapting programs to specific clinical needs, technical issues, and the reluctance of many clinicians to use computer-based technology need to be overcome before VR is likely to be widely used to measure PM.

Traumatic brain injury: future assessment tools and treatment prospects

Traumatic brain injury (TBI) is widespread and leads to death and disability in millions of individuals around the world each year. Overall incidence and prevalence of TBI are likely to increase in absolute terms in the future. Tackling the problem of treating TBI successfully will require improvements in the understanding of normal cerebral anatomy, physiology, and function throughout the lifespan, as well as the pathological and recuperative responses that result from trauma. New treatment approaches and combinations will need to be targeted to the heterogeneous needs of TBI populations. This article explores and evaluates the research evidence in areas that will likely lead to a reduction in TBI-related morbidity and improved outcomes. These include emerging assessment instruments and techniques in areas of structural/chemical and functional neuroimaging and neuropsychology, advances in the realms of cell-based therapies and genetics, promising cognitive rehabilitation techniques including cognitive remediation and the use of electronic technologies including assistive devices and virtual reality, and the emerging field of complementary and alternative medicine.

Neuropsychological sequelae of subthalamic nucleus deep brain stimulation in Parkinson's disease: a critical review

Neuropsychologists are increasingly involved in surgical candidacy evaluations and postoperative neurobehavioral assessments of patients with movement disorders, most notably those with Parkinson's disease (PD). We review here the initial studies regarding neuropsychological outcomes of deep brain stimulation (DBS) within the subthalamic nucleus (STN) for treatment of PD. Overall, these initial investigations provide preliminary support for the cognitive and neurobehavioral safety of STN DBS. Improvements in self-reported symptoms of depression and diminished verbal fluency were the most common findings, whereas changes in global cognitive abilities, memory, attention, and frontal/executive functions were inconsistent and most often described as nominal and/or transient. The generalizability of this literature is hindered by several methodological limitations, including small samples and the absence of appropriate control participants. The clinical and theoretical implications of these initial studies are highlighted and recommendations are offered to guide future research.