Positive neuropsychology: The science and practice of promoting cognitive health

Using Neuropsychological Profiling to Tailor Mental Health Care for Children and Youth: a Quality Improvement Project to Measure Feasibility

OBJECTIVE

Precision child and youth mental healthcare has great potential to improve treatment success by tailoring interventions to individual needs. An innovative care pathway in a pediatric mental health outpatient clinic was designed to allow for neuropsychology data to be integrated in psychotherapeutic care. This paper describes the feasibility of this new pathway, including implementation outcomes, acceptability, and potential for future integration.

METHOD

The target population was outpatients 6-17 years old referred for individual treatment to a tertiary outpatient mental health (OPMH) clinic. The new care pathway was co-developed by neuropsychologists and mental health practitioners. A logic model was created to guide the evaluation, which was informed by the Reach Effectiveness Adoption Implementation Maintenance framework. As part of the logic model, a stepped assessment protocol was implemented, and reports on neuropsychological function were shared with patients, caregivers, and care providers. Evaluation data were collected from phone surveys, questionnaires, a focus group, and administrative records.

RESULTS

Forty-two patients scheduled to receive therapy over a 6-month period were offered the opportunity to participate in the new care pathway and 39 (93%) agreed. Self-reported outcome data showed that 83% of patients and 94% of caregivers valued neuropsychology-informed care, with some describing it as transformative. Almost all practitioners (91%) reported that the project added value to their clinical care. There were no adverse effects on participants nor the flow of patients through the system.

CONCLUSIONS

Neuropsychology-informed pediatric OPMH care was feasible and well-received. Clinical effectiveness should be studied in an experimental trial.

The Misguided Veneration of Averageness in Clinical Neuroscience: A Call to Value Diversity over Typicality

Research and practice in clinical neurosciences often involve cognitive assessment. However, this has traditionally used a nomothetic approach, comparing the performance of patients to normative samples. This method of defining abnormality places the average test performance of neurologically healthy individuals at its center. However, evidence suggests that neurological 'abnormalities' are very common, as is the diversity of cognitive abilities. The veneration of central tendency in cognitive assessment, i.e., equating typicality with healthy or ideal, is, I argue, misguided on neurodiversity, bio-evolutionary, and cognitive neuroscientific grounds. Furthermore, the use of average performance as an anchor point for normal performance is unreliable in practice and frequently leads to the mischaracterization of cognitive impairments. Examples are explored of how individuals who are already vulnerable for socioeconomic reasons can easily be over-pathologized. At a practical level, by valuing diversity rather than typicality, cognitive assessments can become more idiographic and focused on change at the level of the individual. The use of existing methods that approach cognitive assessment ideographically is briefly discussed, including premorbid estimation methods and informant reports. Moving the focus away from averageness to valuing diversity for both clinical cognitive assessments and inclusion of diverse groups in research is, I argue, a more just and effective way forward for clinical neurosciences.

Resilience as a moderator of depression and anxiety: a bidimensional approach to predictors of subjective cognition in older adults

OBJECTIVES

Subjective cognitive complaints (SCCs) have shown to be useful predictors of objective cognitive decline in older adults. Though psychopathology symptoms (e.g. depression, anxiety) have been linked to SCCs, little is known about the influence of positive psychology factors (e.g. resilience) on these complaints. The current study aimed to determine whether resilience predicts SCCs, and whether greater resilience moderates (or lessens) the effect of negative mental health symptoms on SCCs.

METHODS

Four hundred twenty-eight adults aged 60 years or older (M = 67.6, SD = 5.9) were recruited to participate in an online Qualtrics survey study. Surveys included assessed psychological resilience [University of Washington Resilience Scale 8-item short form (UWRS-8)], depression [Geriatric Depression Scale (GDS-15)], anxiety [Geriatric Anxiety Scale (GAS-30)], and SCCs [Perceived Deficits Questionnaire-Depression (PDQ-D); Barkley Deficits in Executive Functioning Scale-Short Form (BDEFS-SF)].

RESULTS

Although greater resilience was only independently associated with less complaints on BDEFS total scores, resilience moderated (i.e. reduced) the negative effects of depression and anxiety on PDQ-D retrospective memory and planning subscales as well as BDEFS-SF total scores. Resilience also moderated (i.e. reduced) the negative effect of anxiety on PDQ-D total scores.

CONCLUSION

With resilience lessening the effect of depression and anxiety on SCCS, our findings suggest positive psychological factors may be useful for understanding the prevalence of complaints. Future research should seek to replicate these findings and investigate relationships between additional positive psychological factors and cognitive health in old age including the use of both objective and subjective assessments of cognition.

The psychological benefits of neuropsychological assessment feedback as a psycho-educational therapeutic intervention: A randomized-controlled trial with cross-over in multiple sclerosis

ABSTRACTEvidence supporting the direct therapeutic benefits of neuropsychological assessment (NPA) feedback relies mostly upon post-feedback consumer surveys. This randomized-controlled trial with cross-over investigated the benefits of NPA feedback in multiple sclerosis (MS). Seventy-one participants were randomly allocated to NPA with feedback or a "delayed-treatment" control group. The primary hypotheses were that NPA feedback would lead to improved knowledge of cognitive functioning and improved coping. Outcome instruments were administered by a research assistant blinded to group allocation. At 1-week post-NPA feedback there were no significant group-by-time interaction effects, indicating no improvement. But nor was there any significant deterioration in psychological wellbeing, despite most participants receiving "bad news" confirming cognitive impairment. At 1-month follow-up, within-subjects' analyses not only found no evidence of any delayed deterioration, but showed clinically significant improvement (small-medium effects) in perceived everyday cognitive functioning, MS self-efficacy, stress and depression. Despite lack of improvement in the RCT component at 1-week post-NPA feedback, the absence of deterioration at this time, in addition to significant improvements in perceived cognitive functioning, self-efficacy and mood at follow-up, together with high satisfaction ratings, all support NPA feedback as a safe psycho-educational intervention that is followed by improved psychological wellbeing over time.Trial registration: Uniform Trial Number identifier: U1111-1127-1585.Trial registration: Australian New Zealand Clinical Trials Registry identifier: ACTRN12612000161820.

A pilot study of cognition and creativity among persons with HIV disease referred for neuropsychological evaluation

Creativity can help people to innovate, overcome obstacles, and successfully navigate challenges in daily life. Some aspects of creativity rely on the prefrontostriatal loops and executive functions, which can be compromised in persons with HIV (PWH). This pilot study examined whether neuropsychological functioning plays a role in creativity in PWH. A consecutive series of 41 PWH who were referred to an urban neuropsychology clinic in southeastern Texas were enrolled. Participants completed the Abbreviated Torrance Test for Adults (ATTA) to measure creativity, from which standardized creativity scores of fluency, originality, elaboration, and flexibility were derived. Participants also completed several measures of everyday functioning and a brief clinical neuropsychological battery measuring executive functions, motor skills, memory, and visuoconstruction. Global neuropsychological functioning showed a large, positive association with ATTA creativity performance that did not vary meaningfully by creativity domain and was independent of premorbid IQ. ATTA creativity scores were not associated with any measure of everyday functioning. Findings from this pilot study suggest that higher levels of neuropsychological functioning may support multiple dimensions of creativity in adults with HIV disease. Future studies might examine whether creativity moderates the association between HIV-associated neurocognitive impairment and various health behaviors (e.g., adherence, appointment attendance).

Nutrition and exercise interventions could ameliorate age-related cognitive decline: a meta-analysis of randomized controlled trials

OBJECTIVE

To evaluate the effect of nutrition combined physical exercise interventions on age-related cognitive decline by a systematic review and meta-analysis.

METHODS

We searched 9 databases, including PubMed, EMbase, The Cochrane Library, Web of Science, Science Direct, China National Knowledge Infrastructure (CNKI), VIP Information, China Biological Medical Database (CBM) and Wanfang for studies published until the end of December 2019. The selected trials should meet the following criteria, study objects: healthy adults aged 65 and over with cognitive dysfunction or diagnosed as MCI, but not meet the diagnostic criteria for dementia as well as no restriction on follow-up time, race or gender. Study interventions: multiple interventions including nutrition and exercise.

EXCLUSION CRITERIA

(1) studies included elderly people with any type of dementia or patients with cognitive impairment induced by secondary causes, including drug, alcohol, severe organic brain diseases, mental disorders. (2) Republished literature. (3) Studies with significant differences in baseline data between groups. (4) The data in the study cannot be converted into the required data format. We reviewed and extracted information and assessed the risk of bias of recruited studies independently. Meta-analysis was performed using STATA v.15.1 software. The bias of publication was estimated by Egger test.

RESULTS

A total of six RCTs representing 1039 participates were included in our meta-analysis. In terms of global cognitive function that has been assessed by neuropsychological test in different combinations, the result showed that the beneficial effect of nutrition combined exercise interventions was statistically significant [SMD = 0.23, 95% CI (0.1, 0.36), P = 0.0004]. There were no statistical differences from assays on MMSE scores, Memory, Executive Function, Attention, and Information Processing Speed across groups.

CONCLUSIONS

The current study shows that nutrition combined exercise interventions can improve global cognitive function in the aged with cognitive decline. Further researches emphasizing on longer follow-up time, experimental randomness, credibility and scale would better elucidate the effect of nutrition combined exercise interventions on cognitive function, particularly in older adults. (registration number: CRD42020159291, date of registration: 28/04/2020).

Paradoxes in rehabilitation

Paradoxical enhancement and paradoxical recovery of function after brain injury harmonize well with the concept of "ultrabilitation" and its focus on novel forms of flourishing in rehabilitation settings. I consider three sets of paradoxes which may impact on brain injury rehabilitation. Firstly, I consider post-traumatic growth after brain injury and its key determinants. Secondly, I review the role of illusions in rehabilitation and the paradox that some clinical conditions may be improved by invoking perceptual distortions. Thirdly, I consider paradoxical recovery profiles after brain injury, since knowledge of such paradoxical profiles may help inform attempts at rehabilitation of some patients. Finally, I consider how some of these paradoxes relate to components of ultrabilitation, and in addition to the nascent field of positive neuropsychology and the concept of resilience after brain injury.Implications for rehabilitationIllusions can sometimes be harnessed as a therapeutic tool in rehabilitation.There may be spontaneous, positive outcomes of an injury or illness, in the form of "post-traumatic growth", and these should be considered as part of a holistic therapeutic approach in rehabilitation.Some patients make an exceptional recovery from a severe brain insult, and lessons could be learned from such cases, such as disciplined use of compensatory strategies, which could have broader implications for neurorehabilitation.