Neuropsychology in a Memory Disorder Clinic

The ambivalence toward neuropsychology in dementia research, diagnosis, and drug development: Myths and misconceptions

Clinical assessment remains the gold standard for diagnosing dementia, monitoring progression, and conducting clinical research. Biomarkers hold promise for targeted therapeutic approaches, selection of participants in clinical trials, and direct physiological efficacy readouts. However, the anchoring of biomarker research to clinical symptomatology is often based on short and insensitive cognitive screening. This gives the impression that cognitive symptoms occur relatively late and that their progression in the early stages of the disease is slow. A thorough cognitive assessment is a powerful tool and has a key role in the accurate and early diagnosis of dementia. It is very different from the cognitive testing usually seen in biomarker research and drug development. Yet the distinction between these approaches is unclear to many. This paper highlights the misconceptions around cognitive research in dementia and suggests a way forward to facilitate biomarker and drug development through the improved utility of cognitive assessment tools.

Multidimensional Clinical Assessment in Frontotemporal Dementia and Its Spectrum in Latin America and the Caribbean: A Narrative Review and a Glance at Future Challenges

Frontotemporal dementia (FTD) is the third most common form of dementia across all age groups and is a leading cause of early-onset dementia. The Frontotemporal dementia (FTD) includes a spectrum of diseases that are classified according to their clinical presentation and patterns of neurodegeneration. There are two main types of FTD: behavioral FTD variant (bvFTD), characterized by a deterioration in social function, behavior, and personality; and primary progressive aphasias (PPA), characterized by a deficit in language skills. There are other types of FTD-related disorders that present motor impairment and/or parkinsonism, including FTD with motor neuron disease (FTD-MND), progressive supranuclear palsy (PSP), and corticobasal syndrome (CBS). The FTD and its associated disorders present great clinical heterogeneity. The diagnosis of FTD is based on the identification through clinical assessments of a specific clinical phenotype of impairments in different domains, complemented by an evaluation through instruments, i.e., tests and questionnaires, validated for the population under study, thus, achieving timely detection and treatment. While the prevalence of dementia in Latin America and the Caribbean (LAC) is increasing rapidly, there is still a lack of standardized instruments and consensus for FTD diagnosis. In this context, it is important to review the published tests and questionnaires adapted and/or validated in LAC for the assessment of cognition, behavior, functionality, and gait in FTD and its spectrum. Therefore, our paper has three main goals. First, to present a narrative review of the main tests and questionnaires published in LAC for the assessment of FTD and its spectrum in six dimensions: (i) Cognitive screening; (ii) Neuropsychological assessment divided by cognitive domain; (iii) Gait assessment; (iv) Behavioral and neuropsychiatric symptoms; (v) Functional assessment; and (vi) Global Rating Scale. Second, to propose a multidimensional clinical assessment of FTD in LAC identifying the main gaps. Lastly, it is proposed to create a LAC consortium that will discuss strategies to address the current challenges in the field.

The "Counseling+" Roles of the Speech-Language Pathologist Serving Older Adults With Mild Cognitive Impairment and Dementia From Alzheimer's Disease

Purpose

Persons with dementia and mild cognitive impairment (MCI) are major consumers of services provided by speech-language pathologists (SLPs). These services include not only direct assessment and treatment of communication and swallowing but also counseling, collaboration, prevention, and wellness. These "counseling+" activities can be especially challenging for SLPs to deliver because of the lack of evidence, as well as the complex nature of Alzheimer's disease (AD) and other conditions that cause MCI and dementia.

Method

This tutorial is written by a speech-language pathologist, a neuropsychologist, and a geriatric psychiatrist to provide education, resources, and recommendations for SLPs delivering counseling+ activities to patients with MCI and dementia from AD and related disorders.

Results and Conclusions

We describe counseling+ activities across the continuum of care ranging from educating and conducting cognitive screenings with adults experiencing age-related cognitive decline to supporting end-of-life wishes. Because of their expertise in communication, SLPs can provide an array of important leading and supporting services to patients, their family, and other health care professionals on the care team, such as providing patients with appropriate feedback following a cognitive screening and helping caregivers identify the communicative intent of a responsive behavior. The demand for SLP services for patients with MCI and dementia will grow significantly over the next few decades, necessitating more systematic research and clinical evidence in this area.

The 100 Top-Cited Studies on Neuropsychology: A Bibliometric Analysis

Objective

The present study aimed to identify and analyze the bibliometric characteristics of the 100 top-cited studies on neuropsychology.

Methods

We searched the Web of Science Core Collection database to collect studies on neuropsychology from inception to 31st December 2019. Two authors independently screened the literature and extracted the data. Statistical analyses were performed using R software.

Results

The 100 top-cited articles were cited a total of 166,123 times, ranging from 736 to 24,252 times per article. All of the studies were published from 1967 to 2014 in 47 journals. Neuropsychologia had the highest number of articles (n = 17), followed by Neurology (n = 8). The top three most productive countries were the USA (n = 60), England (n = 13), and Canada (n = 8). Eight authors contributed the same number of studies as the first author (n = 2) or corresponding author (n = 2). The most productive institute was the University of California (n = 9), followed by the University of Pennsylvania (n = 4). Of the 100 top-cited publications, 64 were original articles, and 36 were reviews. The top three Web of Science categories were clinical neurology (n = 28), behavioral sciences (n = 19), and psychiatry (n = 11).

Conclusion

This study provides insight into the impact of neuropsychology research and may help doctors, researchers, and stakeholders to achieve a more comprehensive understanding of trends and most influential contributions to the field, thus promoting ideas for future investigation.

The role of the neuropsychologist in memory clinics

International recommendations and guidelines on the diagnosis and management of cognitive impairment highlight the relevance of a multidimensional approach with increasing attention to well-established cognitive evaluations and interventions. Memory clinics represent a model that offers the expertise of several health specialties. This commentary aims at detailing the contribution of the neuropsychologist in this setting, and highlighting the need of implementing its presence in all the dedicated services. The neuropsychologist can offer an expertise that can be employed both in clinical routes and research, being able to synergistically interact with all the other health specialists involved in memory clinics. The role of the neuropsychologist in cognitive impairment diagnosis includes the development and the administration of comprehensive test batteries and the determination of both the degree of impairment and the cognitive profile, thus contributing to differential diagnoses. In the management of cognitive impairment, the neuropsychologist expertise can contribute in care planning and monitoring, in administering cognition-focused interventions, and in measuring treatment response. In cognitive impairment research, beyond the development and administration of test batteries, the neuropsychologist can contribute actively to the choice of cognitive study outcomes, data analysis, and results interpretation within an interdisciplinary framework. An overview of the actual weight of neuropsychologists in Italian memory clinics shows that, despite the presence of a psychologist in the team could be felt as an added value, several difficulties are still encountered in the integration of this figure as a permanent member. Efforts need to be made in this direction.