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Siguier PLM, Planton M, Baudou E, Chaix Y, Delage A, Rafiq M, Wolfrum M, Gérard F, Jucla M, Pariente J. Can neurodevelopmental disorders influence the course of neurodegenerative diseases? A scoping review. Ageing Res Rev 2024; 99:102354. [PMID: 38857707 DOI: 10.1016/j.arr.2024.102354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/30/2024] [Accepted: 05/27/2024] [Indexed: 06/12/2024]
Abstract
This scoping review aims at giving an overview of the possible influence of neurodevelopmental disorders (NDDs) on cognitive-behavioral neurodegenerative diseases (CBNDs). Based on the PRISMA-ScR checklist, it details the methods of NDDs screening, the identified NDDs-CBNDs associations, as well as the criteria and types of association. The last literature search was performed in June 2023. In the final study, 32 articles were included. Analysis first showed that NDDs were mainly detected through medical records screening. Second, the association of specific learning disorders and major or mild neurocognitive disorder due to Alzheimer's disease was the most investigated. Third, associations were mostly based on prevalence comparisons. Finally, 66 % of studies reported a positive association between NDDs and CBNDs. Notably, up to 67 % of positive associations were observed with atypical forms of certain CBNDs. Authors' interpretations suggest that NDDs could constitute a risk factor for CBNDs. However, the influence of NDDs on CBNDs still lacks evidence and biological support, possibly due to the heterogeneity of methods and criteria employed. Developing validated assessment tools for all NDDs and conducting cohort studies could be beneficial for research, and clinical practice. Indeed, this review also underlines the importance of adopting a life-span approach regarding CBNDs.
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Affiliation(s)
- Perrine L M Siguier
- Toulouse NeuroImaging Center, UMR1214, Toulouse University III, Inserm, CHU PURPAN - Pavillon BAUDOT, Place du Dr Joseph Baylac, 31024 TOULOUSE cedex 3, France; Laboratoire de Neuropsycholinguistique, EA4156, University of Toulouse II, 5 allée Antonio Machado, 31058 TOULOUSE cedex 9, France.
| | - Mélanie Planton
- Toulouse NeuroImaging Center, UMR1214, Toulouse University III, Inserm, CHU PURPAN - Pavillon BAUDOT, Place du Dr Joseph Baylac, 31024 TOULOUSE cedex 3, France; Department of Neurology, Neuroscience Centre, Toulouse-Purpan University Hospital, Place du Dr Baylac, TSA 40 031, 31059 Toulouse cedex 9, France
| | - Eloise Baudou
- Toulouse NeuroImaging Center, UMR1214, Toulouse University III, Inserm, CHU PURPAN - Pavillon BAUDOT, Place du Dr Joseph Baylac, 31024 TOULOUSE cedex 3, France; Neuropediatric Department, Toulouse-Purpan University Hospital, 330 avenue de Grande Bretagne - TSA 70034 - 31059 Toulouse cedex 9, France
| | - Yves Chaix
- Toulouse NeuroImaging Center, UMR1214, Toulouse University III, Inserm, CHU PURPAN - Pavillon BAUDOT, Place du Dr Joseph Baylac, 31024 TOULOUSE cedex 3, France; Neuropediatric Department, Toulouse-Purpan University Hospital, 330 avenue de Grande Bretagne - TSA 70034 - 31059 Toulouse cedex 9, France
| | - Alix Delage
- MéD@tAS Unit, Clinical Investigation Centre INSERM 1436, Department of Medical and Clinical Pharmacology, Toulouse University Hospital, 37 Allées Jules Guesde, Toulouse 31000, France
| | - Marie Rafiq
- Department of Neurology, Neuroscience Centre, Toulouse-Purpan University Hospital, Place du Dr Baylac, TSA 40 031, 31059 Toulouse cedex 9, France
| | - Marie Wolfrum
- Department of Neurology, Neuroscience Centre, Toulouse-Purpan University Hospital, Place du Dr Baylac, TSA 40 031, 31059 Toulouse cedex 9, France
| | - Fleur Gérard
- Department of Neurology, Neuroscience Centre, Toulouse-Purpan University Hospital, Place du Dr Baylac, TSA 40 031, 31059 Toulouse cedex 9, France
| | - Mélanie Jucla
- Laboratoire de Neuropsycholinguistique, EA4156, University of Toulouse II, 5 allée Antonio Machado, 31058 TOULOUSE cedex 9, France
| | - Jérémie Pariente
- Toulouse NeuroImaging Center, UMR1214, Toulouse University III, Inserm, CHU PURPAN - Pavillon BAUDOT, Place du Dr Joseph Baylac, 31024 TOULOUSE cedex 3, France; Department of Neurology, Neuroscience Centre, Toulouse-Purpan University Hospital, Place du Dr Baylac, TSA 40 031, 31059 Toulouse cedex 9, France
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Qu X, Kalb LG, Holingue C, Rojo-Wissar DM, Pritchard AE, Spira AP, Volk HE, Jacobson LA. Association of Time in Bed, Social Jetlag, and Sleep Disturbances With Cognitive Performance in Children With ADHD. J Atten Disord 2024; 28:99-108. [PMID: 37864347 PMCID: PMC11166002 DOI: 10.1177/10870547231204010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
OBJECTIVES Children with ADHD commonly exhibit sleep disturbances, but there is limited knowledge about how sleep and sleep timing are associated with cognitive dysfunction in children with ADHD. METHODS Participants were 350 children aged 5 to 12 years diagnosed with ADHD. Three sleep-related constructs-time in bed, social jetlag (i.e., discrepancy in sleep timing pattern between school nights and weekend nights), and sleep disturbances were measured using a caregiver-report questionnaire. Linear regression models assessed the associations between sleep-related constructs and cognitive performance. RESULTS After adjustment for sociodemographic variables, there were few associations between time in bed or sleep disturbances and cognitive performance, however, greater social jetlag was negatively associated with processing speed (β = -.20, 95% CI [-0.35, -0.06]), visually-based reasoning (β = -.13, 95% CI [-0.27, 0.00]), and language-based reasoning (β = -.22, 95% CI [-0.36, -0.08]); all p < .05). CONCLUSION Social jetlag, but not time in bed or disturbances, was associated with lower cognitive performance among children with ADHD.
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Affiliation(s)
- Xueqi Qu
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Luther G Kalb
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Kennedy Krieger Institute, Baltimore, MD, USA
| | | | | | - Alison E Pritchard
- Kennedy Krieger Institute, Baltimore, MD, USA
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Adam P Spira
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Heather E Volk
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lisa A Jacobson
- Kennedy Krieger Institute, Baltimore, MD, USA
- Johns Hopkins School of Medicine, Baltimore, MD, USA
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Ng R, Kalinousky A, Fahrner JA, Bjornsson HT, Harris J. The social phenotype associated with Wiedemann-Steiner syndrome: Autistic traits juxtaposed with high social drive and prosociality. Am J Med Genet A 2023; 191:2591-2601. [PMID: 37470210 DOI: 10.1002/ajmg.a.63351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 06/13/2023] [Accepted: 06/28/2023] [Indexed: 07/21/2023]
Abstract
The aim of this study was to provide a descriptive overview of the social characteristics associated with Wiedemann-Steiner syndrome (WSS). A total of 24 parents of children/adults with WSS (11F, mean age = 12.94 years, SD = 8.00) completed the Social Responsiveness Scale 2nd Edition (SRS-2); Colorado Learning Difficulties Questionnaire (CLDQ) and Strengths and Difficulties Questionnaire (SDQ). Almost half our sample reported a diagnosis of autism spectrum disorder (ASD) and 70% had intellectual disability. On the SDQ, over 90% of participants were rated in borderline/clinical ranges in Peer Problems, yet the majority fell within normal limits in Prosocial Behaviors. Most fell in the moderate/severe difficulties ranges across SRS-2 Social Cognition, Communication, and Restricted/Repetitive Behaviors scales (all >70%); whereas substantially less participants met these ranges for deficits in Social Awareness (50%) and Social Motivation (33.33%). A pattern of relatively strong prosocial skills and social drive in the context of difficulties with inflexible behaviors, social cognition, and communication was observed, regardless of gender, ASD or intellectual disability diagnosis. The social phenotype associated with WSS is characterized by some autistic features paired with unusually high social motivation and prosocial tendencies.
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Affiliation(s)
- Rowena Ng
- Kennedy Krieger Institute, Baltimore, Maryland, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Allison Kalinousky
- Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jill A Fahrner
- Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hans Tomas Bjornsson
- Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Landspitali University Hospital, Reykjavik, Iceland
| | - Jacqueline Harris
- Kennedy Krieger Institute, Baltimore, Maryland, USA
- Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Ng R, Bjornsson HT, Fahrner JA, Harris J. Unique profile of academic learning difficulties in Wiedemann-Steiner syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:101-111. [PMID: 36437529 PMCID: PMC9839653 DOI: 10.1111/jir.12993] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 09/06/2022] [Accepted: 11/07/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Wiedemann-Steiner syndrome (WSS) is a rare genetic disorder caused by heterozygous variants in KMT2A. To date, the cognitive profile associated with WSS remains largely unknown, although emergent case series implicate increased risk of non-verbal reasoning and visual processing deficits. This study examines the academic and learning concerns associated with WSS based on a parent-report screening measure. PARTICIPANTS AND METHODS A total of 25 parents of children/adults with a molecularly-confirmed diagnosis of WSS (mean age = 12.85 years, SD = 7.82) completed the Colorado Learning Difficulties Questionnaire (CLDQ), a parent-screening measure of learning and academic difficulties. Parent ratings were compared to those from a normative community sample to determine focal areas in Math, Reading and Spatial skills that may be weaker within this clinical population. RESULTS On average, parent ratings on the Math (mean Z = -3.08, SD = 0.87) and Spatial scales (mean Z = -2.52, SD = 0.85) were significantly more elevated than that of Reading (mean Z = -1.31, SD = 1.46) (Wilcoxon sign rank test Z < -3.83, P < 0.001), reflecting relatively more challenges observed in these areas. Distribution of parent ratings in Math items largely reflect a positively skewed distribution with most endorsing over three standard deviations below a community sample. In contrast, distributions of parent ratings in Reading and Spatial domains were more symmetric but flat. Ratings for Reading items yielded much larger variance than the other two domains, reflecting a wider range of performance variability. CONCLUSIONS Parent ratings on the CLDQ suggest more difficulties with Math and Spatial skills among those with WSS within group and relative to a community sample. Study results are consistent with recent case reports on the neuropsychological profile associated with WSS and with Kabuki syndrome, which is caused by variants in the related gene KMT2D. Findings lend support for overlapping cognitive patterns across syndromes, implicating potential common disease pathogenesis.
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Affiliation(s)
- Rowena Ng
- Kennedy Krieger Institute
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Hans Tomas Bjornsson
- Department of Genetic Medicine, Johns Hopkins University School of Medicine
- Department of Pediatrics, Johns Hopkins University School of Medicine
- Faculty of Medicine, University of Iceland, Reykjavik
- Landspitali University Hospital
| | - Jill A. Fahrner
- Department of Genetic Medicine, Johns Hopkins University School of Medicine
- Department of Pediatrics, Johns Hopkins University School of Medicine
| | - Jacqueline Harris
- Kennedy Krieger Institute
- Department of Genetic Medicine, Johns Hopkins University School of Medicine
- Department of Pediatrics, Johns Hopkins University School of Medicine
- Department of Neurology, Johns Hopkins University School of Medicine
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Tran NN, Pham-The T, Pham TN, Vu HT, Luong KN, Nishijo M. Neurodevelopmental Effects of Perinatal TCDD Exposure Differ from Those of Other PCDD/Fs in Vietnamese Children Living near the Former US Air Base in Da Nang, Vietnam. TOXICS 2023; 11:103. [PMID: 36850978 PMCID: PMC9961255 DOI: 10.3390/toxics11020103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
This study reports that children exposed to 2,3,7,8-tetra-chlorodibenzo-p-dioxin (TCDD), the major toxin in Agent Orange, from the breast milk of mothers residing near the former Da Nang US air base in Vietnam may have specific alterations in higher brain functions, resulting in social and communication deficits, including autism spectrum disorder (ASD). After the age of 8 years, girls with high TCDD showed increased attention deficit hyperactivity disorder (ADHD)-like behaviors and altered mirror neuron activity, which is often observed in children with ASD. However, no significant relationship between autistic traits and toxic equivalency values of polychlorinated dibenzodioxins and polychlorinated dibenzofurans (TEQ-PCDD/Fs) was found in these children. Notably, boys with high levels of TEQ-PCDD/Fs showed poor language and motor development in the first 3 years of life, although boys with high TCDD levels did not. However, at 8 years of age, boys with high TCDD showed reading learning difficulties, a neurodevelopmental disorder. These findings suggest that perinatal TCDD exposure impacts social-emotional cognitive functions, leading to sex-specific neurodevelopmental disorders-learning difficulty in boys and ADHD in girls. Future studies with a greater number of children exposed to high levels of TCDD are necessary to estimate the threshold values for neurodevelopmental effects.
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Affiliation(s)
- Nghi Ngoc Tran
- Ministry of Health, Vietnam Government, Hanoi 10000, Vietnam
| | - Tai Pham-The
- Faculty of Medicine, Vietnam Military Medical University, Hanoi 10000, Vietnam
| | - Thao Ngoc Pham
- Faculty of Medicine, Vietnam Military Medical University, Hanoi 10000, Vietnam
| | - Hoa Thi Vu
- Department of Public Health, Kanazawa Medial University, Uchinada 252-0815, Ishikawa, Japan
| | - Khue Ngoc Luong
- Ministry of Health, Vietnam Government, Hanoi 10000, Vietnam
| | - Muneko Nishijo
- Department of Public Health, Kanazawa Medial University, Uchinada 252-0815, Ishikawa, Japan
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6
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Vasserman M, Virani S, MacAllister WS, Désiré N, Mish S, Fay-McClymont T, Medlin LC, Brooks BL. Parent ratings on the MEMRY questionnaire predict children's academic performance. Child Neuropsychol 2023; 29:96-114. [PMID: 35534941 DOI: 10.1080/09297049.2022.2071420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Given the high rates of learning challenges in children with medical conditions, efficient and reliable screening methods are crucial. This study examined whether parent report of daily learning and memory predicts academic achievement in youth. Parents of 213 youth (aged 6-18) with varied medical diagnoses completed the Multidimensional Everyday Memory Ratings for Youth (MEMRY), and youth completed subtests from the Wechsler Individual Achievement Test-Third Edition (WIAT-III) as part of a comprehensive assessment. All scales of the MEMRY (Learning, Daily Memory, Executive/Working Memory) correlated significantly with WIAT-III Spelling, Word Reading, and Numerical Operations, while only the MEMRY Learning subscale correlated significantly with WIAT-III Pseudoword Decoding. Regression analyses indicated that MEMRY Learning significantly predicted WIAT-III Word Reading and Spelling, while both the MEMRY Learning and MEMRY Daily Memory scales significantly predicted WIAT-III Numerical Operations. When Full Scale IQ was entered into the models first, the MEMRY Learning subscale accounted for an additional 4% of variance in WIAT-III Word Reading and 7% of variance in WIAT-III Spelling, but did not account for additional variance in WIAT-III Numerical Operations or Pseudoword Decoding. Analyses in a subset of children with broadly normal intellectual functioning demonstrated very similar results, with even higher variance in academic testing accounted for by the MEMRY. In sum, the MEMRY questionnaire may serve as an efficient screen to identify children at risk for reading, spelling, and math deficits.
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Affiliation(s)
- Marsha Vasserman
- Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada.,Cumming School of Medicine, University of Calgary, AB, Canada.,Child Brain & Mental Health Program Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - Shane Virani
- Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada.,Department of Kinesiology, University of Calgary
| | - William S MacAllister
- Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada.,Cumming School of Medicine, University of Calgary, AB, Canada.,Child Brain & Mental Health Program Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - Naddley Désiré
- Department of Psychology and Division of Neurology, Hospital for Sick Children, Toronto, ON, Canada
| | - Sandra Mish
- Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada
| | - Taryn Fay-McClymont
- Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada.,Cumming School of Medicine, University of Calgary, AB, Canada.,Child Brain & Mental Health Program Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - L Collins Medlin
- Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada
| | - Brian L Brooks
- Neurosciences Program, Alberta Children's Hospital, Calgary, AB, Canada.,Cumming School of Medicine, University of Calgary, AB, Canada.,Child Brain & Mental Health Program Alberta Children's Hospital Research Institute, Calgary, AB, Canada.,Department of Psychology, University of Calgary
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Suspected neurodevelopmental disorders in adult patients of memory clinics: Start at the beginning. GREDEV proposals for clinical practice. Rev Neurol (Paris) 2022; 179:297-307. [PMID: 36424291 DOI: 10.1016/j.neurol.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/07/2022] [Accepted: 09/07/2022] [Indexed: 11/23/2022]
Abstract
Neurodevelopmental disorders are frequent but underestimated in adult populations, even though the cognitive profile of those affected remains atypical throughout adulthood and the disorders can cause significant impairment in activities of daily living. Retrospective diagnosis in this population is challenging. In this article, the GREDEV (working group for the assessment of neurodevelopmental disorders in adults) proposes a brief screening questionnaire for patients with suspected neurodevelopmental disorders, a checklist to facilitate taking the patient history, a list of self-administered questionnaires, and the different key steps of diagnosing neurodevelopmental disorders in adults.
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Yao M, Wang J, Liu P, Guo Y, Xie Y, Zhang L, Su N, Li Y, Yu D, Hong Q, Chi X. Development, Reliability, and Validity of the Preschool Learning Skills Scale: A Tool for Early Identification of Preschoolers at Risk of Learning Disorder in Mainland China. Front Neurol 2022; 13:918163. [PMID: 35911917 PMCID: PMC9326052 DOI: 10.3389/fneur.2022.918163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundEarly identification of children at risk of learning disorders (LD) may mitigate the adverse effects of delayed intervention by guiding children to receive preventive services at an earlier age. However, there is no assessment tool for the early identification of children at risk of LD in Mainland China. Therefore, this study aimed to create a Chinese version of the Preschool Learning Skills Scale and investigate its validity and reliability.MethodsFirstly, a pilot scale was designed based on literature review and expert review. Secondly, a pre-survey of the pilot scale was conducted. In phase 3, a formal survey was carried out to test the reliability and validity of the scale by involving 2,677 preschool children from 7 kindergartens. Data were collected using a checklist for demographic characteristics, the preschool learning skills scale, the Behavior Rating Inventory of Executive Function-Preschool Version (BRIEF-P), and Conners' Rating Scales.ResultsThe final scale included 38 items under seven factors. The reliability and validity tests confirmed that the Cronbach's alpha, split-half reliability, and test–retest reliability coefficients of the scale were 0.946, 0.888, and 0.941, respectively. The Spearman correlations of factor-total score ranged from 0.685 to 0.876. The results of criterion-related validity showed a direct and significant association between the preschool learning skills scale with the BRIEF-P (r = 0.641, P < 0.001) and the cognitive problems factor of Conners' Rating Scales (r = 0.564, P < 0.001). The model had a good fit (χ2/df = 3.489, RMSEA = 0.047, RMR = 0.024, CFI = 0.912, TLI = 0.900, and IFI = 0.912). Multigroup confirmatory factor analysis supported the structural and measurement invariance on the preschool learning skills scale across gender and grade.ConclusionsThe developed preschool learning skills scale has good reliability and validity, indicating that the scale can be used to identify preschool children at risk of LD and can be recommended for use in clinical research and practice.
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Affiliation(s)
- Mengmeng Yao
- School of Public Health, Nanjing Medical University, Nanjing, China
- Nanjing Maternity and Child Health Care Hospital, Women's Hospital of Nanjing Medical University, Nanjing, China
| | - Jing Wang
- Nanjing Maternity and Child Health Care Hospital, Women's Hospital of Nanjing Medical University, Nanjing, China
- School of Pediatrics, Nanjing Medical University, Nanjing, China
| | - Panting Liu
- Nanjing Maternity and Child Health Care Hospital, Women's Hospital of Nanjing Medical University, Nanjing, China
| | - Yanru Guo
- School of Pediatrics, Nanjing Medical University, Nanjing, China
| | - Yachun Xie
- Nanjing Maternity and Child Health Care Hospital, Women's Hospital of Nanjing Medical University, Nanjing, China
- School of Pediatrics, Nanjing Medical University, Nanjing, China
| | - Lei Zhang
- Nanjing Maternity and Child Health Care Hospital, Women's Hospital of Nanjing Medical University, Nanjing, China
| | - Nan Su
- Nanjing Maternity and Child Health Care Hospital, Women's Hospital of Nanjing Medical University, Nanjing, China
| | - Yanwei Li
- School of Early-Childhood Education, NanJing XiaoZhuang University, Nanjing, China
| | - Dongchuan Yu
- Research Center of Learning Science, Southeast University, Nanjing, China
| | - Qin Hong
- Nanjing Maternity and Child Health Care Hospital, Women's Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Xia Chi
| | - Xia Chi
- Nanjing Maternity and Child Health Care Hospital, Women's Hospital of Nanjing Medical University, Nanjing, China
- School of Pediatrics, Nanjing Medical University, Nanjing, China
- Qin Hong
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Wexler D, Salgado R, Gornik A, Peterson R, Pritchard A. What's race got to do with it? Informant rating discrepancies in neuropsychological evaluations for children with ADHD. Clin Neuropsychol 2022; 36:264-286. [PMID: 34238112 PMCID: PMC8985113 DOI: 10.1080/13854046.2021.1944671] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate race-based discrepancies in informant ratings and in rates of Attention-Deficit/Hyperactivity Disorder (ADHD) diagnosis among a clinically referred sample of Black and White children. METHOD Demographic information and ratings of inattention, hyperactivity/impulsivity, and conduct were collected from caregivers and teachers as part of neuropsychological evaluations at an outpatient clinic. The final sample included 3,943 children (6-18 years), of which 70% were White and 30% were Black. RESULTS Teachers, but not caregivers, endorsed more inattentive symptoms and conduct problems for Black than for White children, irrespective of ADHD diagnostic status and socioeconomic status (SES), and after controlling for child sex, child age, and learning difficulties. Teachers endorsed more hyperactive/impulsive symptoms for Black children with ADHD of lower SES than for White children with these characteristics. Caregivers of Black children of higher SES reported fewer hyperactive/impulsive symptoms than caregivers of White children of higher SES. Despite differences in teachers' ratings by race, diagnostic rates of ADHD in the context of neuropsychological evaluations were comparable for Black and White children. CONCLUSIONS Consistent with previous literature, teachers endorsed more ADHD and conduct problems in Black children. Within our clinically referred sample, this may reflect teacher bias rather than actual prevalence differences by rafce, given that Black caregivers endorsed fewer or similar numbers of symptoms relative to White caregivers. This lack of racial disparities in rates of ADHD diagnosis is inconsistent with findings in community- and population-based samples, and reflectspossible benefit of the use of neuropsychological evaluations in diagnostic decision-making for ADHD.
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Affiliation(s)
- Danielle Wexler
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland, USA;,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rod Salgado
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland, USA;,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Allison Gornik
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland, USA;,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rachel Peterson
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland, USA;,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Alison Pritchard
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland, USA;,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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10
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Wolfe KR, Hutaff-Lee C, Wilkening G. Neuropsychological Screening in Pediatric Multidisciplinary Clinics: Group Characteristics and Predictive Utility. Arch Clin Neuropsychol 2021; 37:789-797. [PMID: 34747436 DOI: 10.1093/arclin/acab090] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the feasibility of administering caregiver-report neuropsychological screening measures in pediatric multidisciplinary clinics (MDCs) and investigate predictive utility for cognitive and academic difficulties on follow-up testing. METHOD The Pediatric Perceived Cognitive Functioning (Peds PCF) and Colorado Learning Difficulties Questionnaire (CLDQ) were administered to caregivers of youth with history of brain tumor (BT), non-central nervous system (CNS) cancer, or Fontan circulation as part of routine neuropsychological consultation in MDCs from 2017 to 2019. We examined cross-sectional differences on screening measures, and relationships between screening and intellectual and academic test performance in a subset who presented for follow-up neuropsychological evaluation. Receiver operating characteristic (ROC) curve analysis was used to identify suggested cut scores on screening measures for predicting who would most benefit from further evaluation. RESULTS Screening was completed with 192 families. Children with history of non-CNS cancer (n = 29) had fewer parent-reported cognitive and academic concerns compared with either BT (n = 88) or Fontan (n = 75) groups. Peds PCF and CLDQ scores were related to intellectual and academic test performance in the group presenting for neuropsychological evaluation (n = 68). ROC curve analysis identified cut scores across screening measures with maximal sensitivity and specificity for detecting neuropsychological difficulties. CONCLUSIONS It is feasible to utilize parent rating measures during neuropsychological consultation in pediatric MDCs. The Peds PCF and CLDQ demonstrated sensitivity to intellectual and academic difficulties in children with significant medical histories. Screening may be a helpful tool for pediatric neuropsychologists and other professionals during MDC consultation to inform clinical management.
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Affiliation(s)
- Kelly R Wolfe
- Section of Neurology, Department of Pediatrics, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Christa Hutaff-Lee
- Section of Neurology, Department of Pediatrics, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Greta Wilkening
- Section of Neurology, Department of Pediatrics, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
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Jones EF, Pritchard A, Jacobson LA, Mahone EM, Zabel TA. How much testing can a kid take? Feasibility of collecting pediatric patient experience ratings of neuropsychological and psychological assessment. APPLIED NEUROPSYCHOLOGY-CHILD 2021; 11:610-617. [PMID: 34100332 DOI: 10.1080/21622965.2021.1917410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Parent-reported satisfaction is an important outcome measure in pediatric neuropsychology; however, self-report of patient experience following lengthy pediatric assessments has been under-investigated. Written at a first grade reading level and utilizing touch screen and read-aloud functionality, a set of 15 operationally-focused items were administered to evaluate pediatric patient experience of neuropsychological and psychological assessment. One-hundred ninety-seven clinically-referred patients (M age = 11.74, SD = 3.17, range = 5.86-19.02 years, 56% male) answered the post-assessment survey. The majority of patients (n = 167; 84.77%) accurately completed the initial two validity items, even though many had parent-reported ratings of reading difficulty. More than a third of patients indicated that the assessment made them tired (39%), but fewer patients reported feeling bored (13%) or worried (7%) during testing. Moreover, most patients reported having fun (66%) and many indicated that testing was preferable to other activities typically performed at that same time (i.e., school, homework). Responses to items assessing the child's interactions with the clinician and the child's effort provided little variation and were answered in a socially desirable manner. Items that focused upon the child's personal response to the assessment appointment (e.g., boredom, worry), however, elicited greater variance in patient responding. In general, patient responses did not suggest that assessment was an aversive experience. Overall, these proof of concept findings suggest that most referred pediatric patients, even those with learning issues, may be capable of independently navigating and completing self-report questionnaires while providing differential responses to items assessing clinical experience. Self-report questionnaires appear to be a feasible method for acquiring pediatric patient-reported experiences of assessment.
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Affiliation(s)
- Erin F Jones
- Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Alison Pritchard
- Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA.,School of Medicine, The Johns Hopkins University Baltimore, MD, USA
| | - Lisa A Jacobson
- Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA.,School of Medicine, The Johns Hopkins University Baltimore, MD, USA
| | - E Mark Mahone
- Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA.,School of Medicine, The Johns Hopkins University Baltimore, MD, USA
| | - T Andrew Zabel
- Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA.,School of Medicine, The Johns Hopkins University Baltimore, MD, USA
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Zabel T, Jacobson L, Pritchard A, Mahone E, Kalb L. Pre-appointment online assessment of patient complexity: Towards a personalized model of neuropsychological assessment. Child Neuropsychol 2021; 27:232-250. [PMID: 32969304 PMCID: PMC8112741 DOI: 10.1080/09297049.2020.1822310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 09/05/2020] [Indexed: 10/23/2022]
Abstract
Recent events such as the global pandemic of COVID-19 have challenged neuropsychologists to scale up their capacity to conduct portions of their assessment remotely. While more complex patients will likely continue to require on-site, office-based interaction and assessment, the current emergency-based expansion of online and telehealth evaluation practices may ultimately lay the groundwork for more routine, online assessment of patients with less complex presentations in the future. To this end, the current study evaluated a pre-appointment, online methodology for differentiating referred pediatric patients based upon the scope and severity of their caregiver-reported adaptive, academic, attentional, behavioral, and emotional impairment. Prior to on-site assessment, parents/caregivers of 2197 children (Mean age = 10.0y, range = 4-19y, 62% male) completed an online developmental history form screening for symptoms of adaptive, attentional, learning, affective, and behavioral impairment; 71% of those children eventually underwent assessment. Using latent class analysis, the data supported a reproducible 4-class model consisting of groups of children at increased risk for: 1) severe multi-domain dysfunction; the "High Complexity" group, 30%, 2) behavioral-affective (but not academic) dysregulation; the "Behavioral Focus" group, 13%, 3) academic (but not behavioral-affective) problems; the "Academic and Inattention" group, 37%, and 4) patients with minimal clinical complexity; the "Low Complexity" group, 20%. Comparison of pre-visit classification with day-of-assessment standardized test scores supported the validity of patient subtypes. Moving forward, pre-appointment clarification of patient complexity may support efficient patient triage with regard to assessment modality (e.g., on-site or online) and length of appointment (e.g., comprehensive or targeted).
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Affiliation(s)
- T.A. Zabel
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - L.A. Jacobson
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - A.E. Pritchard
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - E.M. Mahone
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - L. Kalb
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
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13
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Hewitt KC, Rodgin S, Loring DW, Pritchard AE, Jacobson LA. Transitioning to telehealth neuropsychology service: Considerations across adult and pediatric care settings. Clin Neuropsychol 2020; 34:1335-1351. [DOI: 10.1080/13854046.2020.1811891] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Kelsey C. Hewitt
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Sandra Rodgin
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - David W. Loring
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Alison E. Pritchard
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Lisa A. Jacobson
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Pham The T, Pham Ngoc T, Hoang Van T, Nishijo M, Tran Ngoc N, Vu Thi H, Hoang Van L, Tran Hai A, Nishino Y, Nishijo H. Effects of perinatal dioxin exposure on learning abilities of 8-year-old children in Vietnam. Int J Hyg Environ Health 2020; 223:132-141. [DOI: 10.1016/j.ijheh.2019.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 09/25/2019] [Accepted: 09/25/2019] [Indexed: 12/16/2022]
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Schaefer K, Coninx F, Fischbach T. LittlEARS auditory questionnaire as an infant hearing screening in Germany after the newborn hearing screening. Int J Audiol 2019; 58:468-475. [DOI: 10.1080/14992027.2019.1597287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Karolin Schaefer
- Department of Rehabilitation and Special Education, Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Frans Coninx
- Institute for Audiopedagogics, Solingen, Germany
| | - Thomas Fischbach
- German Pediatrician Association (Berufsverband der Kinder- und Jugendärzte BVKJ), Cologne, Germany
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Seamens A, Taussig B, Penziner K, Smidt A, Lawley LP. Exploring the prevalence of learning disabilities in children with cutaneous mastocytosis: A pilot cohort study. J Am Acad Dermatol 2017; 75:1254-1255. [PMID: 27846948 DOI: 10.1016/j.jaad.2016.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 06/28/2016] [Accepted: 07/01/2016] [Indexed: 10/20/2022]
Affiliation(s)
| | - Brian Taussig
- Department of Dermatology, Emory University, Atlanta, Georgia
| | | | - Aimee Smidt
- Department of Dermatology, University of New Mexico, Albuquerque
| | - Leslie P Lawley
- Department of Dermatology, Emory University, Atlanta, Georgia.
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Pritchard AE, Koriakin T, Carey L, Bellows A, Jacobson L, Mahone EM. Academic Testing Accommodations for ADHD: Do They Help? LEARNING DISABILITIES (PITTSBURGH, PA.) 2016; 21:67-78. [PMID: 28503058 PMCID: PMC5424262 DOI: 10.18666/ldmj-2016-v21-i2-7414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This study investigated the effectiveness of five commonly administered academic testing accommodations on reading and math performance in children with attention deficit hyperactivity disorder (ADHD). A total of 96 parents of 3rd-8th grade students with ADHD participated. More than half of the sample also had parent-reported learning difficulties in reading and/or math. Individually administered cognitive and achievement test scores, types of testing accommodations received, and Maryland School Assessment (MSA) reading and math scores were obtained from these students' school records. Taking into account grade level and co-occurring learning difficulties, none of the five accommodations investigated were associated with better MSA scores among students with ADHD who received the accommodations versus comparable students who did not. Additionally, individual variation in processing speed performance did not moderate the association between receipt of accommodations and reading or math performance. Common testing accommodations, as presently administered, may offer little benefit for students with ADHD, regardless of co-occurring learning difficulties.
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Affiliation(s)
- Alison Esposito Pritchard
- Clinical child psychologist at the Kennedy Krieger Institute and assistant professor of Psychiatry and Behavioral Sciences at the Johns Hopkins University School of Medicine
| | - Taylor Koriakin
- Graduate research assistant at the University of Connecticut Neag School of Education
| | - Lisa Carey
- Education consultant with the Center for Innovation and Leadership in Special Education at the Kennedy Krieger Institute
| | - Alison Bellows
- Research assistant in the Neuropsychology Department at the Kennedy Krieger Institute at the time of this manuscript
| | - Lisa Jacobson
- Faculty neuropsychologist at the Kennedy Krieger Institute and assistant professor of Psychiatry and Behavioral Sciences at the Johns Hopkins University School of Medicine
| | - E Mark Mahone
- Director of the Department of Neuropsychology, co-director of the Center for Innovation and Leadership in Special Education, and co-director of the Intellectual and Developmental Disabilities Research Center at the Kennedy Krieger Institute, as well as professor of Psychiatry and Behavioral Sciences at the Johns Hopkins University School of Medicine
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Seifan A, Isaacson R. The Alzheimer's Prevention Clinic at Weill Cornell Medical College / New York - Presbyterian Hospital: Risk Stratification and Personalized Early Intervention. JPAD-JOURNAL OF PREVENTION OF ALZHEIMERS DISEASE 2015; 2:254-266. [PMID: 28529933 DOI: 10.14283/jpad.2015.81] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In July 2013, Weill Cornell Medical College founded the first Alzheimer's Prevention Clinic (APC) in the United States, providing direct clinical care to family members of patients with Alzheimer's disease (AD) as part of the Weill Cornell Memory Disorders Program. At the APC, patients seeking to lower their AD risk undergo a comprehensive assessment, receive a personalized plan based on rapidly evolving scientific evidence, and are followed over time using validated as well as emerging clinical and research technologies. The APC approach applies the principles of pharmacogenomics, nutrigenomics and clinical precision medicine, to tailor individualized therapies for patients. Longitudinal measures currently assessed in the clinic include anthropometrics, cognition, blood biomarkers (i.e., lipid, inflammatory, metabolic, nutritional) and genetics, as well as validated, self-reported measures that enable patients to track several aspects of health-related quality of life. Patients are educated on the fundamental concepts of AD prevention via an interactive online course hosted on Alzheimer's Universe (www.AlzU.org), which also contains several activities including validated computer-based cognitive testing. The primary goal of the APC is to employ preventative measures that lower modifiable AD risk, possibly leading to a delay in onset of future symptoms. Our secondary goal is to establish a cohort of at-risk individuals who will be primed to participate in future AD prevention trials as disease-modifying agents emerge for testing at earlier stages of the AD process. The clinical services are intended to lower concern for future disease by giving patients a greater sense of control over their brain health.
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Affiliation(s)
- A Seifan
- Department of Neurology, Division of Memory Disorders, Weill Cornell Medical College / New York-Presbyterian Hospital, New York, NY, USA
| | - R Isaacson
- Department of Neurology, Division of Memory Disorders, Weill Cornell Medical College / New York-Presbyterian Hospital, New York, NY, USA
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Seifan A, Assuras S, Huey ED, Mez J, Tsapanou A, Caccappolo E. Childhood Learning Disabilities and Atypical Dementia: A Retrospective Chart Review. PLoS One 2015; 10:e0129919. [PMID: 26106899 PMCID: PMC4481274 DOI: 10.1371/journal.pone.0129919] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 05/14/2015] [Indexed: 11/19/2022] Open
Abstract
Objective To further our understanding of the association between self-reported childhood learning disabilities (LDs) and atypical dementia phenotypes (Atypical Dementia), including logopenic primary progressive aphasia (L-PPA), Posterior Cortical Atrophy (PCA), and Dysexecutive-type Alzheimer’s Disease (AD). Methods This retrospective case series analysis of 678 comprehensive neuropsychological assessments compared rates of self-reported LD between dementia patients diagnosed with Typical AD and those diagnosed with Atypical Dementia. 105 cases with neuroimaging or CSF data available and at least one neurology follow-up were identified as having been diagnosed by the neuropsychologist with any form of neurodegenerative dementia. These cases were subject to a consensus diagnostic process among three dementia experts using validated clinical criteria for AD and PPA. LD was considered Probable if two or more statements consistent with prior LD were documented within the Social & Developmental History of the initial neuropsychological evaluation. Results 85 subjects (Typical AD n=68, Atypical AD n=17) were included in the final analysis. In logistic regression models adjusted for age, gender, handedness, education and symptom duration, patients with Probable LD, compared to patients without Probable LD, were significantly more likely to be diagnosed with Atypical Dementia vs. Typical AD (OR 13.1, 95% CI 1.3-128.4). All three of the L-PPA cases reporting a childhood LD endorsed childhood difficulty with language. By contrast, both PCA cases reporting Probable childhood LD endorsed difficulty with attention and/or math. Conclusions In people who develop dementia, childhood LD may predispose to atypical phenotypes. Future studies are required to confirm whether atypical neurodevelopment predisposes to regional-specific neuropathology in AD and other dementias.
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Affiliation(s)
- Alon Seifan
- Department of Neurology Weill Cornell Medical College, New York, New York, United States of America
- * E-mail:
| | - Stephanie Assuras
- Department of Neuropsychology, Columbia University, New York, New York, United States of America
| | - Edward D. Huey
- Department of Neurology Columbia University, New York, New York, United States of America
- Gertrude H. Sergievsky Center, Columbia University, New York, New York, United States of America
- Cognitive neuroscience division, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, New York, United States of America
| | - Jesse Mez
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Angeliki Tsapanou
- Cognitive neuroscience division, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, New York, United States of America
| | - Elise Caccappolo
- Department of Neuropsychology, Columbia University, New York, New York, United States of America
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