Neuropsychological Assessment of the Aging Physician: A Review & Commentary

2021 ◽  
pp. 089198872110160
Author(s):  
Charles E. Gaudet ◽  
Victor A. Del Bene
Keyword(s):  
At Risk ◽  
Cognitive Functioning ◽  
Neuropsychological Assessment ◽  
Potential Role ◽  
Cognitive Testing ◽  
Test Interpretation ◽  
Cognitive Screening ◽  
Cognitive Changes ◽  
Fitness For Duty

Late-career physicians (LCPs) are at risk for cognitive changes that may affect their ability to practice medicine. This review aggregates and discusses research that has examined cognitive functioning among physicians, typically when clinically referred for various medical and psychological reasons that may interfere with their ability to practice medicine. Special consideration is devoted to the role of approaches for examining cognitive functioning (e.g., cognitive screening, cognitive testing, & neuropsychological assessment), normative challenges, and cultural factors that should be considered when evaluating a physician. Based on published studies, there is evidence supportive of the use of cognitive testing and neuropsychological assessment among physicians in a fitness for duty setting. However, prospective studies designed to identify physicians at-risk (i.e., to prevent medical error) are lacking. Additional research is warranted to establish physician-based normative reference groups and aid in test interpretation and prognostication. Moreover, given limitations associated with cognitive testing in isolation, there is a potential role for comprehensive neuropsychological assessment to identify cognitive changes in physicians and provide a supportive pathway to preserve physicians’ ability to practice medicine.

scholarly journals Cognitive assessment using ERP in child and adolescent psychiatry: difficulties and opportunities

2021 ◽  
Author(s):  
Cristina Berchio ◽  
Keyword(s):  
Cognitive Functioning ◽  
Adolescent Psychiatry ◽  
Cognitive Assessment ◽  
Potential Role ◽  
Event Related Potentials ◽  
Child And Adolescent ◽  
Child And Adolescent Psychiatry ◽  
Diagnostic Categories ◽  
Related Potentials

Event related potentials (ERPs) represent powerful tools to investigate cognitive functioning in child and adolescent psychiatry. So far, the available body of research has largely focused on advancements in analysis methods, with little attention given to the perspective of assessment. The aim of this brief report is to provide recommendations for cognitive ERPs assessment that can be applied across diagnostic categories in child and adolescent psychiatry. First, we discuss major issues for ERPs testing using examples from common psychiatric disorders. We conclude by summing up our recommendations for methodological standards and highlighting the potential role of ERPs in the field.

Potential role of botanic garden collections in predicting hosts at risk globally from invasive pests: a case study using Scirtothrips dorsalis

2017 ◽  
Vol 91 (2) ◽  
pp. 601-611 ◽  
Author(s):  
A. S. Scott-Brown ◽  
J. Hodgetts ◽  
J. Hall ◽  
M. J. S. Simmonds ◽  
D. W. Collins
Keyword(s):  
At Risk ◽  
Potential Role ◽  
Botanic Garden ◽  
Invasive Pests ◽  
Scirtothrips Dorsalis

scholarly journals Role of neuropsychological assessment in the differential diagnosis of Alzheimer's disease and vascular dementia

2009 ◽  
Vol 3 (3) ◽  
pp. 214-221 ◽  
Author(s):  
Érica Maria Lima Pimentel
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Differential Diagnosis ◽  
Cognitive Function ◽  
Vascular Dementia ◽  
Neuropsychological Assessment ◽  
Neurological Examination ◽  
Cognitive Changes ◽  
Neuropsychological Assessments

Abstract The prevalence of dementia increases significantly from the age of 65 years, doubling every five years thereafter. Alzheimer's disease (AD) and vascular dementia (VaD) constitute the two main dementia types. Differentiating them encompasses anamnesis, neurological examination, laboratory and neuroimaging exams and neuropsychological assessment. Neuropsychological assessment produces different findings for each dementia type, and reveals those areas most impaired as well as those most preserved. The aim of the present article was to describe the role of neuropsychology in diagnosing dementia and achieving a differential diagnosis between AD and VaD. A general overview follows of the most widely known instruments used to assess cognitive function in dementia, and the cognitive changes seen in AD and VaD. The conclusion drawn was that there is significant overlap in cognitive changes between both these dementia types, while each type has its own specific characteristics which are identifiable and quantifiable on neuropsychological assessments and provide the basis for reaching a differential diagnosis.

Abstract 68: Impaired Perfusion in Intracranial Atherosclerotic Disease Predicts Cognitive Outcomes

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
David S Liebeskind ◽  
Jose G Romano ◽  
George A Cotsonis ◽  
Shadi Yaghi ◽  
Tristan Honda ◽  
...  
Keyword(s):  
Collateral Circulation ◽  
Recurrent Stroke ◽  
Cognitive Outcomes ◽  
Cognitive Testing ◽  
Atherosclerotic Disease ◽  
Collateral Flow ◽  
Cognitive Changes ◽  
Intracranial Atherosclerotic Disease ◽  
Antegrade Flow

Background: Poor collateral circulation and hypoperfusion may lead to recurrent stroke in intracranial atherosclerotic disease (ICAD). The role of perfusion in silent strokes and potentially insidious cognitive impairment in ICAD is unknown. We used evidence of impaired perfusion at angiography in SAMMPRIS to predict subsequent cognitive changes. Methods: Angiography at enrollment in the SAMMPRIS trial was independently evaluated, blind to clinical data and cognitive testing. Antegrade flow in the symptomatic arterial territory and corresponding collateral flow were scored. Impaired perfusion was defined by poor antegrade and poor collateral flow. Serial testing with the Montreal Cognitive Assessment (MoCA) was done in subjects without aphasia or neglect at baseline, 4 mo, 12 mo and closeout, or until subjects had a clinical stroke endpoint. Results: 207 subjects (median age 61, range 33-81 years; 37% women) had baseline MoCA scores with angiography data on territorial perfusion. Baseline MoCA scores (mean 24.2±4.1) were similar between categories of antegrade flow and collateral circulation. Impaired perfusion was noted in 33/207 (16%). Serial MoCA revealed that changes in cognition over time were different at 4 mo, 12 mo and closeout based on the presence of impaired perfusion at baseline (p<0.001). After more modest (mean MoCA change = 0.5 increase from baseline, p=0.80) early improved cognitive function at 4 mo, those with impaired perfusion had cognitive decline at 12 mo (mean MoCA change, p<0.01) unlike the continued improvement in other subjects. Cognitive changes in those with impaired perfusion were associated with a higher frequency of subsequent stroke in the territory. Conclusions: Impaired perfusion in the symptomatic arterial territory of ICAD predicts cognitive outcomes that may precede recurrent ischemia. Future studies may define the role of noninvasive perfusion imaging in ICAD to predict cognitive trajectories and recurrent stroke.

scholarly journals Emergency department and early detection of adolescents and young adults at risk of developing mental disorders: an exploratory study

2020 ◽  
Vol 23 (2) ◽  
Author(s):  
Marco Solmi ◽  
Foscarina Della Rocca ◽  
Vito Cianci ◽  
Alessandro Giacometti ◽  
Chiara Alexopulos ◽  
...  
Keyword(s):  
At Risk ◽  
Emergency Department ◽  
Mental Disorders ◽  
Early Detection ◽  
Mental Disorder ◽  
Primary Outcome ◽  
Potential Role ◽  
Contact Point ◽  
Screening Approaches

The objective of this study is to assess the potential role of Emergency Department (ED) for early detection of mental disorders. Two cohorts (6,759 subjects aged 14 to 24 accessing ED, 165 subjects with mental disorders) were matched by ID and merged. Primary outcome was the proportion of individuals accessing ED before receiving a diagnosis of mental disorder in Mental Health Service (MHS). Secondary outcomes were age of first access to ED in subjects later accessing to MHS, and time from first ED access to receiving a diagnosis of mental disorder at MHS. We assessed whether gender, severity of ED presentation, and number of ED accesses predicted primary outcome. Almost half of individuals who later developed mental disorders (49.7%) accessed ED before access to MHS. Mean age of first ED contact among those later accessing to MHS was 17.34 (2.1), and ED access preceded access to MHS by 3.68 (2.11) years. Gender and severity of ED presentation were not associated with the access to MHS, while higher number of ED accesses was associated with later access to MHS (OR range: 1.17-1.36, p<0.05). Despite its limitations, the present study suggests ED might represent a contact point for individuals who later access to MHS. Future early detection programs should involve ED in their outreach and screening approaches. Additional studies are needed to assess if subjects earlier accessing to ED are at risk-of-developing or already suffer from a mental disorder, and to validate screening instruments specifically designed for ED.

Telephone Interview for Cognitive Status Scores Associate with Cognitive Impairment and Alzheimer’s Disease Pathology at Death

2021 ◽  
pp. 1-11
Author(s):  
Andrew C. Robinson ◽  
Yvonne S. Davidson ◽  
Federico Roncaroli ◽  
James Minshull ◽  
Phillip Tinkler ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
At Risk ◽  
Cognitive Impairment ◽  
Cognitive Status ◽  
Cognitive Testing ◽  
Braak Stage ◽  
Cognitive Screening ◽  
Time Points ◽  
The University

Background: Early diagnosis of Alzheimer’s disease (AD) provides an opportunity for early intervention. Cognitive testing has proven to be a reliable way to identify individuals who may be at risk of AD. The Telephone Assessment for Cognitive Screening (TICS) is proficient in screening for cognitive impairment. However, its ability to identify those at risk of developing AD pathology is unknown. Objective: We aim to investigate associations between TICS scores, collected over a period of 13 years, and the cognitive status of participants at death. We also examine relationships between TICS scores and neuropathological indices of AD (CERAD score, Thal phase, and Braak stage). Methods: Between 2004 and 2017, participants from The University of Manchester Longitudinal Study of Cognition in Normal Healthy Old Age underwent cognitive assessment using TICS. Scores from four time points were available for analysis. Cognitive impairment and AD pathology at death was evaluated in 101 participants. Results: TICS scores at time points 2, 3, and 4 were significantly lower in those cognitively impaired at death compared to those considered cognitively normal. There were significant negative correlations between TICS scores and CERAD score and Braak stage at time points 2 and 4. No correlations between Thal phase and TICS were found. Conclusion: Findings indicate that TICS could be used not only to screen for cognitive impairment, but also to identify individuals at risk of developing AD pathology, many years before any overt symptoms occur. Once identified, ‘at risk’ individuals could be targeted for early interventions which could attenuate the progression of the disease.

scholarly journals The Influence of Atypical Sleep Before Baseline Concussion Testing

2019 ◽  
Vol 34 (6) ◽  
pp. 853-853
Author(s):  
K Riegler ◽  
P Arnett
Keyword(s):  
Cognitive Functioning ◽  
Processing Speed ◽  
Neuropsychological Testing ◽  
Cognitive Testing ◽  
Depression Symptoms ◽  
Baseline Assessment ◽  
Neuropsychological Battery ◽  
Symptom Scale ◽  
Memory And Attention

Abstract Objective To examine the role of an atypical night of sleep prior to baseline neuropsychological testing on symptom reporting and cognitive functioning in student-athletes. Method 182 (M = 138, F = 44) athletes were assessed on neuropsychological battery at baseline. Athletes were categorized as sleeping a typical amount (within 1.5 hours, N = 128) or less (> 1.5 hours less, N = 54) the night prior to baseline. The Cognitive Health Questionnaire (CHQ) assessed typical levels of sleep and the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) assessed hours of sleep the night before. Independent samples t-tests compared the two groups on the following outcome measures: affective, somatic, sleep, and cognitive post-concussion symptom scale (PCSS) clusters, headache, Beck-Depression Inventory-Fast Screen (BDI-FS), and composites of memory and attention/processing speed. Results Athletes getting less sleep than typical the night before a baseline assessment reported significantly more depression symptoms on the BDI-FS (p < .001) and significantly more symptoms on all PCSS symptoms scales: affective (p < .001), cognitive (p < .001), physical (p < .001), and sleep (p = .001). A trend in the same direction was present for headache (p = .06). The groups did not significantly differ on performance on either composite of cognitive functioning (p > .05). Conclusions Sleeping less than the typical amount the night before a baseline assessment results in self-reported higher levels of depression symptoms across all domains of the PCSS.

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