Visual memory failure presages conversion to MELAS phenotype.

OBJECTIVE: To examine the correlation between verbal and visual memory function and correlation with brain metabolites (lactate and N-Acetylaspartate, NAA) in individuals with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS). METHODS: Memory performance and brain metabolites (ventricular lactate, occipital lactate, and occipital NAA) were examined in 18 MELAS, 58 m.3243A > G carriers, and 20 familial controls. Measures included the Selective Reminding Test (verbal memory), Benton Visuospatial Retention Test (visual memory), and MR Spectroscopy (NAA, Lactate). ANOVA, chi-squared/Fisher's exact tests, paired t-tests, Pearson correlations, and Spearman correlations were used. RESULTS: When compared to carriers and controls, MELAS patients had the: (1) most impaired memory functions (Visual: p = 0.0003; Verbal: p = 0.02), (2) greatest visual than verbal memory impairment, (3) highest brain lactate levels (p < 0.0001), and (4) lowest brain NAA levels (p = 0.0003). Occipital and ventricular lactate to NAA ratios correlated significantly with visual memory performance (p ≤ 0.001). Higher lactate levels (p ≤ 0.01) and lower NAA levels (p = 0.0009) correlated specifically with greater visual memory dysfunction in MELAS. There was little or no correlation with verbal memory. INTERPRETATION: Individuals with MELAS are at increased risk for impaired memory. Although verbal and visual memory are both affected, visual memory is preferentially affected and more clearly associated with brain metabolite levels. Preferential involvement of posterior brain regions is a distinctive clinical signature of MELAS. We now report a distinctive cognitive phenotype that targets visual memory more prominently and earlier than verbal memory. We speculate that this finding in carriers presages a conversion to the MELAS phenotype.

Neuropsychology trainee concerns during the COVID-19 pandemic: A 2021 follow-up survey.

OBJECTIVE: As the COVID-19 pandemic continues, the impact on neuropsychology trainees continues to evolve. This paper describes the results of a survey of neuropsychology trainee (graduate student through postdoctoral resident) perspectives on the COVID-19 pandemic and compares them to a previous survey conducted in Spring 2020. METHOD: The survey used several questions from the 2020 survey and added applicable new questions based on the results of the 2020 survey. The survey was distributed to listservs, training directors, and student organizations in neuropsychology with snowball sampling used. RESULTS: Respondents were primarily female (82.4%) and white (63%). The majority of trainees (66%) reported loss of clinical hours. Interestingly, the average training time missed was approximately 3.36 weeks (SD = 9.27). Trainees continue to report that they have experienced increased anxiety, depression, and stress since the beginning of the pandemic; however, compared to a prior survey, rates of increased anxiety/stress remained stable, but more trainees reported increased depression. Approximately 31% of trainees reported that they were differentially impacted by the pandemic due to racial/ethnic background and female trainees were more likely to report increased personal stress, anxiety and depression than their male counterparts. CONCLUSIONS: Results suggest continued wide-reaching pandemic related impacts on neuropsychology trainees. For example, trainees continue to be concerned about the impact of lost clinical hours on their professional futures. The most notable of the personal impacts included increased rates of mental health concerns and differential impacts on trainees from ethnoracial minority communities. Recommendations are provided to assist trainees in coping with pandemic-related disruptions.

2020 COVID-19 American Academy of Clinical Neuropsychology (AACN) Student Affairs Committee survey of neuropsychology trainees.

Objective: To conduct an online survey in order to understand neuropsychology trainees' perspectives during the COVID-19 pandemic and identify pertinent concerns, training gaps, and recommendations.Method: A total of 874 neuropsychology trainees (81% female) completed the 69-item survey. Of the included trainees, 48% were doctoral students, 17% were interns, and 35% were postdoctoral residents (50% of resident respondents were in their first year).Results: The majority of neuropsychology trainees reported some impact of the pandemic on their professional and/or personal life. Overall, the impact did not differ by training level, geographic location, or demographic factors. Trainees' primary professional concerns included uncertainty about the impact of the pandemic on their professional future, loss of clinical hours, and desire for increased and ongoing communication from their leadership. A notable percentage of trainees reported increased personal mental health symptoms (i.e. anxiety/depression; 74%/54%), as well as a number of other personal stressors. Despite the transition to telehealth (mostly interviews/feedback sessions), few trainees have prior training or experience in providing neuropsychological services via phone or video platform. A limited proportion of trainees (approximately 10%) were still seeing patients face-to-face for neuropsychological evaluations during the COVID-19 pandemic as of 14 April 2020.Conclusions: The COVID-19 pandemic is impacting neuropsychological training and the well-being of trainees. This survey highlights the importance of communication with trainees during uncertain times. Based on the survey results, recommendations were developed to assist neuropsychology organizations in developing initiatives to support trainees during the current pandemic and in the future.

Digit Span Performance in Children with Dystrophinopathy: A Verbal Span or Working Memory Contribution?

OBJECTIVES: In a large cohort of boys with dystrophinopathies and their unaffected siblings, we examined whether consistently observed performance on digit span is due primarily to a verbal span or executive deficit. We additionally assessed whether digit span performance contributed to the observed variability in reading performance noted in this population. METHODS: Performance of 170 boys with dystrophinopathy was compared to 95 unaffected sibling controls on measures of verbal function, reading, and digit span. Maximum digit span forward (DSF) and backward (DSB) lengths were converted to Z-scores using normative data. Independent sample t tests, analysis of variance, and hierarchical multiple regression were run (α=0.05). RESULTS: Probands performed worse than controls on digit span, even after accounting for differences in general verbal function (p<.0001). Differences were significant for both DSF (p<.005) and DSB (p<.0001) span length, and an interaction effect yielded significantly worse DSB compared with DSF (p=.01). Reading performance was also lower in probands (p<.0001). The contribution of general level of verbal function, and forward and backward span lengths, did not vary between groups. CONCLUSIONS: In boys with dystrophinopathy, decreased performance on digit span appears to be due to both decreased span forward (measuring verbal span only) and backward (measuring verbal span and working memory). The extent to which sibling controls exhibited better performance compared to the probands was significantly greater for backward span when compared with forward span. Thus, immediate verbal memory and executive control are differentially compromised among boys with dystrophinopathy, and both of these abilities independently contribute to reading performance. (JINS, 2016, 22, 777-784).

Psychosocial and sociodemographic associates of felt stigma in epilepsy.

BACKGROUND: Lack of a sufficient range in socioeconomic status (SES) in most prior studies of felt stigma and epilepsy has hampered the ability to better understand this association. METHODS: We assessed the burden and associates of felt stigma in 238 individuals with prevalent epilepsy aged 18 and older, comparing low SES with high SES. RESULTS: Reported levels of stigma were higher in low SES than in high SES (p<0.0001), and all psychosocial variables were associated with stigma, including depression severity (p<0.0001), knowledge of epilepsy (p=0.006), quality of life (p<0.0001), social support (p<0.0001), and self-efficacy (p=0.0009). Stigma was statistically significantly associated with quality of life in the low SES group and with depression severity and social support in the high SES group. CONCLUSIONS: Low SES alone did not account for felt stigma; rather, we found that quality of life, depressive symptoms, and social support have the greatest impact on reported felt stigma in individuals with prevalent epilepsy.

Longitudinal assessment of skill development in children with first febrile seizure.

To determine whether first febrile seizure (FS) has detrimental effects on development, 159 children (aged 6 months to 5 years) with FS were compared to 142 controls on measures of cognition, motor ability, and adaptive behavior. Participants were identified through the emergency department in an urban, low-income community. Children were evaluated within one month of the ED visit and one year later, and difference in performance over one year was examined. Performance did not differ between cases and controls on measures of cognition (baseline: p=0.5, one year: p=0.2, change over time: p=0.1) or motor skills (baseline: p=0.9, one year: p=0.7, change over time, p=0.6). The adaptive behavior composite score did not differ by FS case status at baseline (p=0.2) or one year later (p=0.6); however, between-group differences over time approached significance (p=0.05). Findings support the idea that first FS does not pose developmental or behavioral consequences in a low socioeconomic environment.

Associates of stigma in an incident epilepsy population from northern Manhattan, New York City.

OBJECTIVE: Stigma is associated with prevalent epilepsy, but its association with incident epilepsy is unknown. METHODS: We identified 209 children and adults with incident seizures from the diverse impoverished community of northern Manhattan. We interviewed 94 participants, aged 16 and older, about lifetime history of depression, health status, medical history, and stigma. RESULTS: At baseline, 18 (22.5%) participants reported experiencing stigma. Stigma was reported by 9 (50.0%) with depression and 9 (14.5%) without depression (P=0.002). At 1 year, 7 (8.1%) participants reported experiencing stigma. Stigma was reported by 5 (31.3%) with depression versus 1 (1.6%) without depression (P<0.0001). At both time points, odds of stigma increased when lifetime history of depression and fair/poor health was present. CONCLUSIONS: Previous work revealed negative effects of prevalent epilepsy on stigma. In the low-income, predominantly Hispanic community of northern Manhattan, we found incident epilepsy was associated with stigma when lifetime history of depression or fair/poor health was present.