Introducing the North American Association of Practicum Sites in Neuropsychology (NAPSN): development of a new organization devoted to facilitating high quality practicum training.

Introduction: In February 2023, a work group began to develop a new North American organization in neuropsychology to represent and support practicum-training sites. While other training-focused organizations such as the Association of Postdoctoral Programs in Clinical Neuropsychology (APPCN) and the Association of Internship Training in Clinical Neuropsychology (AITCN) have existed for many years, no organization exists to promote and support practicum level training outside of doctoral degree programs. The work group developed such an organization, subsequently named the North American Association of Practicum Sites in Neuropsychology (NAPSN), beginning with a mission statement and general purpose of the organization. Methods: The work group divided members into five task forces focused on various tasks needed to start the organization, including Mission/Vision, Administrative Structure, Membership, Financials, and Bylaws. The entire work group met monthly with additional meetings and work via email for the various task forces, which resulted in the development of a mission statement and bylaws, as well as a framework for program administration, membership requirements and financial needs. Conclusions: The group developed NAPSN primarily as a resource to support diverse practicum programs in urban, suburban, and rural areas in the US and Canada to provide optimal graduate level clinical training in neuropsychology. Didactics aimed specifically at practicum students was one need identified early in the process. NAPSN is developing a website-based resource in collaboration with other training organizations to increase the didactic offerings to practicum students. Other initiatives and collaborative efforts will be undertaken over time as circumstances warrant.

Chemotherapy-Induced Taste Alteration.

Taste alteration is a common side effect of chemotherapy and can have a direct impact on patients' quality of life. Consistent evaluation of alteration in taste is lacking in clinical practice. The literature strongly suppo.

Neuropsychological and Emotional Functioning in Patients with Cushing's Syndrome.

Patients with Cushing's syndrome (CS) frequently report impairments in cognitive and emotional functioning. Given neuroimaging research that implicates alterations in structure and function in the brain in this population, goals of this study were to investigate neuropsychological and emotional functioning, with particular emphasis on complex attention and memory. In a clinical sample of 18 adults with CS referred for neuropsychological evaluation (age 41.6 ± 10.6, 72% Caucasian), patients' most common subjective complaints were in attention and increased irritability. On objective testing, patients exhibited significant declines in the consistency of their sustained attention and visual-spatial functioning compared to normative peers. Patients exhibited on average significantly reduced initial learning following first exposure to visual and verbal stimuli but intact retention of information learned. Patients with CS endorsed highly elevated levels of somatization, depression, and anxiety, and 59% of them scored in the clinically elevated range for somatization and depressive symptomatology. Exploratory analyses suggested that the 11 patients with active Cushing's exhibited lower processing speed, poorer sustained attention, naming, and cognitive flexibility compared to the 7 patients who achieved biochemical remission. Patients with active Cushing's also reported higher levels of somatization and anxiety compared to patients in biochemical remission. Overall, this study provides new insights into complex attention and memory deficits in patients with CS and concern regarding cognitive and emotional issues despite resolution of hypercortisolism. Our study opens several avenues for further exploration.

The Effect of Body Mass Index on Pulmonary Related Debility Rehabilitation.

BACKGROUND: Obesity is a known factor for the development of abnormal respiratory physiology. However, several studies have found that obesity does not hinder functional recovery in patients hospitalized for postacute care following a stroke or cardiovascular event. This study was designed to determine the effect of overweight and obesity on patients with acute pulmonary disease, hospitalized in an inpatient rehabilitation facility (IRF). OBJECTIVE: To investigate the impact of body mass index (BMI) on indices of function, specifically, the functional independence measure (FIM) among patients with pulmonary related debility admitted to a rehabilitation hospital. DESIGN: Retrospective cohort study. SETTING: Pulmonary unit in an acute freestanding rehabilitation hospital. PATIENTS: All patients admitted to an IRF with a diagnosis of pulmonary related debility over a 6-year period. METHODS: The data used in the study included the patient height and weight (measured on admission) and FIM (scored on admission and discharge). MAIN OUTCOME MEASURES: The primary study outcome measure was the change in FIM per day by the patients' BMI category. RESULTS: For the 381 patients admitted during the observation period, BMI was compared with FIM score changes per day (FIM efficiency). After adjusting for age and sex, the FIM efficiency only slightly differed by BMI, failing to reach statistical significance. However, age did significantly influence the outcome (P = .05). CONCLUSION: This study demonstrates that among a large group of patients with a pulmonary related debility, there was no statistically significant correlation between BMI and FIM efficiency. The overweight patients were similar in progression to those who were underweight, normal weight, and obese. However, this study found that increased age adversely affected the outcome of rehabilitation. LEVEL OF EVIDENCE: III.

Psychometric properties of the Saint Louis University Mental Status Examination.

The Saint Louis University Mental Status (SLUMS) Examination is a brief screening measure for mild neurocognitive disorder developed for use with veterans. To date, there has been a paucity of research on its psychometric properties. The purpose of this study is to evaluate the psychometric properties of the SLUMS in a referred sample to a specialty clinic. Using a sample of 148 male veterans referred to a Mild Cognitive Impairment (MCI) Clinic for evaluation, the ability of the SLUMS to discriminate between MCI versus Major Depressive Disorder (MDD) or no diagnosis was compared to results from a more comprehensive neuropsychological battery. The SLUMS was significantly correlated with every neuropsychological measure (r = .25 to .46), except for Trails B (r = .14). Diagnostic discriminability was comparable to a typical, longer, neuropsychological battery for discriminating between MCI and no diagnosis, and between MCI and MDD. The study provides additional psychometric support for the SLUMS as a viable brief cognitive screening measure in veteran populations, particularly when discriminating between MCI and MDD.

Cognitive and emotional dysfunction in mild cognitive impairment.

Although mild cognitive impairment (MCI) is a widely accepted construct both clinically and in the research literature, it remains a heterogeneous condition that varies in presentation and prognosis. This article first reviews the evolution of the diagnosis of MCI, followed by examination of pros and cons of cognitive assessments commonly used to assess for MCI. Emotional changes commonly seen in MCI are also reviewed. Finally, the relation between cognitive and emotional dysfunction is examined, including a discussion of specific psychological symptoms seen in subtypes of MCI, and how the presence of neuropsychiatric symptoms may affect the risk for progression to dementia.

Residence following traumatic brain injury: a longitudinal study.

OBJECTIVE: To examine change in residence following traumatic brain injury (TBI) as a function of preinjury residential status, demographic factors, and injury-related characteristics. DESIGN: Prospective, observational study. SETTING: Inpatient, comprehensive rehabilitation programs for persons with TBI. PARTICIPANTS: A total of 7925 patients with moderate or severe TBI receiving acute rehabilitation, and enrolled in the TBI Model Systems National Database. MAIN MEASURES: Preinjury and discharge residential status determined during rehabilitation, and at 1, 2, and 5 years postinjury by telephone interview. Variables contributing to residential status included injury severity, demographic information, and functional status. RESULTS: There was significant change in residence across 5 years characterized by discharge to a less independent residence following injury, with a return to a more independent residence over time. The most significant transition took place in the first year after injury. Residence prior to injury was the strongest predictor of residence after injury. Age and race were significantly associated with residence following TBI, with increasing age related to more independent residence, and whites more likely to live independently than are African Americans. Severity of injury had little impact, although functional status at rehabilitation discharge was associated with residence, with higher functional status associated with a more independent residence. CONCLUSION: Among persons who received acute rehabilitation for TBI, 35.4% were discharged from rehabilitation to a setting different from the one in which they resided before injury. The degree of change varied on the basis of preinjury residence. Overall, the results indicate that while many patients are discharged to a different residential setting than prior to their injury, some patients recover to the point where they are able to return to their premorbid residential setting. The most substantial change was for those living alone at the time of injury, and within the first year of injury.

Factors contributing to performance on the Rey Complex Figure Test in individuals with traumatic brain injury.

When examining visual memory test results one must be aware of other variables that impact performance, particularly in individuals with traumatic brain injury who have broad cognitive deficits. The present investigation sought to determine the extent to which executive functioning, as operationally defined as perceptual organization, planning, and mental flexibility, impacted Rey Complex Figure Test (RCFT) performance. Results indicated that executive functioning measures accounted for between 11% and 16% of the variance in RCFT scores. ANCOVAs revealed that the relationship between degree of executive impairment and RCFT memory trials were non-significant when performance on the copy trial was controlled for. Furthermore, speed of processing and word reading were significantly related to RCFT performance. The predicted relationship with fine motor functioning was not supported. Implications and future research directions are discussed.

Further validation of the Orientation and Cognitive Logs: their relationship to the Mini-Mental State Examination.

OBJECTIVE: To further evaluate the construct validity of bedside screening measures of orientation (Orientation Log [O-Log]) and cognition (Cognitive-Log [Cog-Log]) by examining the relationship between these measures and the Mini-Mental State Examination (MMSE). DESIGN: Correlational analysis used to assess the degree of overlapping variance among the O-Log, Cog-Log, and MMSE. Qualitative item analysis used to assess strengths and weaknesses of the measures. SETTING: Inpatient rehabilitation center affiliated with a large university medical school. PARTICIPANTS: Participants were 45 inpatients receiving neurorehabilitation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The O-Log, Cog-Log, and MMSE. RESULTS: The MMSE correlated significantly with both measures (O-Log, r=.65, P<.001; Cog-Log, r=.75, P<.001). The O-Log and C-Log were significantly related to each other (r=.75, P<.001). CONCLUSIONS: The results indicated good construct validity of the O-Log and Cog-Log. These measures may be better suited for a population with moderate to severe brain injury in a rehabilitation setting, compared with the MMSE, because scales were developed to give partial credit based on partially correct answers. Further, the O-Log and C-Log do not have a written component, allowing administration for persons with hemiparesis.

A double-blind, multicenter, parallel-group study of paroxetine, desipramine, or placebo in breast cancer patients (stages I, II, III, and IV) with major depression.

OBJECTIVE: This study compared the efficacy and safety of paroxetine and desipramine with those of placebo in the treatment of depressive disorders in adult women with breast cancer, stages I-IV. METHOD: In a double-blind, placebo-controlled study, 35 female outpatients with breast cancer and DSM-III-R major depression or adjustment disorder with depressed mood were randomly assigned to treatment with paroxetine (N=13), desipramine (N=11), or placebo (N=11) for 6 weeks. Primary efficacy was assessed by change from baseline in score on the 21-item Hamilton Rating Scale for Depression (HAM-D), and the secondary outcome measure was change from baseline in the Clinical Global Impressions-Severity of Illness scale (CGI-S) score. RESULTS: Mean changes in the total HAM-D and CGI-S scores from baseline to 6-week endpoint for the paroxetine and desipramine groups were not significantly different than those for the placebo-treated group. An unusually high rate of response (defined as >or=50% improvement in the HAM-D score) in the placebo group was observed (55% [N=6]); adverse events precipitated patient discontinuation in the active treatment groups (9% [N=1] for desipramine, 15% [N=2] for paroxetine) similar to that in the placebo-treated patients (18% [N=2]). Improvement on symptom dimensions within the HAM-D and Hamilton Rating Scale for Anxiety (depressive, anxiety, cognitive, neurovegetative, or somatic) was also similar between groups. CONCLUSION: The small number of women in this study most likely contributed to the lack of observed differences in efficacy observed during the 6 weeks of treatment. Randomized, placebo-controlled trials of adequate power seeking to determine efficacy of antidepressants in the United States for the treatment of women with breast cancer and comorbid depression remain of paramount importance.

Cognitive aspects of chronic depression.

Previous research on chronic depression has focused on its link with other mood disorders and Axis II personality disorders. However, there are few data examining whether the cognitive perspective applies to this condition. In this cross-sectional study, 42 outpatients with chronic depression were compared with 27 outpatients with nonchronic major depressive disorder and 24 never psychiatrically ill controls on cognitive variables thought to be related to vulnerability to depression (e.g., dysfunctional attitudes, attributional style, a ruminative response style, and maladaptive core beliefs). Both depressed groups were more elevated than a never-ill comparison group. However, chronically depressed individuals were generally more elevated on measures of cognitive variables than those with major depressive disorders even after controlling for mood state and personality disorder symptoms.