Barriers to board certification in clinical neuropsychology identified by surveyed trainees and professionals.

Objective: Board certification (BC) in clinical neuropsychology via the American Board of Clinical Neuropsychology (ABCN) is a rigorous process demonstrating clinical competence to practice. While myths about BC have been addressed, barriers to BC have yet to be studied. The aim of this study was to identify barriers to BC among neuropsychology trainees and professionals. Method: Data were collected through pre-webinar surveys administered to 1202 participants across four webinars conducted between 2018 and 2021. The surveys, via open-ended questions, captured specific concerns about BC as well as, demographic information including self-identification with racial/ethnic and culturally diverse groups. Qualitative analyses of self-reported barriers were conducted, and themes were identified. Results: The themes identified included Preparedness (11.8%), Lack of Training and Mentoring Opportunities (5.8%), Training Flexibility (11.9%), BC Knowledge (13.4%), Overall Knowledge of neuropsychology (4.4%), Time (24.7%), Money (10.9%), Documentation (3.4%), International Issues (1.5%), and COVID-19 concerns (2.5%). Respondents that identified with a racial/ethnic diverse group were more likely to report Opportunities and International Issues, whereas White respondents more frequently identified Time and Documentation as barriers. Trainees were more likely to report Training Flexibility, Opportunities, BC Knowledge, whereas Professionals were more likely to report Preparedness and Time as barriers. Conclusions: Results from this survey demonstrate that Time, BC Knowledge, Training Flexibility, Preparedness, and Money related to the examination were the most frequently reported barriers. However, differences across groups (i.e. career stage, racial/ethnic) emerged, highlighting the need to develop initiatives that address the specific needs of different groups of neuropsychology trainees and professionals.

A case report of long-term effects of Delayed post-hypoxic leukoencephalopathy (DPHL) following benzodiazepine overdose.

Objective: We report a neuropsychological evaluation for a 39-year-old, right-handed, white female who 8 years ago developed delayed post-hypoxic leukoencephalopathy (DPHL), a rare demyelinating syndrome, two-weeks following an anoxic brain injury due to an overdose from benzodiazepines. Methods: An extensive record review documenting her medical timeline and treatment over the last 8 years was conducted using the available EMR system, which also included both EEG and neuroimaging data. Eight years post injury, a comprehensive neuropsychological battery was administered with corrected normative data for age, race, education, and other demographic factors when available. Collected data was compared with other case reports of DPHL. Results: The neuropsychological profile indicated difficulties across multiple cognitive domains that appeared driven by executive dysfunction, likely related to fronto-subcorto-striatal dysfunction. Conclusion: As a rare disease, the process by which DPHL occurs is not fully understood. Our results revealed similar findings in the literature for learning and memory, attention, processing speed, and executive functions. This is discussed in the context of available neuroimaging while highlighting the value of comprehensive neuropsychological assessment in DPHL even years post-injury.

A comparison of neuropsychological function between monozygotic twins with neurofibromatosis, type 1: A case report.

Objective: Neurofibromatosis type 1 (NF-1) is an autosomal dominant genetic disorder that commonly presents with cognitive impairment and greater rates of learning disorders and academic difficulty compared to the general population. Investigations of neurological and physiological expression of NF-1 in monozygotic twins identified intrapair similarities and differences. Monozygotic twins with NF-1 have been found to have similar IQ scores as well as concordant diagnoses of attention-deficit/hyperactivity disorder and learning disabilities. There have been no previous reports on similarities and differences in neuropsychological profiles between monozygotic twins with NF-1. The purpose of this article is to examine the results of comprehensive neuropsychological evaluations for a pair of monozygotic twins with NF-1.Method: A pair of 19-year-old female, African-American monozygotic twins with NF-1 underwent neuropsychological evaluations in an outpatient clinic. Findings are reported following the CAse REport (CARE) guidelines.Results: The twins demonstrated similar impairment in processing speed, working memory, and attention span; however, differences also were found.Conclusions: Intrapair similarities and differences on neuropsychological assessment were found between monozygotic twins with NF-1. Primary deficits were suggestive of a frontal-subcortical pattern and could be consistent with remote neuroimaging. When differences did occur, performance was typically better for Twin A, who had also showed greater improvement on neuroimaging. Implications and directions for future research are discussed. Specifically, this case demonstrates the need for inclusion of neuropsychological assessment in studies of larger cohorts of monozygotic twins with NF-1 and correlation of neuropsychological findings with neuroimaging and postzygotic mutations.

Atypical parietal lobe activity to subliminal faces in youth with a family history of alcoholism.

BACKGROUND: Adults with alcohol use disorders (AUDs) show different behavioral and neurological functioning during emotional processing tasks from healthy controls. Adults with a family history (FHP) of AUD also show different activation in limbic brain areas, such as the amygdala. However, it is unclear if this pattern exists during adolescence before any episodes of heavy alcohol use. OBJECTIVES: We hypothesized that the amygdalar response to subliminally-presented fearful faces would be reduced in FHP adolescents compared to peers who were family history negative (FHN) for AUD. METHOD: An adapted Masked Faces paradigm was used to examine blood oxygen level-dependent response to subliminal fearful vs. neutral faces in 14 FHP (6 females, 8 males) and 15 FHN (6 females, 9 males) youth, ages 11-15 years. Both FHP and FHN youth had no history of heavy alcohol consumption. RESULTS: A significant difference was seen between groups in the left superior parietal lobule FHN youth showed deactivation to fearful and neutral masked faces compared to baseline, whereas FHP youth showed deactivation only to fearful masked faces. No significant differences in amygdalar activation were seen between groups. CONCLUSION: The left superior parietal lobule is part of the fronto-parietal network, which has been implicated in attentional control. Lack of reduced neural activity to neutral faces among FHP youth may represent differences in suppressing attention networks to less salient emotional stimuli, or perhaps, a higher threshold of saliency for emotional stimuli among at-risk youth.

Merging clinical neuropsychology and functional neuroimaging to evaluate the construct validity and neural network engagement of the n-back task.

The n-back task is a widely used neuroimaging paradigm for studying the neural basis of working memory (WM); however, its neuropsychometric properties have received little empirical investigation. The present study merged clinical neuropsychology and functional magnetic resonance imaging (fMRI) to explore the construct validity of the letter variant of the n-back task (LNB) and to further identify the task-evoked networks involved in WM. Construct validity of the LNB task was investigated using a bootstrapping approach to correlate LNB task performance across clinically validated neuropsychological measures of WM to establish convergent validity, as well as measures of related but distinct cognitive constructs (i.e., attention and short-term memory) to establish discriminant validity. Independent component analysis (ICA) identified brain networks active during the LNB task in 34 healthy control participants, and general linear modeling determined task-relatedness of these networks. Bootstrap correlation analyses revealed moderate to high correlations among measures expected to converge with LNB (|ρ|≥ 0.37) and weak correlations among measures expected to discriminate (|ρ|≤ 0.29), controlling for age and education. ICA identified 35 independent networks, 17 of which demonstrated engagement significantly related to task condition, controlling for reaction time variability. Of these, the bilateral frontoparietal networks, bilateral dorsolateral prefrontal cortices, bilateral superior parietal lobules including precuneus, and frontoinsular network were preferentially recruited by the 2-back condition compared to 0-back control condition, indicating WM involvement. These results support the use of the LNB as a measure of WM and confirm its use in probing the network-level neural correlates of WM processing.