Alissa M. Butts

Preeclampsia and cognitive impairment later in life

BACKGROUND: Hypertension is a risk factor for cerebrovascular disease and cognitive impairment. Women with hypertensive episodes during pregnancy report variable neurocognitive changes within the first decade following the affected pregnancy. However, long‐term follow‐up of these women into their postmenopausal years has not been conducted. OBJECTIVE: The aim of this study was to examine whether women with a history of preeclampsia were at increased risk of cognitive decline 35‐40 years after the affected pregnancy. STUDY DESIGN: Women were identified and recruited through the medical linkage, population‐based Rochester Epidemiologic Project. Forty women with a history of preeclampsia were age‐ and parity‐matched to 40 women with a history of normotensive pregnancy. All women underwent comprehensive neuropsychological assessment and completed self‐report inventories measuring mood, ie, depression, anxiety, and other symptoms related to emotional state. Scores were compared between groups. In addition, individual cognitive scores were examined by neuropsychologists and a neurologist blinded to pregnancy status, and a clinical consensus diagnosis of normal, mild cognitive impairment, or dementia for each participant was conferred. RESULTS: Age at time of consent did not differ between preeclampsia (59.2 [range 50.9‐71.5] years) and normotensive (59.6 [range 52.1‐72.2] years) groups, nor did time from index pregnancy (34.9 [range 32.0‐47.2] vs 34.5 [range 32.0‐46.4] years, respectively). There were no statistically significant differences in raw scores on tests of cognition and mood between women with histories of preeclampsia compared to women with histories of normotensive pregnancy. However, a consensus diagnosis of mild cognitive impairment or dementia trended toward greater frequency in women with histories of preeclampsia compared to those with normotensive pregnancies (20% vs 8%, P = .10) and affected more domains among the preeclampsia group (P = .03), most strongly related to executive dysfunction (d = 1.96) and verbal list learning impairment (d = 1.93). CONCLUSION: These findings suggest a trend for women with a history of preeclampsia to exhibit more cognitive impairment later in life than those with a history of normotensive pregnancy. Furthermore, the pattern of cognitive changes is consistent with that observed with vascular disease/white matter pathology.

Neuropsychological Profiles Differ among the Three Variants of Primary Progressive Aphasia

The objective of this study was to describe the neuropsychological profiles of the three variants of primary progressive aphasia (PPA). Based on a comprehensive speech and language evaluation, 91 subjects were classified as logopenic (lvPPA=51), semantic (svPPA=13), or agrammatic (agPPA=27). All subjects completed a separate neuropsychological evaluation assessing verbal and visual memory, processing speed, executive function, and visuospatial function. The groups did not differ on demographic variables or on measures of disease duration or aphasia severity. There were group differences on aspects of learning and memory, as well as aspects of executive and visuospatial functions, primarily with the lvPPA group performing lower than the agPPA and svPPA groups. The agPPA group showed subtle deficits consistent with frontal lobe impairment, whereas neurocognitive weaknesses in the svPPA group were restricted to temporal lobe functions. The pattern of neurocognitive dysfunction in lvPPA suggests disease involvement of frontal lobe functions in addition to temporoparietal functions. These neurocognitive findings emphasize the value of a comprehensive neuropsychological evaluation of individuals who present with primary language disturbance, given the pattern of cognitive deficits may provide additive information for differentiating these clinical syndromes.

Education, training and practice of clinical neuropsychologists in the United States of America

Abstract Objective: This invited paper is intended to give an overview regarding the education and training pathways for the practice of neuropsychology in the United States. It is also meant to describe the types of activities engaged in by neuropsychologists, a description of their work settings and the amounts/ways in which they are compensated for their work. Method: The authors reviewed the literature and relied on their professional and organizational experiences to collect the necessary data. Results: The United States has well-defined pathways for one to follow to gain the experiences and knowledge necessary to practice clinical neuropsychology in a competent way. Compensation varies widely among workplace settings but overall neuropsychologists appear to be well-paid. Challenges now and in the foreseeable future include a need to develop tests that have better ecological validity and that better reflect the demographics of a changing population, and an increasing need for neuropsychologists to identify key roles as members of integrated care teams. Conclusions: The United States has played an important role in the development of the practice and science of neuropsychology. Its continued success will, at least in part, depend on innovations in test development and application, and further demonstration of its relevance to health care and academic settings.

Postdoctoral training in clinical neuropsychology in America: how did we get here and where do recent applicants suggest we go next?

Abstract Objective: The United States appears to be the only country which typically requires completion of a two-year postdoctoral fellowship for one to be considered competent to practice clinical neuropsychology. We review the history of how this came to be in the United States. Further, we describe obstacles that postdoctoral trainees face during this stage of training. Method: We first describe the most significant events leading to the requirement of a two-year fellowship in clinical neuropsychology. Next, we describe factors that trainees face when selecting and completing postdoctoral training. Finally, we review the results of the most recent annual survey of applicants for postdoctoral training to measure their experiences. Results: Postdoctoral training in the United States is a relatively recent requirement in neuropsychology. Trainees face many obstacles when obtaining a postdoctoral position some of which can be addressed by the field. Conclusions: Training in Clinical Neuropsychology in the United States has evolved considerably over at least the last 45 or so years to the point that a two-year postdoctoral fellowship is now required for one to be a candidate for board certification through the American Board of Clinical Neuropsychology. We review many of the challenges that postdoctoral trainees face and provide survey data to describe their experiences and preferences.

2015 American Academy of Clinical Neuropsychology (AACN) student affairs committee survey of neuropsychology trainees.

Abstract Objective: Surveys of practicing neuropsychologists have been conducted for years; however, there have been no comprehensive surveys of neuropsychology trainees, which may result in important issues being overlooked by the profession. This survey assessed trainees’ experiences in areas such as student debt, professional development, and training satisfaction. Method: Survey items were written by a task force of the AACN Student Affairs Committee (SAC), and neuropsychology trainees were recruited via neuropsychology-focused listservs. In total, 344 trainees completed the survey (75% female) and included participants from every region of the US and Canada. Results: Based on the survey questions, nearly half of all trainees (47%) indicated financial factors were the greatest limitation in their training. Student debt had a bimodal distribution; 32.7% had minimal debt, but 45% had debt >

Varying Degrees of Temporoparietal Hypometabolism on FDG-PET Reveal Amyloid-Positive Logopenic Primary Progressive Aphasia is not a Homogeneous Clinical Entity

100,000. In contrast, expected starting salaries were modest, but consistent with findings (

Neurocognition in individuals with incidentally-identified meningioma

80–100,000). While almost all trainees intended to pursue board certification (97% through ABPP), many were ‘not at all’ or only ‘somewhat’ familiar with the process. Conclusions: Results indicated additional critical concerns beyond those related to debt and lack of familiarity with board certification procedures. The results will inform SAC conference programming and the profession on the current ‘state of the trainees’ in neuropsychology.