Ida Kellison

Deep Brain Stimulation and the Role of the Neuropsychologist

Deep brain stimulation (DBS) now plays an important role in the treatment of Parkinsons disease, tremor, and dystonia. DBS may also have a role in the treatment of other disorders such as obsessive-compulsive disorder, Tourettes syndrome, and depression. The neuropsychologist plays a crucial role in patient selection, follow-up, and management of intra-operative and post-operative effects (Pillon, 2002; Saint-Cyr & Trepanier, 2000). There is now emerging evidence that DBS can induce mood, cognitive, and behavioral changes. These changes can have dramatic effects on patient outcome. There have been methodological problems with many of the studies of DBS on mood, cognition, and behavior. The neuropsychologist needs to be aware of these issues when following up patients, and constructing future studies. Additionally, this article will review all aspects of the DBS procedure that can result in mood, cognitive, and behavioral effects and what role(s) the neuropsychologist should play in screening and follow-up.

Abnormal affective startle modulation in individuals with psychogenical movement disorder

Despite recent advances, psychogenic movement disorder (PMD) remains a poorly understood phenomenon. Emotional functioning and responsiveness to stress are believed to play a role in the development of psychogenic symptoms, but empirical studies examining emotional responsiveness in PMD and other conversion disorders are lacking. We investigated modulation of the startle eyeblink reflex by affective pictures in 12 patients with PMD and 12 age‐ and education‐matched control participants. Participants viewed positive, neutral, and negative pictures, while eyeblink responses to white noise bursts were recorded. Control participants showed the expected pattern of startle modulation, with significant potentiation by negative pictures and slight (nonsignificant) inhibition by positive pictures. In the PMD group, however, both positive and negative pictures yielded significantly greater startle responses than neutral pictures. Depression and anxiety symptomatology did not correlate with startle modulation, and the two groups did not differ in self‐reported emotional reactions to the pictures. Our findings suggest that individuals with PMD show aversive physiological reactions to positive as well as negative stimuli. Abnormal affective startle modulation may be used to help distinguish between malingering and PMD. Future studies using larger samples are needed to better understand the role of emotions in conversion disorder.

Assessment of stigma associated with attention deficit hyperactivity disorder: Psychometric evaluation of the ADHD Stigma Questionnaire

This study evaluated the psychometric properties of the attention deficit hyperactivity disorder (ADHD) Stigma Questionnaire (ASQ) among a community sample of 301 adolescents ages 11-19 years at high (n=192) and low risks (n=109) for ADHD. Study subjects were drawn from a cohort study assessing ADHD detection and service use. The 26-item ASQ demonstrated good internal consistency. Confirmatory factor analysis using random parceling supported a three-factor structure with highly correlated subscales of disclosure concerns, negative self image, and concern with public attitudes, and a Schmid-Leiman analysis supported an overall stigma factor. Test-retest stability was assessed after two weeks (n=45) and found to be adequate for all three subscales. Construct validity was supported by relationships with related constructs, including clinical maladjustment, depression, self-esteem, and emotional symptoms, and the absence of a relationship with school maladjustment. Findings indicate that the ASQ has acceptable psychometric properties in a large community sample of adolescents, some of whom met Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria for ADHD.

Parental adherence to child psychologists' recommendations from psychological testing.

Nonadherence to prescribed regimens is a significant cause of treatment failure across pediatric andpsychological/psychiatric childhood conditions. Although a modest literature exists for medical condi-tions, the literature on adherence to psychologists’ recommendations is sparse. We review the extantliterature on this topic, highlighting areas for further study and intervention. Implications for policy andthe practice of psychoeducational assessment are also discussed.

Change blindness, aging, and cognition

Change blindness (CB), the inability to detect changes in visual scenes, may increase with age and early Alzheimers disease (AD). To test this hypothesis, participants were asked to localize changes in natural scenes. Dependent measures were response time (RT), hit rate, false positives (FP), and true sensitivity (d′). Increased age correlated with increased sensitivity and RT; AD predicted even slower RT. Accuracy and RT were negatively correlated. Differences in FP were nonsignificant. CB correlated with impaired attention, working memory, and executive function. Advanced age and AD were associated with increased CB, perhaps due to declining memory and attention. CB could affect real-world tasks, like automobile driving.

Entorhinal cortex volume in older adults: reliability and validity considerations for three published measurement protocols.

Measuring the entorhinal cortex (ERC) is challenging due to lateral border discrimination from the perirhinal cortex. From a sample of 39 nondemented older adults who completed volumetric image scans and verbal memory indices, we examined reliability and validity concerns for three ERC protocols with different lateral boundary guidelines (i.e., Goncharova, Dickerson, Stoub, & deToledo-Morrell, 2001; Honeycutt et al., 1998; Insausti et al., 1998). We used three novice raters to assess inter-rater reliability on a subset of scans (216 total ERCs), with the entire dataset measured by one rater with strong intra-rater reliability on each technique (234 total ERCs). We found moderate to strong inter-rater reliability for two techniques with consistent ERC lateral boundary endpoints (Goncharova, Honeycutt), with negligible to moderate reliability for the technique requiring consideration of collateral sulcal depth (Insausti). Left ERC and story memory associations were moderate and positive for two techniques designed to exclude the perirhinal cortex (Insausti, Goncharova), with the Insausti technique continuing to explain 10% of memory score variance after additionally controlling for depression symptom severity. Right ERC-story memory associations were nonexistent after excluding an outlier. Researchers are encouraged to consider challenges of rater training for ERC techniques and how lateral boundary endpoints may impact structure-function associations.

Awareness of Expressivity Deficits in Non-Demented Parkinson Disease

A masked facial expression, one of the hallmark features of Parkinson disease (PD), can form the basis for misattributions by others about a patients mood or interest levels. Reports of preserved intensity of internal emotional experience in PD participants raise the question of whether patients are aware of their outward expressivity levels. The aim of the present study was to determine whether PD participants exhibit deficits in overall emotional expressivity, and if so, whether they are aware of these deficits. We evaluated 37 non-demented PD participants and 21 comparison participants using the Berkeley Expressivity Questionnaire (BEQ). To examine awareness of emotional expressivity, we compared participant self-ratings of their own expressivity to ratings made by family members or close friends. Participants also completed questionnaires regarding depression and apathy and underwent motor examination and cognitive screening. PD participants’ self-ratings of emotional expressivity were significantly lower than comparison participants’ self-ratings. Even so, the PD participants viewed themselves as experiencing equivalent levels of emotional intensity to comparison participants, based on analysis of the BEQ subscales. Informant and PD participant self-ratings did not differ, indicating that PD participants accurately appraise the extent of their reduced expressivity. These findings suggest that anosognosia for emotional expressivity is not a prominent feature of nondemented Parkinson disease. Importantly, PD participants are aware of their reduced expressivity and report experiencing emotions as intensely as comparison participants. These findings highlight the view that diminished emotional expressivity in PD should not be mistaken for decreased subjective emotional experience.

Stops for Cops: Impaired Response Implementation for Older Drivers with Cognitive Decline

Response to an emergency vehicle requires detection and recognition of an object in peripheral vision, situation recognition, and a rapid response to execute a safety maneuver to decrease the potential for crashing into the vehicle or striking people situated near it. To investigate situation awareness and response to a roadway emergency in at-risk elderly drivers, 149 licensed older drivers were tested with a battery of visual and cognitive tests and in a driving simulator scenario in which drivers encountered a police car on the shoulder of the road. Forty-eight drivers (mean age of 73.5) had cognitive impairments caused by mild to moderate Alzheimers disease, and 101 (mean age of 69.3 years) were neurologically normal. Results showed that compared with controls, drivers with Alzheimers reacted more slowly (P=0.0008)—with abrupt decelerations resulting—or failed to steer clear of the police car (P = 0.0036). Several older drivers stopped in the middle of the road. Poorer scores on neuropsychological t...

Neuropsychological Profile of a Filipino Gentleman with X-Linked Dystonia–Parkinsonism: A Case Report of Lubag Disease

X-Linked Dystonia–Parkinsonism (XDP or “Lubag”) is a progressive neurodegenerative disorder unique to the Island of Panay in the Philippines. Imaging and autopsy studies have suggested involvement of the caudate and putamen in late stages. Because the clinical presentation of patients with XDP resembles that of patients with Parkinson disease or dystonia, it is reasonable to predict the neuropsychological profile might be similar; however, the neuropsychological profile of a XDP patient has not previously been published. We present the neuropsychological findings of a 67-year-old gentleman with a 10-year history of XDP who presented with parkinsonian and dystonic symptoms. He was evaluated for suitability for deep brain stimulation surgery. Neuropsychological findings demonstrated diffuse impairment involving memory, visuospatial, language, and executive functioning.