IMPORTANCE: Polycyclic aromatic hydrocarbons (PAHs) are ubiquitous and neurotoxic environmental contaminants. Prenatal PAH exposure is associated with subsequent cognitive and behavioral disturbances ...in childhood. OBJECTIVES: To identify the effects of prenatal PAH exposure on brain structure and to assess the cognitive and behavioral correlates of those abnormalities in school-age children. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional imaging study in a representative community-based cohort followed up prospectively from the fetal period to ages 7 to 9 years. The setting was urban community residences and an academic imaging center. Participants included a sample of 40 minority urban youth born to Latina (Dominican) or African American women. They were recruited between February 2, 1998, and March 17, 2006. MAIN OUTCOMES AND MEASURES: Morphological measures that index local volumes of the surface of the brain and of the white matter surface after cortical gray matter was removed. RESULTS: We detected a dose-response relationship between increased prenatal PAH exposure (measured in the third trimester but thought to index exposure for all of gestation) and reductions of the white matter surface in later childhood that were confined almost exclusively to the left hemisphere of the brain and that involved almost its entire surface. Reduced left hemisphere white matter was associated with slower information processing speed during intelligence testing and with more severe externalizing behavioral problems, including attention-deficit/hyperactivity disorder symptoms and conduct disorder problems. The magnitude of left hemisphere white matter disturbances mediated the significant association of PAH exposure with slower processing speed. In addition, measures of postnatal PAH exposure correlated with white matter surface measures in dorsal prefrontal regions bilaterally when controlling for prenatal PAH. CONCLUSIONS AND RELEVANCE: Our findings suggest that prenatal exposure to PAH air pollutants contributes to slower processing speed, attention-deficit/hyperactivity disorder symptoms, and externalizing problems in urban youth by disrupting the development of left hemisphere white matter, whereas postnatal PAH exposure contributes to additional disturbances in the development of white matter in dorsal prefrontal regions.
BACKGROUND:Advanced age, frailty, low education level, and impaired cognition are generally reported to be associated with postoperative cognitive complications. To translate research findings into ...hospital-wide preoperative assessment clinical practice, we examined the feasibility of implementing a preoperative frailty and cognitive assessment for all older adults electing surgical procedures in a tertiary medical center. We examined associations among age, education, frailty, and comorbidity with the clock and 3-word memory scores, estimated the prevalence of mild to major cognitive impairment in the presurgical sample, and examined factors related to hospital length of stay.
METHODS:Medical staff screened adults ≥65 years of age for frailty, general cognition (via the clock-drawing test command and copy, 3-word memory test), and obtained years of education. Feasibility was studied in 2 phases(1) a pilot phase involving 4 advanced nurse practitioners and (2) a 2-month implementation phase involving all preoperative staff. We tracked sources of missing data, investigated associations of study variables with measures of cognition, and used 2 approaches to estimate the likelihood of dementia in our sample (ie, using extant data and logistic regression modeling and using Mini-Cog cut scores). We explored which protocol variables related to hospital length of stay.
RESULTS:The final implementation phase sample included 678 patients. Clock and 3-word memory scores were significantly associated with age, frailty, and education. Education, clock scores, and 3-word scores were not significantly different by surgery type. Likelihood of preoperative cognitive impairment was approximately 20%, with no difference by surgery type. Length of stay was significantly associated with preoperative comorbidity and performance on the clock copy condition.
CONCLUSIONS:Frailty and cognitive screening protocols are feasible and provide information for perioperative care planning. Challenges to clinical adaptation include staff training, missing data, and additional administration time. These challenges appear minimal relative to the benefits of identifying frailty and cognitive impairment in a group at risk for negative postoperative cognitive outcome.
Medications for opioid use disorder such as opioid agonist treatment (OAT, including methadone, buprenorphine) are the gold standard intervention for opioid use disorder (OUD). Persons with OUD have ...high rates of neurocognitive impairment and psychiatric and substance use disorders, but few studies have examined these characteristics in diverse patients initiating OAT in opioid treatment programs (OTPs). Additionally, in these individuals, poor neurocognitive functioning and psychiatric/other substance use disorders are associated with poor OUD treatment outcomes. Given rapid changes in the opioid epidemic, we sought to replicate findings from our pilot study by examining these characteristics in a large diverse sample of persons with OUD starting OTP-based OAT.
Ninety-seven adults with OUD (M age = 42.2 years SD = 10.3; M education = 11.4 years SD = 2.3; 27% female; 22% non-Hispanic white) were enrolled in a randomized longitudinal trial evaluating methadone versus buprenorphine/naloxone on neurocognitive functioning. All participants completed a comprehensive neurocognitive, psychiatric, and substance use evaluation within one week of initiating OAT.
Most of the sample met criteria for learning (79%) or memory (69%) impairment. Half exhibited symptoms of current depression, and comorbid substance use was highly prevalent. Lifetime cannabis and cocaine use disorders were associated with better neurocognitive functioning, while depression was associated with worse neurocognitive functioning.
Learning and memory impairment are highly prevalent in persons with OUD starting treatment with either methadone or buprenorphine/naloxone in OTPs. Depression and comorbid substance use are prevalent among these individuals, but neither impact learning or memory. However, depression is associated with neurocognitive impairment in other domains. These findings might allow clinicians to help persons with OUD starting OAT to develop compensatory strategies for learning and memory, while providing adjunctive treatment for depression. Trial Registration NCT, NCT01733693. Registered November 4, 2012, https://clinicaltrials.gov/ct2/show/NCT01733693 .
Abstract
Objective
Overall, 256,000 bariatric surgeries were completed in the United States in 2019 (ASMBS, 2023). Bariatric surgeries are effective in reducing morbidity, prolonging life, and ...improving cognition, particularly among patients with BMI >40 and those with BMI >35 and obesity-related complications (Handley et al., 2016; Cornejo-Pareja et al., 2021). Nevertheless, up to 16% of patients undergoing bariatric procedures experience neurological sequelae (Thaisetthawatku et al., 2004) that is likely secondary to surgery-related nutritional deficiencies (Gasmi et al., 2022). Although neuropsychological assessments may help to identify postsurgical cognitive changes, cultural and linguistic differences may preclude reliable and valid assessment of non-native English-speaking persons.
Method
A Spanish-dominant 38-year-old, right-handed, female reported diminished attention, reduced thinking speed, and memory difficulties that were interfering with her daily functioning. She completed a thorough Clinical Interview (both individually and with collaterals), Record Review, and a comprehensive neuropsychological workup.
Results
She demonstrated multi-domain impairment (>1.5 S.D. below the normative mean), suggesting a possible dementia or encephalopathy. When her cognitive profile was interpreted in the context of her medical history, further testing was recommended to rule out reversible etiologies. Interdisciplinary collaborations with primary care and gastroenterology revealed nutritional deficiencies that had persisted for over 18 months after bariatric surgery and that were not fully resolved with regular oral vitamin consumption.
Conclusions
Cultural and linguistic differences were relevant when assessing cognitive changes in non-native English-speaking persons, and in helping to determine whether pharmacological and behavioral interventions are ameliorating these complications. Practical considerations of these high-stakes assessments will be discussed from neuropsychological, psychosocial, and ethical perspectives.
•This case report highlights the intricacies and challenges of conducting a comprehensive neuropsychological evaluation and Wada test with a deaf adult.•In the absence of ASL proficiency on the part ...of the neuropsychologist, consultation, extensive review of the literature, and close collaboration with qualified interpreters are instrumental.•ASL interpreters must be involved prior to the evaluation to ensure test instructions and content are understandable and relevant. It is also helpful to score tests and discuss behavioral observations with the interpreter subsequent to testing.•Tests that are heavily verbal and depend on knowledge in English may not be appropriate.
In high-stake cases (e.g., evaluating surgical candidacy for epilepsy) where neuropsychological evaluation is essential to care, it is important to have culturally and linguistically appropriate and accessible neuropsychological instruments and procedures for use with deaf individuals who use American Sign Language (ASL). Faced with these ethical and professional issues, clinicians may be unable to provide equitable services without consulting with other psychologists and collaborating with the patient and interpreter. This is a case report describing a 43-year-old male with bilateral sensorineural deafness and a lifelong history of drug-resistant temporal lobe epilepsy who presented as a candidate for a comprehensive neurological workup to determine surgical candidacy. He was bilingual (ASL and written English). We describe all aspects of the evaluation, including functional magnetic resonance imaging (fMRI) and Wada testing, using an ASL interpreter. Results from the neuropsychological evaluation were not clearly lateralizing, but suggested greater compromise to the non-dominant right hemisphere. fMRI and Wada test results revealed language and verbal memory functions were lateralized to the left hemisphere. The patient was deemed to be an adequate candidate for surgical resection of portions of the right hemisphere. Comprehensive assessment of neuropsychological functioning in deaf persons who use ASL is feasible. This case report illustrates the important considerations relevant to neuropsychologists providing culturally and linguistically informed assessments to deaf ASL users with epilepsy. Additional research in this area will support future efforts to develop effective and efficient models that could be implemented across different settings. Moreover, clinical guidance is warranted to guide professionals interested in promoting access to high quality neuropsychological services.
Among persons with opioid use disorder (OUD), neuropsychological dysfunction is associated with depression, and better neuropsychological function is associated with opioid abstinence. However, it is ...unknown whether depressive symptomatology or adherence to opiate agonist treatment are associated with neuropsychological change over time.
We recruited 20 buprenorphine/naloxone-treated adults with OUD (M Age = 45.2 years SD = 8.1; 25% female) to complete baseline and 6 month visits containing a neuropsychological test battery and self-reported measures of depressive symptomatology and medication adherence.
Depressive symptomatology was not significantly related to neuropsychological change (p's > .05). Greater adherence to buprenorphine/naloxone was associated with improvements in learning, memory, and global functioning (r's = .52-60; p's < .05).
Among OUD patients, greater adherence to buprenorphine/naloxone is associated with improved neuropsychological functioning over time. In contrast, depressive symptomatology is not associated with neuropsychological functioning over time. Supporting adherence to buprenorphine/naloxone may improve and/or preserve learning and memory functioning in individuals treated for OUD.
NCT01108679 . Registered 21 April 2010.
Abstract
Objective
Despite a growing ethnically and linguistically diverse population, the medical system in the U.S. continues to lack the cultural sensitivity needed to provide patients from ...underrepresented groups with culturally relevant care. This case study of a 32-year-old Mexican woman, by the pseudo name of Ella, will be reviewed to describe her family’s journey through the medical system. Ella was referred for neuropsychological testing to determine medical capacity for kidney transplant. She’s an example of how our health care system has inadequately adapted to our diversification and how lower literacy and disempowerment has led to misinformed ideas about illness and higher risk of health complications.
Method
This case study will review Ella’s medical, developmental, and psychosocial history, will illustrate the important considerations relevant to providing culturally, ethically, and linguistically informed neuropsychological and medical evaluations.
Results
Through neuropsychological testing, Ella was diagnosed with a severe intellectual disability, solidifying that she doesn’t have the capacity to make medical decisions. Her mother, a monolingual Spanish speaker, bringing another daughter as she’s the only fluent English speaker in the family. After having her kidney transplant surgery halted due to an allergic reaction, Ella’s life is at risk due to translational fallouts in communication between Ella’s providers and family, and misinformation regarding her medical diagnoses and treatments.
Conclusions
Advocacy for a healthcare system that adapts to language, lower health literacy, socioeconomic/legal statuses will ensure that our ethnic minorities are informed of their medical conditions and management, and receive the lifesaving care they need, when the need it.
Abstract
Objective
Numerous non-pharmacological treatments (NPT) have been developed for older adults with mild cognitive impairment (MCI) (Bahar-Fuchs, Mowszowski, Lautenschlager, & Cox, 2021). Two ...forms of NPTs, namely cognitive rehabilitation (CR) and cognitive training (CT) may demonstrate cognitive benefit, but there remain significant methodological challenges in the field (Barban et al., 2016; McPhee, Downey & Stough, 2019; Sherman et al., 2020). One such limitation is the contribution of cultural and demographic factors to study outcome heterogeneity. Our goal was to highlight examples of select culturally informed NPTs and provide recommendations to expand diversity into clinical practice and research.
Data Selection
Discussed results and limitations of recent meta-analyses and systematic reviews that focused on NPTs for MCI in older adults. We completed a review of culturally informed NPTs from the past two years. Clinician experiences informed the inclusion of additional diversity variables (e.g., methodological, demographic, social, systemic) that could be integrated into clinical practice and research.
Data Synthesis
There is a paucity of research considering cultural and demographic factors when delivering NPTs. Results of culturally informed CR or CT highlighted themes in the adaptation of language, cognition, function, diet, and physical activity. Additional provider, patient, and systemic factors can be considered to promote diversity, equity, and inclusion (DEI).
Conclusions
Culturally informed NPTs are understudied. Practical recommendations for US-based clinicians and researchers are provided that could increase access/recruitment, retention, and outcome in CT and CR for diverse populations.
Abstract
Objetivo
Los objetivos del estudio fueron describir los niveles de aflicción y bienestar psicológico en cuidadores informales (CI) de personas diagnosticadas con demencia en Puerto Rico, así ...como determinar la relación entre estos, durante el periodo de pandemia por COVID-19.
Método
En este estudio descriptivo y correlacional participaron 84 adultos puertorriqueños entre las edades de 21 y 65 años. El 92.9% se identificó con el género femenino. Se administró un cuestionario sociodemográfico, la Escala de Bienestar Psicológico de Ryff (EBPR) y el Inventario de Aflicción del Cuidador Marwit y Meuser (IACMM), formulario corto, a través de Psychdata.
Resultados
Un 70.0% de la muestra (n = 59) reportó presentar niveles de aflicción promedio, un 19.0% (n = 16) bajos, y 11.0% (n = 9) altos. El promedio de aflicción reportada en la IACMM fue de 63.89 (DE = 13.31). Un 61.0% (n = 51) de los participantes reportó niveles bajos de bienestar psicológico. La EBPR reflejó un promedio de 70.39 (DE = 13.09). Se llevó a cabo un análisis de correlación Pearson para evaluar la relación entre puntuaciones en la IACMM y la EBPR. Los resultados reflejaron una correlación negativa, moderada baja y estadísticamente significativa, r = −0.374 (p < 0.01).
Conclusión
La muestra reportó niveles de aflicción comparables con los reportados por muestras de CI en tiempos pre-pandemia. También reportaron niveles de bienestar psicológico por debajo de lo esperado para la población puertorriqueña en general. Los resultados apoyaron la correlación inversa entre aflicción y bienestar psicológico documentada previamente en la literatura. Se discutirán implicaciones de estos hallazgos para la población puertorriqueña de CI.
Abstract
Objective
This review aimed to examine and compare norm stratification of available normative data of neuropsychological tests for Spanish-speakers in the United States, Latin America, the ...Caribbean, and Spain.
Data Selection
English and Spanish studies focused on acquiring normative data for Latinx/Hispanics in Latin America, the Caribbean, the United States, and Spain, were searched from Embase, PubMed, PsycINFO APA, ClinicalTrials.gov, Science Direct, and ProQuest with the date before August 31st, 2022. We used the terms “Neuropsychological testing”, “Cognitive assessment”, “Hispanic”, “Latinx” and “Latinos”. Studies were imported to COVIDENCE, and reviewed by two Spanish-English bilingual reviewers, and one proficient English-only reviewer. Out of 345 records identified, 55 met inclusion and exclusion criteria and were not two standard deviations below the quality criteria index.
Data Synthesis
Age, education, and sex were the most common variables included in the stratification of normative data. Age was a predictor of lower performance in adults, and higher education was a predictor of better performance. With children and adolescents, increased age was related to better cognitive performance. Most of the studies were written in English and included a cognitively intact sample that was assessed either with the Mini-Mental State Examination, health history, or other clinical interviews or exams.
Conclusion
There is an evident improvement in the availability of measures for Spanish speakers. However, there is a need for better-developed tests for this population. Future studies in this area should consider adding variables such as acculturation and bilingualism into research, as well as developing novel measures for Spanish speakers.
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