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      Clinical applications of neuropsychological assessment

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          Abstract

          Neuropsychological assessment is a performance-based method to assess cognitive functioning. This method is used to examine the cognitive consequences of brain damage, brain disease, and severe mental illness. There are several specific uses of neuropsychological assessment, including collection of diagnostic information, differential diagnostic information, assessment of treatment response, and prediction of functional potential and functional recovery. We anticipate that clinical neuropsychological assessment will continue to be used, even in the face of advances in imaging technology, because it is already well known that the presence of significant brain changes can be associated with nearly normal cognitive functioning, while individuals with no lesions detectable on imaging can have substantial cognitive and functional limitations.

          Translated abstract

          La evaluación neuropsicológica es un método basado en el rendimiento para evaluar el funcionamiento cognitivo. Este método se emplea para examinar las consecuencias cognitivas del daño cerebral, de enfermedades cerebrales y de enfermedades mentales graves. Hay varios usos específicos de la evaluación neuropsicológica, que incluyen elementos para información diagnóstica y para el diagnóstico diferencial, para la evaluación de la respuesta terapéutica y para la predicción del potencial funcional y de la recuperación funcional. Se anticipa que se continuará aplicando la evaluación neuropsicológica clínica, a pesar de los avances en la tecnología de imágenes, ya que es bien sabido que la presencia de importantes cambios cerebrales pueden estar asociados con un funcionamiento cognitivo cercano a lo normal y que individuos sin lesiones detectables en las imágenes pueden tener limitaciones significativas tanto cognitivas como funcionales.

          Translated abstract

          L'évaluation neuropsychologique est une méthode basée sur la performance permettant d'évaluer le fonctionnement cognitif. Cette méthode est utilisée pour analyser les conséquences cognitives des lésions cérébrales, de la pathologie cérébrale et des maladies mentales sévères. II existe plusieurs utilisations spécifiques de l'évaluation neuropsychologique, comprenant le recueil d'informations diagnostiques, d'informations diagnostiques différentielles, d'évaluation de la réponse au traitement et de la prévision du potentiel fonctionnel et de la récupération fonctionnelle. Nous prévoyons que l'évaluation clinique neuropsychologique continuera à être utilisée malgré les avancées technologiques de l'imagerie, car il est déjà bien connu que des modifications cérébrales significatives peuvent être associées à un fonctionnement cérébral presque normal tandis que certaines personnes sans lésion détectable à l'imagerie peuvent présenter des limitations fonctionnelles et cognitives importantes.

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          Most cited references50

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          The MATRICS Consensus Cognitive Battery, part 1: test selection, reliability, and validity.

          The lack of an accepted standard for measuring cognitive change in schizophrenia has been a major obstacle to regulatory approval of cognition-enhancing treatments. A primary mandate of the National Institute of Mental Health's Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) initiative was to develop a consensus cognitive battery for clinical trials of cognition-enhancing treatments for schizophrenia through a broadly based scientific evaluation of measures. The MATRICS Neurocognition Committee evaluated more than 90 tests in seven cognitive domains to identify the 36 most promising measures. A separate expert panel evaluated the degree to which each test met specific selection criteria. Twenty tests were selected as a beta battery. The beta battery was administered to 176 individuals with schizophrenia and readministered to 167 of them 4 weeks later so that the 20 tests could be compared directly. The expert panel ratings are presented for the initially selected 36 tests. For the beta battery tests, data on test-retest reliability, practice effects, relationships to functional status, practicality, and tolerability are presented. Based on these data, 10 tests were selected to represent seven cognitive domains in the MATRICS Consensus Cognitive Battery. The structured consensus method was a feasible and fair mechanism for choosing candidate tests, and direct comparison of beta battery tests in a common sample allowed selection of a final consensus battery. The MATRICS Consensus Cognitive Battery is expected to be the standard tool for assessing cognitive change in clinical trials of cognition-enhancing drugs for schizophrenia. It may also aid evaluation of cognitive remediation strategies.
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            A meta-analysis of cognitive remediation for schizophrenia: methodology and effect sizes.

            Cognitive remediation therapy for schizophrenia was developed to treat cognitive problems that affect functioning, but the treatment effects may depend on the type of trial methodology adopted. The present meta-analysis will determine the effects of treatment and whether study method or potential moderators influence the estimates. Electronic databases were searched up to June 2009 using variants of the key words "cognitive," "training," "remediation," "clinical trial," and "schizophrenia." Key researchers were contacted to ensure that all studies meeting the criteria were included. This produced 109 reports of 40 studies in which ≥70% of participants had a diagnosis of schizophrenia, all of whom received standard care. There was a comparison group and allocation procedure in these studies. Data were available to calculate effect sizes on cognition and/or functioning. Data were independently extracted by two reviewers with excellent reliability. Methodological moderators were extracted through the Clinical Trials Assessment Measure and verified by authors in 94% of cases. The meta-analysis (2,104 participants) yielded durable effects on global cognition and functioning. The symptom effect was small and disappeared at follow-up assessment. No treatment element (remediation approach, duration, computer use, etc.) was associated with cognitive outcome. Cognitive remediation therapy was more effective when patients were clinically stable. Significantly stronger effects on functioning were found when cognitive remediation therapy was provided together with other psychiatric rehabilitation, and a much larger effect was present when a strategic approach was adopted together with adjunctive rehabilitation. Despite variability in methodological rigor, this did not moderate any of the therapy effects, and even in the most rigorous studies there were similar small-to-moderate effects. Cognitive remediation benefits people with schizophrenia, and when combined with psychiatric rehabilitation, this benefit generalizes to functioning, relative to rehabilitation alone. These benefits cannot be attributed to poor study methods.
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              Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the "right stuff"?

              There has been a surge of interest in the functional consequences of neurocognitive deficits in schizophrenia. The published literature in this area has doubled in the last few years. In this paper, we will attempt to confirm the conclusions from a previous review that certain neurocognitive domains (secondary verbal memory, immediate memory, executive functioning as measured by card sorting, and vigilance) are associated with functional outcome. In addition to surveying the number of replicated findings and tallying box scores of results, we will approach the review of the studies in a more thorough and empirical manner by applying a meta-analysis. Lastly, we will discuss what we see as a key limitation of this literature, specifically, the relatively narrow selection of predictor measures. This limitation has constrained identification of mediating variables that may explain the mechanisms for these relationships.
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                Author and article information

                Contributors
                University of Miami Miller School of Medicine, Research Service, Bruce W. Carter VA Medical Center, Miami, Florida, USA
                Journal
                Dialogues Clin Neurosci
                Dialogues Clin Neurosci
                Dialogues Clin Neurosci
                Dialogues in Clinical Neuroscience
                Les Laboratoires Servier (France )
                1294-8322
                1958-5969
                March 2012
                March 2012
                : 14
                : 1
                : 91-99
                Affiliations
                University of Miami Miller School of Medicine, Research Service, Bruce W. Carter VA Medical Center, Miami, Florida, USA
                Author notes
                Article
                10.31887/DCNS.2012.14.1/pharvey
                3341654
                22577308
                8f3ad5a7-424d-4358-b64a-aea4c523aa52
                Copyright: © 2012 LLS

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Clinical Research

                Neurosciences
                neuropsychology,schizophrenia,disability,alzheimer's disease
                Neurosciences
                neuropsychology, schizophrenia, disability, alzheimer's disease

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