Due to advancements in neuroimaging, Chiari malformation type I (CM-I) has become more widely recognized in pediatric populations. While its neurological manifestations are well documented, research on its neurocognitive impact remains limited and poorly characterized. This scoping review facilitates a comprehensive mapping of the current evidence, identifies the neurocognitive domains most frequently assessed, evaluates the extent of available evidence regarding surgical outcomes, and highlights critical knowledge gaps. The most frequently examined domains were working memory, executive function, language, and attention. Parental reports commonly indicated executive dysfunction, particularly within metacognitive processes. Evidence linking surgical decompression to improvements in neurocognitive function was inconsistent, and most studies lacked baseline or longitudinal assessments. Across studies, substantial methodological heterogeneity and variable use of validated instruments limited cross-comparison. Current evidence on the neurocognitive sequelae of pediatric CM-I is fragmented and methodologically diverse. The findings underscore the need for standardized neurocognitive assessments at diagnosis, the use of validated pediatric instruments, and prospective, longitudinal research integrating clinical, neuroimaging, and neurocognitive data to clarify the developmental impact of CM-I and its management.

This systematic review aims to examine the relationship between Chiari Malformation Type I (CM-I) and cognitive impairment, with particular attention to five key research questions: (1) the association between the degree of tonsillar ectopia and cognitive deficits; (2) the mediating role of chronic pain and psychological comorbidities; (3) the relationship between diffusion tensor imaging (DTI) metrics and cognitive dysfunction; (4) the reversibility of microstructural abnormalities and associated cognitive changes following decompression surgery; and (5) whether cognitive impairment alone may justify surgical intervention.Following PRISMA 2020 guidelines, a systematic review of the Medline/PubMed database was conducted for studies reporting on adult CM-I patients with cognitive assessments between 2000 and 2025. The extracted data included demographics, clinical and radiological characteristics, surgical status, cognitive domains affected, and the cognitive assessment tools used.Nineteen studies involving 1,226 patients were included. Cognitive impairments were frequently observed, particularly in processing speed (42.1

Objective: To critically examine the assumption that protective orders are adequately protective of sensitive psychological/neuropsychological test information. Attorneys at times claim that to adequately cross-examine neuropsychological experts, they require direct access to protected test information, rather than having test data analyzed by retained neuropsychological experts. As a compromise, judges sometimes order that protected test information be released to attorneys under a protective order. Method: An appointed writing group of forensic experts developed a position paper addressing the history of protective orders and their presumed effectiveness in protecting psychological and neuropsychological test content. The expert panel consisted of 12 forensic neuropsychologists, a forensic neuropsychologist/attorney, and a forensic psychologist/attorney. Results: Eight reasons are enumerated as to why protective orders do not sufficiently safeguard protected psychological/neuropsychological information and thereby jeopardize future use of the tests. Recommendations are provided to the expert witness practitioner for navigating demands by non-psychologists for direct access to protected test information. Conclusions: There is strong agreement within the practicing neuropsychology community that test security is a vital matter, which, if properly enforced, can ensure the validity of present and future psychological and neuropsychological assessments but, if ineffectively managed, will undermine such evaluations. Because the effectiveness of protective orders has not been, and cannot be, guaranteed, protected psychological and neuropsychological test information should not be released under a protective order.

Meningiomas are the most common intracranial tumors, predominantly affecting adults, with a higher incidence in female and elderly populations. Despite their prevalence, research on neurocognitive impairment in meningioma patients remains limited compared to intra-axial tumors such as gliomas. We conducted a comprehensive systematic review of the current literature on neurocognitive outcomes in meningioma patients pre- and post-surgery. Our review revealed significant disparities in reported neurocognitive outcomes, with prospective studies suggesting tumor-related factors as the primary contributors to postoperative deficits, while retrospective studies imply surgical intervention plays a significant role. Regardless of study design or specifics, most studies lack baseline preoperative neurocognitive assessments and standardized protocols for evaluating neurocognitive function. To address these gaps, we advocate for standardized neurocognitive assessment protocols, consensus on neurocognitive domains to be targeted in this population by tailored test batteries, and more prospective studies to elucidate correlations between tumor characteristics, patient attributes, surgical interventions, neurocognitive status, and planning for implementing tailored neurocognitive rehabilitation strategies early in the postoperative course which is crucial for achieving optimal long-term neurocognitive outcomes and enhancing patients' quality of life.

Abstract Endoscopic resection of colloid cysts, a rare pathology of the third ventricle, is now accepted clinical practice. Owing to their location proximal to numerous deep gray nuclei and to the forniceal columns, colloid cysts have always been feared to cause cognitive decline, whether operated on or not. Detailed cognitive testing before and after endoscopic resection, however, has rarely been described. Thus, out objective was to determine the neurocognitive effects of endoscopic colloid cyst resection. We analyzed formal pre- and postoperative neuropsychological testing performed in 20 patients undergoing endoscopic colloid cyst resection. Performance was compared either for each individual patient on a test-by-test basis or according to aggregated neuropsychological factor scores grouped via expert census. A clinical change was defined significant if (i) reaching statistical significance, and (ii) it was greater than 1.5 times the standard deviation of the preoperative performance distribution. Overall, 20 adult patients with colloid cysts (diameter 13.3 ± 1.3 mm) underwent matched pre- and postoperative testing generating 679 data points. No patient had a significant change in cognitive performance. When neurocognitive metrics assessing cognitive functions typically subsumed by the temporal (p = 0.35), extratemporal (p = 0.20), occipitoparietal (p = 0.31), or frontal lobes (p = 0.11), no statistically significant difference was observed between pre- and postoperative cognitive performance. No significant differences emerged when factor scores were generated according to composite score of different neurocognitive domains: attention (p = 0.32), executive function (p = 0.14), language (p = 0.98), and visuospatial function (p = 0.42). In conclusion, neuropsychological testing allows for the careful longitudinal monitoring of cognitive status and the identification of patients who may benefit from pre- and postoperative cognitive rehabilitation, and should be used as a valuable surgical psychometric marker and adjuvant. No significant cognitive decline was observed, again confirming the safety of endoscopic colloid cyst resection.

The disciplines of neuropsychology and neurosurgery have a history of partnership that has improved prognoses for patients with neurologic diagnoses that once had poor outcomes. This article outlines the evolution of this relationship and describes the current role that clinical neuropsychology has within a department of neurological surgery across the preoperative, intraoperative, and postoperative stages of treatment. Understanding the foundations of collaboration between neuropsychology and neurosurgery contextualizes present challenges and future innovations for advancing excellence along the continuum of care for all neurosurgical patients.

Grief and associated mood disturbances are to be prioritized and carefully considered in the evaluation and treatment plan with middle-old older adults.

Objective Epilepsy is one of the most common reasons for referral for a pediatric neuropsychological evaluation due its high prevalence in childhood and our well-established clinical role in tertiary care settings. Emerging evidence indicates that racial and ethnic minority populations experience increased epilepsy burden compared with White peers. Although there has been heightened recognition in our specialty regarding the dire need for culturally and linguistically responsive evaluations, the scientific evidence to support effective neuropsychological service delivery for bi/multilingual and bi/multicultural youth with epilepsy is comparatively scant and of poor quality. As a result, significant patient and clinical challenges exist, particularly in high stakes presurgical pediatric epilepsy evaluations of bi/multilingual and bi/multicultural children. Method Given that Spanish is the most common language spoken in the United States after English, this paper will focus on Spanish and English measures, but will provide evidence-based practice considerations that can inform practices with other non-English speaking communities. Cultural and linguistic factors that affect clinical decision-making regarding test selection, test interpretation, and feedback with families are highlighted. Results We offer a review of neuropsychological profiles associated with pediatric epilepsy as well as a flexible, multimodal approach for the assessment of linguistically and culturally diverse children with epilepsy based on empirical evidence and the clinical experiences of pediatric neuropsychologists from diverse backgrounds who work with children with epilepsy. Conclusion Limitations to this approach are discussed, including the lack of available measures and resources for culturally and linguistically diverse pediatric populations. A case illustration highlights a culturally informed assessment approach.

Clinical neuropsychology has been a valuable asset to neurologic surgery, contributing to lateralization and localization of pathologic brain tissue, identification of eloquent cortex, and evaluation of postoperative neuropsychological functioning. Moreover, neuropsychologists provide empirically driven interventions aimed at supporting preparation and/or recovery of neurosurgery patients. Nonetheless, several challenges may limit the reliability, validity, and generalizability of the assessment data obtained and reduce the usefulness of other neuropsychological services provided. Specifically, linguistic, cultural, educational, and other biases associated with demographic characteristics can lead to a narrowed view of an individual's life experiences, which must be confronted to fulfill the mission of ensuring that all patients have access to care that is appropriate to their needs. Instead of perceiving these challenges as insurmountable barriers, such issues can be viewed as opportunities to catalyze change and foster innovation for the future of neuropsychological care in neurosurgical settings. In addition to reviewing the possible mechanisms of these obstacles, the current article offers tangible solutions at both a macro level (e.g., discipline-wide transformations) and micro level (e.g., individualized patient-centric approaches). Outlined are practical techniques to potentially improve consensus and standardization of methods, advance and globalize research, expand representativeness of measures and practices to serve diverse individuals, and increase treatment adherence through engagement of patients and their families.

Meningioma is the most common primary brain tumor in adults. Patients may become symptomatic due to the resultant mass effect and the peritumoral vasogenic edema. The majority of existing research on neurocognitive impairment in patients with brain tumors has focused on gliomas while less research has been conducted on the effects of tumor and/or surgical intervention on neurocognitive function in patients with meningioma. We conducted a prospective study on the utilization of the Cogmed Working Memory Training (CWMT) program in patients who underwent surgical resection of WHO grade I intracranial meningioma and experienced neurocognitive impairment after surgery. All patients had a significant improvement in their post-CWMT neurocognitive function evaluation compared to their baseline post-surgical neurocognitive evaluation, and the improvement was maintained at a three-month follow-up. This study is the first to evaluate the effectiveness of a neurocognitive rehabilitation program in augmenting the neurocognitive functioning of patients with Intracranial WHO Grade I Meningioma. The results of this study demonstrate the efficacy of the CWMT program in improving postoperative impaired neurocognitive function and potentially improving the quality of life of our patients.

Over the last century, collaboration between clinical neuropsychologists and neurosurgeons has advanced the state of the science in both disciplines. These advances have provided the field of neuropsychology with many opportunities for innovation in the care of patients prior to, during, and following neurosurgical intervention. Beyond giving a general overview of how present-day advances in technology are being applied in the practice of neuropsychology within a neurological surgery department, this article outlines new developments that are currently unfolding. Improvements in remote platform, computer interface, "real-time" analytics, mobile devices, and immersive virtual reality have the capacity to increase the customization, precision, and accessibility of neuropsychological services. In doing so, such innovations have the potential to improve outcomes and ameliorate health care disparities.

Consistent with the literature, this pre-surgical case demonstrated significant psychiatric symptoms in the context of right-sided treatment refractory epilepsy. While psychiatric comorbidities contributed to non-adherence with medical recommendations, under-functioning in vocational goals, and general hopelessness, the neuropsychological evaluation revealed strengths that impacted surgical candidacy and rapport-building that facilitated patient engagement and understanding of the surgical process.

Purpose: Compare the detection rate of seizures on scalp EEG with simultaneous intracranial stereo EEG (SEEG) recordings. Methods: Twenty-seven drug-resistant epilepsy patients undergoing SEEG with simultaneous scalp EEG as part of their surgical work-up were included. A total of 172 seizures were captured. Results: Of the 172 seizures detected on SEEG, 100 demonstrated scalp ictal patterns. Focal aware and subclinical seizures were less likely to be seen on scalp, with 33% of each observed when compared with focal impaired aware (97%) and focal to bilateral tonic-clonic seizures (100%) (P < 0.001). Of the 72 seizures without ictal scalp correlate, 32 demonstrated an abnormality during the SEEG seizure that was identical to an interictal abnormality. Seizures from patients with MRI lesions were statistically less likely to be seen on scalp than seizures from nonlesional patients (P = 0.0162). Stereo EEG seizures not seen on scalp were shorter in duration (49 seconds) compared with SEEG seizures seen on scalp (108.6 seconds) (P < 0.001). Conclusions: Scalp EEG is not a sensitive tool for the detection of focal aware and subclinical seizures but is highly sensitive for the detection of focal impaired aware and focal to bilateral tonic-clonic seizures. Longer duration of seizure and seizures from patients without MRI lesions were more likely to be apparent on scalp. Abnormalities seen interictally may at times represent an underlying seizure. The cognitive, affective, and behavioral long-term effects of ongoing difficult-to-detect seizures are not known.

Recent evidence indicates that World Trade Center Responders (WTCRs) are apparently at increased risk for a clinical syndrome that includes PTSD (posttraumatic stress disorder) and MCI (mild cognitive impairment). The association of these behavioral and cognitive symptoms was first described by Bromet, Luft, Clouston, and colleagues. No autopsy characterization of the syndrome has yet emerged, though biofluid and neuroimaging biomarker data support features of (1) progressive behavioral and cognitive dysfunction, (2) proteinopathy involving the appearance of neurodegeneration-related molecules in the peripheral circulation, and (3) a substantial regional loss of brain volume. Inciting factors such as inhalation of neurotoxins and/or psychological stressors (or a combination of both) have been proposed as contributory to the pathogenesis, but no definitive etiologic agent has been identified. In general, the subpopulation of WTCRs who developed PTSD and MCI were those with documentable extended exposure to the central feature of “Ground Zero” known as “the pile”, and those who developed MCI were primarily a subgroup of those who had developed PTSD. Multiomic studies are underway to determine whether this subgroup might be enriched for genetic, genomic, and/or proteomic features that might have predisposed them to pathological responses to stress, environmental toxins, or both. In 2017, we had occasion to evaluate “E.T.”; at that time, a 57-year-old bilingual (English and Spanish speaking) right-handed WTCR was referred to an urban medical center dementia specialty clinic for assessment of his cognitive and behavioral functioning. While early-onset dementia can occur sporadically, the proximity of E.T. to “the pile” at “Ground Zero”, and the course of E.T.’s illness raise the possibility that WTC-related cognitive-behavioral syndromes may progress well beyond the stage of MCI to that of moderate dementia (and beyond) and that this progression may occur in the absence of full-blown PTSD.

Patients with dementia have a five- to ten fold increase in risk of seizures, and approximately 12% of new-onset seizures in elderly patients are attributed to degenerative disorders. Likewise, individuals with epilepsy are at an increased risk for developing dementia as an older adult. Due to the high comorbid rates of epilepsy and dementia, it is important for neuropsychologists to understand the bidirectional relationship between dementia and epilepsy. This chapter provides a foundation for understanding the overlap between epilepsy and dementia and provides guidance for diagnostic decision-making and differential diagnosis. Practical tools for clinical assessment are presented as well as a case example.

Neuropsychologists working with elderly adult populations are increasingly seeking alternative interventions for their patients. Cognitive training and rehabilitation are a set of noninvasive activities aimed at enhancing a patient’s overall cognitive and behavioral functioning in pursuit of both overarching and subordinate goals. Neuropsychologists are a natural fit as both cognitive remediationalists and careful consumers of related literature, owing to their nuanced understanding of brain-behavior relationships, sophisticated interpretations of cognitive metrics, and keen insight into the range of functional changes regarding their patient’s health-related quality of life. However, even for practitioners for whom providing cognitive training and rehabilitation (CTR) is beyond their scope of practice, it is key for neuropsychologists to have a more comprehensive understanding of this area of treatment to facilitate informed, meaningful recommendations that help optimize patient care. This chapter reviews much of the current extant literature specific to both healthy older adults and those with a variety of neurological challenges.

Proactive interference (PI) is when something learned earlier impairs the ability to remember something learned more recently. PI can be observed in all subject populations and in all memory systems, including the perceptual representation system, procedural memory, semantic memory, long-term episodic memory, and short-term/working memory. One current theoretical account of PI attributes its cause to cue overload: the more items a cue subsumes, the less effective the cue will be. Other accounts suggest that items learned earlier can reduce the distinctiveness of current items, making successful retrieval less likely.

The present study evaluated an important variable in neuropsychology, which is the impact of patient emotional associations to verbal stimuli during memory testing. Accurate and detailed memory testing is vital to the diagnosis and treatment of neuropathology (e.g. traumatic brain injury). Students were asked to learn a series of word pairs that varied in emotional valence: positive (happy—merry), negative (slay—murder), and neutral or original (curtains—blinds). A one-way repeated-measures ANOVA illustrated a significant effect of emotional valence [F(2 ) = 14.5, p<0.001], with recall for the neutral/original word pairs (M = 8.3) being significantly greater than recall for the negative (M = 5.4) and positive (M = 5.13) word pairs. Since the emotional (negative or positive) word pairs were synonyms, they could have been more difficult to recall than the neutral/original word pairs. The neutral/original word pairs may also have been higher in imagery than the emotional word pairs. Implications for future research will be discussed. Paired-Associate Learning Research in the area of learning and memory has rapidly expanded during the last few decades. Researchers now have access to an extensive body of knowledge about the use of mnemonic devices or associations between semantically related words. The present study used an exploratory technique to evaluate the use of semantically associated words in relation to learning and memory. The present study focused on paired associative memory, which is an important neuropsychology issue in which emotional associations to verbal stimuli are tested for better understanding of cognitive processes. Emotional valence effect on memory and learning is also of great importance for the area of neuropsychology. This study is also specifically relevant to the improvement and understanding of college learning. It was hypothesized that emotional valence will have an effect on memory and learning, and the negative words would be recalled more frequently than positive or neutral/original words. However, the findings partially support this hypothesis. The neutral/original word pairs were recalled more frequently than either the negative or positive word pairs, a result attributed to the higher imagery of the neutral/original pair words. After numerous studies, scientists are able to identify the areas of the brain associated with memory. The structures involved in learning and memory include the