There is minimal research on how test administration location affects performance on visuospatial tests. This study examined the difference in performance between administration groups using data from the National Neuropsychology Network. This study compared the visuospatial test performance of 3122 clinical subjects, across 11 tests and subtests. Participants were categorized by test administration type: in person with personal protective equipment (In Clinic PPE), or virtually (TeleNP Home). We hypothesized that the administration method of the visuospatial tests would affect the performance of participants given the novelty of the clinic environment. Using a Bonferroni-corrected significance threshold of p< 0.0045, univariate analyses of covariance (ANCOVAs) revealed that there were significant main effects, showing higher performance for patients in the TeleNP Home group versus the In-Clinic PPE groups on the BVMT Delayed Recall trial, BVMT total score, JLO, WMS-IV Older Adult Visual Reproduction I, WMS-IV Older Adult Visual Reproduction II (OA-VR-II), WAIS Matrix Reasoning (MR), WAIS Symbol Search, and WAIS Coding. The BVMT Delayed Recall trial, BVMT Total Score, WAIS Visual Puzzles, and WAIS Symbol Search had covariate effects of both age and education. The WMS-IV OA-VR-II and WAIS MR had a covariate effect of education. The JLO had a covariate effect of age. See attached table for numerical results. Significant test performance differences suggest that patients at home may score higher than in-clinic. This may be a limitation when clinicians assess patient performance on tests. Further research on relationships between performance, administration type, and demographics are necessary to determine limiting factors for performance.

Background: Abnormal reward processing has been considered as a core feature of severe mental illness (SMI), such as bipolar disorder and schizophrenia. Deficits in this domain can have severe implications in daily functioning, such as a decreased motivation to engage in social activities or make healthy lifestyle choices. The Online Positive Valence Study aimed to assess reward processing in bipolar disorder and schizophrenia using the NIMH Research Domain Criteria (RDoC) Positive Valence Systems (PVS) framework in an online task-based study. Recruitment and study adherence fell short of expectations.Objective: The current paper critically evaluates the used methodology and shares the lessons learned of conducting an online task-based study of reward processing in a severe mental illness sample.Methods: Participants were recruited mainly via email from two existing cohorts. The research team consisted of a part-time research assistant, a part-time postdoctoral researcher and the principal investigators. The study was built using several software packages and comprised a number of questionnaires and three reward tasks, the monetary incentive delay task (MID), effort expenditure of rewards task (EEfRT) and a social and coin version of the Bandit task. From 2023 onwards, the research team accepted that the initial recruitment goal would not be attained.Results: Participants who were additionally called were over four times more likely to respond “no” and more than twice as likely to respond “yes” versus no response compared to those who received only emails. Personal salutations in invitation mails reduced the likelihood of participation compared to nonpersonal salutations. Reward task performance was largely similar between the in-lab MRI and online groups, though online participants showed longer reaction times on the MID task and lower win-stay rates on both Bandit tasks.Conclusion: It is advised to carefully consider recruiting from existing cohorts, hire full-time dedicated personnel and use personal approaches to recruitment, like phone calls, and adjust recruitment to the target population(s). Furthermore, participation should be technically as simple as possible, using for example browser-based presentation of tasks, after checking their consistency across the most common browsers. Attrition during the course of the study can be limited even more by shortening the duration of participation and/or adding gamification. Keywords: Positive Valence System; reward processing; bipolar disorder; schizophrenia; online study

BACKGROUND:Females with greater cardiometabolic burden (CMB) exhibit faster rates of cognitive decline compared to their male counterparts. Critical knowledge gaps exist, however, in understanding whether biological sex, a fundamental determinant of health outcomes, moderates the association between CMB and cognition differentially across cognitive domains. This is concerning given the well-documented sex disparities in both cardiometabolic and cognitive disorders, suggesting distinct pathophysiological mechanisms. This study leverages the resources available through the National Neuropsychology Network (NNN), a multi-site observational study, to delineate how sex and CMB interact to shape cognitive outcomes. METHOD:This cross-sectional analysis included 4,258 participants enrolled in the NNN study (50.3% Female, 49.7% Male; Meducation = 15.2 ±  2.8; 80.0% Non-Hispanic White; Mage = 69.3 ±  8.35). We identified the most prevalent cardiometabolic conditions in the United States and used pre-visit ICD-10 diagnostic codes to determine the prevalence of these conditions in our sample. CMB was estimated based on the aggregated number of conditions present. Neuropsychological measures were grouped by domain and statistically confirmed via confirmatory factor analysis (CFA): working memory/attention, language, executive function, memory, visuoperceptual abilities, and processing speed. MANCOVAs were used to compare domain-level performance across CMB groups, accounting for sex, education, race, and age. RESULT:The CFA supported the proposed model (Χ2(856)=2524.135, p < .001; RMSEA =  0.046; CFI = 0.916; TLI = 0.909). There was a main effect of CMB on reduced performance in executive function (F(2,1569)=6.14, p < .01), processing speed (F(2, 726)=12.98, p < .001), and language (F(3,952)=3.96, p < .01). Female sex was associated with reduced performance in working memory/attention (F(2,733)=25.61, p < .001), executive function (F(2,1569)=5.72, p < .01), processing speed (F(2,726)=5.81, p < .01), and visuoperceptual abilities (F(2,464)=26.15, p < .001). The interaction effect between sex and CMB was significant for visuoperceptual abilities (F(2,464)=5.66, p < .01). CONCLUSION:Sex and increasing CMB differentially predicted domain-level cognitive deficits, with female sex conferring increased vulnerability in visuoperceptual abilities. While cardiometabolic conditions were similarly prevalent in both sexes, their impact on cognition varied. These results underscore the importance of reducing CMB to promote brain health and the need for tailored cognitive assessment and intervention. Future research should investigate underlying mechanisms of noted sex differences, including potential hormonal influences, vascular factors, and sex-specific inflammatory responses.

Objective: The American Academy of Clinical Neuropsychology (AACN) has proposed standardized performance labels to enhance consistency in neuropsychological reporting. While valuable in forensic and medicolegal contexts, these guidelines may limit interpretive flexibility and clinical relevance in diverse practice settings. This manuscript examines the contextual appropriateness of AACN labels across diverse clinical and research settings, highlighting the need for diagnostic flexibility over rigid adherence to normative descriptors. Methods: We reviewed the historical and conceptual underpinnings of neuropsychological assessment, focusing on Ward Halstead's distinction between "biological" and "psychometric" intelligence. This framework was used to explore how interpretive models shape clinical reasoning and test interpretation. Special attention was given to the implications of score labeling in multidisciplinary team settings (e.g. dementia diagnosis, epilepsy surgery and within large-scale research initiatives, including Alzheimer's Disease Research Centers (ADRCs). Conclusions: Although AACN performance labels support greater transparency and consistency in select contexts, their universal implementation may obscure meaningful cognitive patterns and diminish diagnostic precision. Labels such as "below average" may fail to capture clinically meaningful decline in high-functioning individuals or obscure clinically relevant cognitive patterns critical for diagnosis and treatment planning. We argue for a context-sensitive approach to score interpretation that allows flexible, informed use of descriptors aligned with specific referral questions and clinical goals. Neuropsychological assessment is most effective when guided by integrative clinical reasoning rather than uncritical application of standardized labeling conventions.

Females with greater cardiometabolic burden (CMB) exhibit faster rates of cognitive decline compared to their male counterparts. Critical knowledge gaps exist, however, in understanding whether biological sex, a fundamental determinant of health outcomes, moderates the association between CMB and cognition differentially across cognitive domains. This is concerning given the well-documented sex disparities in both cardiometabolic and cognitive disorders, suggesting distinct pathophysiological mechanisms. This study leverages the resources available through the National Neuropsychology Network (NNN), a multi-site observational study, to delineate how sex and CMB interact to shape cognitive outcomes. This cross-sectional analysis included 4,258 participants enrolled in the NNN study (50.3% Female, 49.7% Male; M education  = 15.2 ±  2.8; 80.0% Non-Hispanic White; M age  = 69.3 ±  8.35). We identified the most prevalent cardiometabolic conditions in the United States and used pre-visit ICD-10 diagnostic codes to determine the prevalence of these conditions in our sample. CMB was estimated based on the aggregated number of conditions present. Neuropsychological measures were grouped by domain and statistically confirmed via confirmatory factor analysis (CFA): working memory/attention, language, executive function, memory, visuoperceptual abilities, and processing speed. MANCOVAs were used to compare domain-level performance across CMB groups, accounting for sex, education, race, and age. The CFA supported the proposed model ( Χ 2 (856)=2524.135, p  < .001; RMSEA  =  0.046; CFI  = 0.916; TLI  = 0.909). There was a main effect of CMB on reduced performance in executive function ( F (2,1569)=6.14, p  < .01), processing speed ( F (2, 726)=12.98, p  < .001), and language ( F (3,952)=3.96, p  < .01). Female sex was associated with reduced performance in working memory/attention ( F (2,733)=25.61, p  < .001), executive function ( F (2,1569)=5.72, p  < .01), processing speed ( F (2,726)=5.81, p  < .01), and visuoperceptual abilities ( F (2,464)=26.15, p  < .001). The interaction effect between sex and CMB was significant for visuoperceptual abilities ( F (2,464)=5.66, p  < .01). Sex and increasing CMB differentially predicted domain-level cognitive deficits, with female sex conferring increased vulnerability in visuoperceptual abilities. While cardiometabolic conditions were similarly prevalent in both sexes, their impact on cognition varied. These results underscore the importance of reducing CMB to promote brain health and the need for tailored cognitive assessment and intervention. Future research should investigate underlying mechanisms of noted sex differences, including potential hormonal influences, vascular factors, and sex-specific inflammatory responses.

An important task in clinical neuropsychology is to evaluate whether scores obtained on a test battery, such as the Wechsler Adult Intelligence Scale Fourth Edition (WAIS-IV), can be considered “credible” or “valid” for a particular patient. Such evaluations are typically made based on responses to performance validity tests (PVTs). As a complement to PVTs, we propose that WAIS-IV profiles also be evaluated using a residual-based M-distance ( d ri 2 ) person fit statistic. Large d ri 2 values flag profiles that are inconsistent with the factor analytic model underlying the interpretation of test scores. We first established a well-fitting model with four correlated factors for 10 core WAIS-IV subtests derived from the standardization sample. Based on this model, we then performed a Monte Carlo simulation to evaluate whether a hypothesized sampling distribution for d ri 2 was accurate and whether d ri 2 was computable, under different degrees of missing subtest scores. We found that when the number of subtests administered was less than 8, d ri 2 could not be computed around 25% of the time. When computable, d ri 2 conformed to a χ 2 distribution with degrees of freedom equal to the number of tests minus the number of factors. Demonstration of the d ri 2 index in a large sample of clinical cases was also provided. Findings highlight the potential utility of the d ri 2 index as an adjunct to PVTs, offering clinicians an additional method to evaluate WAIS-IV test profiles and improve the accuracy of neuropsychological evaluations.

The Boston Naming Test (BNT) is widely used in neuropsychology to assess language and cognitive functioning. However, its validity for younger populations is increasingly questioned due to outdated stimuli. This study tested the hypothesis that younger individuals would be less likely than older individuals to correctly identify specific BNT items. We analyzed 1,642 clinical cases of adults aged 18 to 89 (M = 59.1, SD = 15.7) with diverse diagnoses from the National Neuropsychology Network. Only participants who began the BNT at item 30 and completed items 30-60 were included, consistent with standard administration for individuals without suspected impairment. A primary analysis of logistic regression was used to assess age-related differences in item-level performance on the BNT. The primary variables were participant age and accuracy on individual test items. Logistic regression revealed six items with lower accuracy among younger participants: knocker (p=.001, CI [1.011, 1.039]), accordion (p<.001, CI [1.010, 1.039]), yoke (p<.001, CI [1.020, 1.033]), trellis (p<.001, CI [1.038, 1.052]), palette (p<.001, CI [1.010, 1.024]), and abacus (p<.001, CI [1.013, 1.026]). While older adults are often assumed to struggle with word retrieval, younger adults' poorer performance likely reflects reduced exposure rather than cognitive decline. This generational gap is expected to widen as language and culture continue evolving, while the test has not been updated since the 1980s. Additionally, scoring inconsistencies and ambiguous discontinue rules may further limit the BNT’s effectiveness in modern clinical practice. These findings highlight the need to modernize neuropsychological tools to ensure equitable assessment across generations.

OBJECTIVE:The Houston Conference Guidelines (Hannay et al., 1998) provided an initial framework for North American neuropsychology training that served the specialty well for several decades. Subsequent advances in technology, increased diversity of the U.S. and Canadian populations, and the adoption of competency-based training models within Health Service Psychology have created a need to update neuropsychology training guidelines. Therefore, in 2022, the Minnesota Conference to Update Education and Training Guidelines in Clinical Neuropsychology began a two-year drafting process leading to the currently proposed update. METHOD:A Steering Committee worked with content experts, consultants, and delegates representing North American neuropsychological organizations and specialists. The final version of the guidelines was developed after reviewing neuropsychological training literature, gathering feedback from specialists, and making iterative revisions of earlier drafts to reach consensus. CONCLUSION:The resulting "Minnesota Guidelines" include five foundational (Neuroscience and Brain Behavior Relationships; Integration of Science and Practice; Ethics, Standards, Laws, and Policies; Diversity; and Professional Relationships) and eight functional (Assessment; Intervention; Interdisciplinary Systems and Consultation; Research and Scholarship; Technology and Innovation; Teaching, Supervision, and Mentoring; Health and Professional Advocacy; and Administration, Management, and Business) areas of competency required for entry level specialty practice. While consensus was not achieved, a majority of voting delegates recommended the Guidelines for adoption and the Guidelines have been endorsed by six neuropsychology education and board certification organizations. The American Academy of Clinical Neuropsychology has not endorsed the Minnesota Guidelines and will not make an endorsement decision until three months after online publication.

There are few studies of impacts of arts on recovery in schizphrenia, on audience mood and social connection. We developed a pilot evaluation of opera performances in a university setting on Elyn Saks’ journey from psychosis, teaching law and falling in love, coupled with pre-opera workshop on approaches to resilience. Using surveys, primary outcomes were pre and post affect (PANAS-X positive, negative; visual “affect grid” touchscreen for affective valence and arousal) and social connectedness with secondary outcomes of increasing understanding, reducing stigma and willingness to socialize or serve persons with mental illness. Of 107 live and 117 online attendees, 64 completed pre, 24 post, and 22 both surveys. Respondent characteristics were similar for those with pre and pre and post surveys: average age mid 50’s, half female, 10% sexual minority, half White/Caucasian, 13% Hispanic/Latino, 11% Black/African American and 20% Asian; of 22 with pre and post, 9 (41%) were providers. There were significant post–pre increases in positive affect (PANAS-X) and arousal (visual grid) and social connectedness (Cohen’s d = 0.82 to 1.24, each p < .001); and willingness to socialize with someone with schizophrenia (d = 0.68, p = .011). In this pilot evaluation of opera in a university auditorium, despite small sample sizes, there were significant post–pre increases in audience positive affect and social connection, which could reflect selection (those with positive response completing surveys) or may suggest that arts events promote well-being and connection, issues for future larger studies.

Brain mechanisms underlying creativity are largely unknown and few studies have involved exceptionally creative individuals. We examined functional MRI (fMRI) connectivity in a "smart comparison group" (SCG; n = 24), and in exceptionally creative ("Big C") visual artists (VIS; n = 21) and scientists (SCI; n = 21). Groups were matched on age, sex, and estimated IQ. FMRI scans were acquired during the resting-state and performance of two tasks: (a) alternative uses test (AUT), putatively measuring divergent thinking; and (b) remote associates test (RAT), putatively engaging convergent thinking. Graph theory measures of functional connectivity were compared across groups using generalized linear mixed models. Global connectivity measures included small-worldness (indexing efficiency), clustering coefficient, and characteristic path length. Local connectivity measures included local efficiency and clustering coefficients within default mode, dorsal attention, frontoparietal, salience, ventral attention, and visual networks. During the resting-state, global small-worldness was lower for SCI than SCG; VIS had intermediate values. Relative to SCG, the Big C groups had higher local clustering coefficients during the resting-state conditions but lower local clustering during the AUT condition. No significant differences were found during the convergent thinking test (RAT). These findings suggest that Big C creativity is associated with more "random" rather than more "efficient" global network functional architecture, with condition-dependent variations in local clustering and efficiency. Large condition-dependent correlations between global and local clustering measures deserve further examination in exceptionally creative and other groups to more fully characterize the functional topology of brain networks most relevant to creativity.

Experimental cognitive tests are designed to measure particular cognitive domains, although evidence supporting test validity is often limited. The Consortium for Neuropsychiatric Phenomics test battery administered 23 experimental and traditional neuropsychological tests to a large sample of community volunteers (n = 1,059) and patients with psychiatric diagnoses (n = 137), providing a unique opportunity to examine convergent validity with factor analysis. Traditional tests included subtests from the Wechsler and Delis-Kaplan batteries, while experimental tests included the Attention Networks Test, Balloon Analogue Risk Task, Delay Discounting Task, Remember-Know, Reversal Learning Task, Scene Recognition, Spatial and Verbal Capacity and Manipulation Tasks, Stop-Signal Task, and Task Switching. Several experimental cognitive measures were insufficiently related to other tests and were excluded from factor analyses. In the remaining 18 tests, exploratory factor analysis and subsequent multigroup confirmatory factor analysis supported a three-factor structure broadly corresponding to domains of verbal/working memory, inhibitory control, and memory. In sum, several experimental measures of inhibitory control had weak relationships with all other tests, while the convergent validity of most tests of working memory and memory was supported.

A multitude of clinical trials measuring hemodynamic and psychological parameters have shown the beneficial effects of music on health. However, there are no clear instructions on how to utilize the potential benefits of music to improve health outcomes. Moreover, whether the effect of music is transient or enduring has yet to be determined. To address the effect of music on vital parameters and emotional well-being of patients we provide an overview of methods and findings of some studies that have evaluated the physiological or psychological impacts of music. This review puts forward a proposed model for fostering an individualized approach that can examine the therapeutic effects of music.

AbstractObjective:Most neuropsychological tests were developed without the benefit of modern psychometric theory. We used item response theory (IRT) methods to determine whether a widely used test – the 26-item Matrix Reasoning subtest of the WAIS-IV – might be used more efficiently if it were administered using computerized adaptive testing (CAT).Method:Data on the Matrix Reasoning subtest from 2197 participants enrolled in the National Neuropsychology Network (NNN) were analyzed using a two-parameter logistic (2PL) IRT model. Simulated CAT results were generated to examine optimal short forms using fixed-length CATs of 3, 6, and 12 items and scores were compared to the original full subtest score. CAT models further explored how many items were needed to achieve a selected precision of measurement (standard error ≤ .40).Results:The fixed-length CATs of 3, 6, and 12 items correlated well with full-length test results (with r = .90, .97 and .99, respectively). To achieve a standard error of .40 (approximate reliability = .84) only 3–7 items had to be administered for a large percentage of individuals.Conclusions:This proof-of-concept investigation suggests that the widely used Matrix Reasoning subtest of the WAIS-IV might be shortened by more than 70% in most examinees while maintaining acceptable measurement precision. If similar savings could be realized in other tests, the accessibility of neuropsychological assessment might be markedly enhanced, and more efficient time use could lead to broader subdomain assessment.

Objective: In this position article, we highlight the importance of considering cultural and linguistic variables that influence neuropsychological test performance and the possible moderating impact on our understanding of brain/behavior relationships. Increasingly, neuropsychologists are realizing that cultural and language differences between countries, regions, and ethnic groups influence neuropsychological outcomes, as test scores may not have the same interpretative meaning across cultures. Furthermore, attempts to apply the same norms across diverse populations without accounting for culture and language variations will result in detrimental ethical dilemmas, such as misdiagnosis of clinical conditions and inaccurate interpretations of research outcomes. Given the lack of normative data for ethnically and linguistically diverse communities, it is often challenging to merge data across diverse populations to investigate research questions of global significance. Methodological Considerations: We highlight some of the inherent challenges, limitations, and opportunities for efforts to harmonize cross-cultural neuropsychological data. We also explore some of the cultural factors that should be considered when attempting to harmonize cross-cultural neuropsychological data, sources of variance that should be accounted for in data analyses, and the need to identify evaluative criteria for interpreting data outcomes of cross-cultural harmonization approaches. Conclusion: In the future, it will be important to further solidify principles for aggregating data across diverse cultural and linguistic cohorts, validate whether assumptions are being satisfied regarding the relationship between neuropsychological measures and the brain and/or behavior of individuals from diverse cultural and linguistic backgrounds, as well as methods for evaluating relative successful validation for data harmonization efforts.

Risky decision-making is a common, heritable endophenotype seen across many psychiatric disorders. Its underlying genetic architecture is incompletely explored. We examined behavior in the Balloon Analogue Risk Task (BART), which tests risky decision-making, in two independent samples of European ancestry. One sample ( n = 1138) comprised healthy participants and some psychiatric patients (53 schizophrenia, 42 bipolar disorder, 47 ADHD); the other ( n = 911) excluded for recent treatment of various psychiatric disorders but not ADHD. Participants provided DNA and performed the BART, indexed by mean adjusted pumps. We constructed a polygenic risk score (PRS) for discovery in each dataset and tested it in the other as replication. Subsequently, a genome-wide MEGA-analysis, combining both samples, tested genetic correlation with risk-taking self-report in the UK Biobank sample and psychiatric phenotypes characterized by risk-taking (ADHD, Bipolar Disorder, Alcohol Use Disorder, prior cannabis use) in the Psychiatric Genomics Consortium. The PRS for BART performance in one dataset predicted task performance in the replication sample ( r = 0.13, p = 0.000012, pFDR = 0.000052), as did the reciprocal analysis ( r = 0.09, p = 0.0083, pFDR=0.04). Excluding participants with psychiatric diagnoses produced similar results. The MEGA-GWAS identified a single SNP (rs12023073; p = 3.24 × 10 −8 ) near IGSF21 , a protein involved in inhibitory brain synapses; replication samples are needed to validate this result. A PRS for self-reported cannabis use ( p = 0.00047, pFDR = 0.0053), but not self-reported risk-taking or psychiatric disorder status, predicted behavior on the BART in our MEGA-GWAS sample. The findings reveal polygenic architecture of risky decision-making as measured by the BART and highlight its overlap with cannabis use.

: Repetitive Transcranial Magnetic Stimulation (rTMS) shows promise for treating sequelae of traumatic brain injury (TBI) including headache and depression. The few studies examining rTMS for cognitive recovery after TBI have reported mixed outcomes. The role of rTMS in cognitive recovery remains unclear. : A 23-year-old woman with persistent executive dysfunction after severe TBI primarily affecting the right prefrontal region underwent 19 sessions of rTMS treatment (2,000 pulses of 1 Hz stimulation delivered to right dorsolateral prefrontal cortex [DLPFC]) 12 months after the injury while continuing cognitive rehabilitation. Response to treatment was evaluated using neuropsychological testing, EEG, and rehabilitation assessments. Significant improvements were observed in basic attention, working memory, processing speed, and executive function. EEG changes were consistent with suppression of pathologic and enhancement of normal neurophysiologic activity in the prefrontal regions. The patient made significantly more progress in rehabilitation in the six months following conclusion of rTMS treatment. : This case demonstrates that low frequency rTMS delivered to right DLPFC can produce significant changes in oscillatory activity and in basic attention, working memory, and executive functioning after TBI, and may enhance rehabilitation outcomes. This case further demonstrates that neuropsychological testing and EEG may be employed to guide rTMS treatment of cognitive deficits following TBI.