OBJECTIVE:Hospitalized people with Parkinson's disease (PwP) face increased risks of medication errors and discharge to non-home settings, both of which are associated with adverse outcomes. This study assessed differences in medication error rates and discharge outcomes before and after implementation of a dedicated inpatient program for hospitalized PwP. METHODS:During 2023, a Parkinson's disease (PD) inpatient program was implemented and refined combining: (1) an electronic health record (EHR) census for identification of hospitalized PwP; (2) inpatient monitoring and alignment of inpatient and outpatient regimens by movement-disorders-trained advanced practitioners; (3) customized EHR alerts and levodopa orders; (4) pharmacist support, and (5) staff education. Medication error rates and clinical outcomes were compared between January and June 2024 (post-implementation phase) and a pre-implementation retrospective cohort from 2018. RESULTS:From January to June 2024, 366 post-implementation admissions were monitored. Among those receiving contraindicated medications, the median number of doses decreased from 2 (interquartile range [IQR] = 1-6) during pre-implementation to 1 (IQR: 1-2) post-implementation (p = 0.015). Days with a levodopa dose deviation decreased from 43.1% to 38.3%, p < 0.0001, improper levodopa formulation substitutions from 18.6% to 5%, p < 0.0001, timing deviations from 72.2% to 51.8%, p < 0.00001, missed doses from 21.5% to 16.8%, p = 0.013, and discharged to non-home settings from 44.8% to 38.3%, p = 0.038. INTERPRETATION:Following implementation of a multidisciplinary and proactive inpatient program, reductions in medication errors and improved discharge outcomes were observed among PwP. ANN NEUROL 2026.

Objective: Despite significant progress in understanding the factors influencing cognitive function in Parkinson's disease (PD), there is a notable gap in data representation for the Latinx population. This study aims to evaluate the contributors to and disparities in cognitive performance among Latinx patients with PD. Methods: A retrospective analysis was conducted based on cross-sectional data encompassing demographic, environmental, motor, and non-motor disease characteristics from the Latin American Research Consortium on the Genetics of PD (LARGE-PD) and the Parkinson's Progression Markers Initiative (PPMI) cohorts. Linear regression multivariable models were applied to identify variables affecting Montreal Cognitive Assessment (MoCA) scores, accounting for age, sex, and years of education. Results: The analysis comprised of 3,054 PD patients (2,041 from LARGE-PD and 1,013 from PPMI) and 1,303 Latinx-controls. Latinx-PD patients (mean age 63.0 ± 11.8, 56.8% male) exhibited a significantly lower average MoCA score (p < .001) compared to white Non-Hispanic PD patients from PPMI (mean age 67.5 ± 9.9, 61.7% male). This difference persisted when comparing the Latinx-PD to the Latinx-controls (mean age 58.7 ± 9.3, 33.2% male; p < .001). Factors significantly associated with better MoCA scores in Latinx-PD included unilateral symptom onset (p = .009), and higher educational attainment (p < .001). Conversely, those associated with worse scores included the use of dopamine agonists (p = .01), previous tobacco use (p = .01), older age (p < .001), and a higher Hoehn and Yahr scale score (p < .001). Conclusions: Latinx-PD patients demonstrated significantly lower cognitive scores compared to their white non-Hispanic PD counterparts and Latinx-controls. These results highlight the importance of interpreting MoCA scores in a nuanced manner within diverse populations.

OBJECTIVE:Between May 2021 and January 2022, the American Psychological Association (APA) Division 40: Society for Clinical Neuropsychology's (SCN) Strategic Planning Committee conducted multiple methods of data collection to inform the development of an organizational strategic plan. METHODS:Professional consultants conducted semi-structured interviews with members of the SCN Executive Committee (EC) and targeted focus groups in May and June 2021. SCN members and non-member neuropsychology interested parties were surveyed between October 2021 and January 2022 about their perspectives of 1) membership satisfaction, 2) the historical and current strengths and weaknesses of the SCN, 3) equity, diversity, and inclusion (EDI) within the SCN and clinical neuropsychology, 4) current and potential membership benefits, 5) professional challenges and difficulties facing the specialty, and 6) areas that the SCN should prioritize when investing its resources. RESULTS:Seven and five major themes were identified from the EC interviews and focus groups, respectively. These themes overlapped with data from the strategic planning survey, which was completed by nearly 700 people with diverse professional and personal identities. Overall, the data indicated high membership satisfaction and a desire for the SCN to strengthen its professional advocacy, better leverage its relationship with the APA, infuse EDI throughout the organization, and enhance member benefits and professional development opportunities across the career span. CONCLUSIONS:Member satisfaction with the SCN is high. Members and non-members believe that the SCN should expend its resources to bolster its professional advocacy and EDI efforts, thereby increasing its value proposition, long-term viability, and value to society.

Traditional neuropsychology training models in the United States and other Westernized countries rely on structured graduate programs, clinical experiences, and postdoctoral fellowships. However, access to neuropsychology education is often inequitable, hindered by limited coursework availability, geographic barriers to learning and practice opportunities, and systemic disparities affecting underrepresented groups. The COVID-19 pandemic further exposed these gaps, disrupting in-person clinical training and educational opportunities. KnowNeuropsychology was established in response to these challenges in 2020, with the goal of providing freely accessible virtual neuropsychology lectures to an international audience. Although KnowNeuropsychology was initially launched as a 12-week webinar series to address training disruptions caused by the pandemic, it has evolved into a nonprofit organization offering over 100 high-quality didactics on diverse clinical and research topics in neuropsychology, including clinical disorders, cultural diversity (among other aspects), neuroanatomy, and professional development. KnowNeuropsychology prioritizes diversity, equity, and inclusion by amplifying voices from underrepresented groups, students, and early career professionals and ensuring accessible, culturally relevant content. The platform has achieved a global reach by leveraging virtual tools and addressing training gaps in low- and middle-income countries and underserved regions. Lessons learned from KnowNeuropsychology underscore the potential of digital tools to expand access to neuropsychology education and inform systemic changes, aligning with updated training guidelines to increase equity and inclusion in the field.

OBJECTIVES:To examine differences between demographic and cultural identity group responses on the Society for Clinical Neuropsychology's (SCN) Strategic Planning Survey. METHODS:Respondents were grouped into self-identified demographic and cultural identity groups. Descriptive statistics were used to summarize responses to demographic and survey data. We used Chi-square and Fisher's Exact tests to compare group differences. Adjusted residuals were calculated for post-hoc testing, when appropriate. RESULTS:Membership satisfaction was high across groups. Respondents who identified as persons of color, women, with a disability, or students/trainees were more likely to indicate that the SCN could better represent them by increasing diversity and inclusion efforts. Persons of color and other historically marginalized/minoritized groups viewed the SCN's equity, diversity, and inclusion (EDI) efforts as less successful than comparative groups, but they expressed more optimism that initiatives could increase the engagement of persons of color in the SCN. Respondents earlier in their career and from marginalized/minoritized groups more frequently viewed the lack of diversity in clinical neuropsychology as an important issue facing the specialty and the desire for the SCN to prioritize improving EDI within clinical neuropsychology. Women and earlier career respondents were more likely to indicate that the SCN should focus efforts on increasing clinical neuropsychology's value to society. CONCLUSIONS:Respondents earlier in their careers and from marginalized/minoritized groups were more likely to identify EDI related issues as significant to the SCN and specialty, and a desire for the SCN to prioritize efforts to improve EDI.

OBJECTIVE:To assess the reliability and diagnostic validity of in-home tele-neuropsychological testing (in-home tele-npt) in individuals with Parkinson's disease (PD). METHOD:We randomized 79 individuals with PD to in-person npt or in-home tele-npt at Baseline, and again to the same or crossover group for Week 4 testing. We assessed group differences in mean test scores using ANOVAs with Dunnett's t-tests. Test-retest reliability was assessed using intraclass correlation coefficients and Pearson correlations and compared across groups using 95% confidence intervals and z-tests with Fisher's z transformations. We compared the percentage of participants exceeding each test's standardized regression-based index across groups. We examined diagnostic validity by comparing group differences in cognitive classifications using Pearson's Chi-square test and Fisher's Exact test. RESULTS:For most tests, the mean scores between in-home tele-npt and in-person npt were not significantly different. In-home tele-npt had weaker Baseline processing speed scores. The test-retest reliability was similar between the repeated tele-npt and repeated in-person npt groups in most tests. The crossover groups had weaker test-retest reliability in processing speed, verbal fluency, and memory tests. The percentage of significant change scores varied between groups and across tests. The percentage of participants classified as cognitively impaired, and the agreement of cognitive classification between testing sessions, were not significantly different between groups. CONCLUSIONS:With few exceptions, in-home tele-npt and in-person tele-npt yield similar scores. Test-retest reliability is better when the testing paradigm is held constant. There are no significant differences in cognitive diagnostic classification rates between testing paradigms in individuals with PD.

Objective: This paper is the first in a series of three that describe the context, rationale, and results of the American Psychological Association's Division 40: Society for Clinical Neuropsychology's (SCN) strategic planning initiative. Methods: In this paper, we provide a review of the SCN's history, including previous organizational changes and strategic planning efforts, and discuss the rationale for undertaking the current strategic planning process. We discuss the development and work of the SCN Strategic Planning Committees (SPCs) and their multi-method approach to assessing the SCN's strengths and weaknesses, the needs and preferred organizational priorities of membership, and opportunities for improving organizational inclusivity and member benefits. We discuss how the results of extensive qualitative and quantitative data collection methods were used to develop the SCN 2023 Strategic Plan and guide organizational changes. Results: The SCN 2023 Strategic Plan was approved by the SCN Executive Committee in 2023. It includes six guiding principles, three operating principles, five strategic priorities, and specific organizational objectives. Based on the data collected, the plan includes a focus on strengthening professional advocacy and equity, justice, and inclusion within the SCN, increasing organizational effectiveness, and improving the SCN's membership value proposition. To align the SCN with the strategic plan, subsequent implementation efforts include changes to the SCN Bylaws, policies and procedures, and organizational structure. Conclusions: The SCN 2023 Strategic Plan operationalizes the values, strategies priorities, and objectives of the organization, and in doing so, enhances the SCN's capacity to optimize its value to members and societal impact.

Background Parkinson's disease psychosis (PDPsy) is associated with increased nursing home placement and mortality and is closely linked with cognitive dysfunction. Objective Assess the clinical and cognitive features associated with PDPsy in patients without dementia. Methods We prospectively recruited people with Parkinson's disease (PwP) without dementia for a 3-year, longitudinal study at an outpatient movement disorders clinic. Participants completed annual visits involving assessment of motor and non-motor symptoms including neuropsychological testing. PDPsy was defined as the recurring presence of visual illusions, sense of presence, hallucinations, or delusions for at least 1 month. Using generalized estimating equations, we conducted two sets of analyses to separately assess the clinical and the cognitive predictors of PDPsy. Results We enrolled 105 participants. At baseline, mean age was 67.8 (SD = 8.0), median disease duration was 4.9 years (IQR: 3.4-7.7), and mean MoCA was 24.8 (SD = 2.3). Prevalence of PDPsy increased over 3 years from 31% (n = 32) to 39% (n = 26). Forty-five participants (43%) experienced PDPsy. Visual illusions were most common (70%, n = 84), followed by hallucinations (58.3%, n = 70). In multivariate analysis, of the clinical variables, only depressive symptoms [OR 1.09, 95% CI: (1.03, 1.16), p = 0.004] increased the odds of PDPsy; of the cognitive variables, only Trail Making Test B-A scores [OR 1.43, 95% CI: (1.06, 1.93), p = 0.018] significantly increased the odds of PDPsy. Conclusions In PwP without dementia, depressive symptoms were associated with increased risk of PDPsy. Executive/attentional dysfunction was also associated with PDPsy and may mark the transition from isolated minor hallucinations to more complex psychotic symptoms.

OBJECTIVE:The primary aim of this paper is to review evidence and clinical implications related to lifestyle activities associated with promoting brain and cognitive health. Our review targets four key lifestyle factors: physical activity and exercise, social engagement, cognitively stimulating activity, and consuming Mediterranean-style diets.METHOD:We conducted a critical review of the lifestyle factor literature in the four domains listed earlier. We contextualize this literature review by translating findings, when possible, into evidence-based recommendations to consider when providing neuropsychological services.RESULTS:There is significant current evidence supporting the role of physical activity and exercise, social engagement, cognitively stimulating activity, and consuming Mediterranean-style diets on positive brain and cognitive health outcomes. While some null findings are present in all four areas reviewed, the weight of the evidence supports the notion that engaging in these activities may promote brain and cognitive functioning.CONCLUSIONS:Clinical neuropsychologists can have confidence in recommending engagement in physical activity, social activity, and cognitively stimulating activity, and adhering to a Mediterranean-style diet to promote brain and cognitive health. We discuss limitations in existing lifestyle factor research and future directions to enhance the existing evidence base, including additional research with historically underrepresented groups and individuals with neurological conditions.

ObjectiveFeedback on neuropsychological assessment is a critical part of clinical practice, but there are few empirical papers on neuropsychological feedback practices. We sought to fill this gap in the literature by surveying practicing neuropsychologists in the United States. Questions addressed how they provide verbal and written feedback to patients and referral sources. Survey questions also addressed billing practices and training in the provision of feedback.MethodsA survey was developed using Qualtrics XM to survey currently licensed, independently practicing clinical neuropsychologists in the United States about their feedback practices. The survey was completed by 184 individuals.ResultsNearly all respondents reported that they provide verbal feedback to patients, most often in-person, within three weeks following testing. Typically, verbal feedback sessions with patients last 45 min. Verbal feedback was provided to referrals by about half of our sample, typically via a brief phone call. Most participants also reported providing written feedback to both the patient and referring provider, most commonly via the written report within three weeks after testing. Regarding billing, most respondents use neuropsychological testing evaluation codes. The COVID-19 pandemic appeared to have had a limited impact on the perceived effectiveness and quality of verbal feedback sessions. Finally, respondents reported that across major stages of professional development, training in the provision of feedback gradually increased but was considered inadequate by many participants.ConclusionsResults provide an empirical summary of the "state of current practice" for providing neuropsychological assessment feedback. Further experimental research is needed to develop an evidence-base for effective feedback practices.

OBJECTIVE:The primary aim of this paper is to accelerate the number of randomized experimental studies of the reliability and validity in-home tele-neuropsychological testing (tele-np-t).METHOD:We conducted a critical review of the tele-neuropsychology literature. We discuss this research in the context of the United States' public and private healthcare payer systems, including the Centers for Medicare & Medicaid Services (CMS) and Current Procedural Terminology (CPT) coding system's telehealth lists, and existing disparities in healthcare access.RESULTS:The number of tele-np publications has been stagnant since the onset of the COVID-19 pandemic. There are less published experimental studies of tele-neuropsychology (tele-np), and particularly in-home tele-np-t, than other tele-np publications. There is strong foundational evidence of the acceptability, feasibility, and reliability of tele-np-t, but relatively few studies of the reliability and validity of in-home tele-np-t using randomization methodology.CONCLUSIONS:More studies of the reliability and validity of in-home tele-np-t using randomization methodology are necessary to support inclusion of tele-np-t codes on the CMS and CPT telehealth lists, and subsequently, the integration and delivery of in-home tele-np-t services across providers and institutions. These actions are needed to maintain equitable reimbursement of in-home tele-np-t services and address the widespread disparities in healthcare access.

Background: The complexity of antiparkinsonian medications makes patients vulnerable to medication de-viations. This study examines the frequency and outcomes of deviations between outpatient and inpatient medication administrations in patients with Parkinson's disease (PD). Methods: We included hospital admissions of patients with PD during a 12-month period at the Cleveland Clinic Main and Fairview campuses. Outpatient regimens were compared with hospital medication administration records to establish rates of deviations in terms of levodopa equivalent daily dose (LEDD) difference, timing deviations/omissions of time-critical medications, substitution of levodopa compounds, and administration of antidopaminergic medications. Logistic regression analyses were used to investigate associations with length of stay (LOS), readmission rates, and mortality. Results: The study included 492 patients with 725 admissions. Of those on time-critical medications, 43% had a LEDD deviation and 19% had levodopa formulation substitutions. Of the admission days with known outpatient timing regimens, 47% had an average deviation of more than 30 min and 22% had at least one missed levodopa dose. LOS was longer with each additional day of over-dose (4%), under-dose (14%), missed dose (21%), timing deviation (15%) and substitution (19%), (all p < 0.0001). Administration of antidopaminergic medications (9.9% of admissions) was associated with increased 30-day readmission/death (OR 1.85, p = 0.041), 90-day mortality (OR 2.2, p = 0.018), and LOS (7.6 vs. 3.8 days, p < 0.0001). LEDD underdose was associated with 30-day readmission/death (OR 1.78, p = 0.025) and 90-day mortality (OR 1.14, CI 1.05-1.24, p = 0.002). Conclusions: Deviations between outpatient and hospital regimens, and administration of antidopaminergic medications, were associated with poor outcomes.

Objective The aims of this study were twofold. First, we examined the relationship between patient and caregiver ratings of neuropsychiatric symptoms in Parkinson’s disease (PD). Second, we examined if the severity of depressive symptoms affects patient and caregiver perceptions of other neuropsychiatric symptoms and contributes to discrepancies between their perceptions.Method We examined data from a retrospective clinical cohort of 209 patients with PD and their caregivers. We used intra-class correlation coefficients and the Bland Altman method to assess intra-respondent (retrospective versus current) and inter-respondent (patient versus caregiver) agreement between Frontal Systems Behavior Scales (FrSBe) subscale scores. We then used generalized estimating equation models to examine FrSBe subscale scores and the magnitude of the intra- and inter-respondent discrepancies in FrSBe subscale scores, as a function of Beck Depression Inventory-2nd Edition scores, with patient demographic variable adjustments.Results There was low agreement between patient and caregiver ratings on all three subscales, at both time points, and high response variability within and between raters. Patients generally reported more severe neuropsychiatric symptoms than caregivers. Depression severity predicted patients’ perceptions at both time points, but was more strongly associated with current perceptions. Depression severity predicted caregivers’ current perceptions only. The inter-respondent discrepancy in perceived apathy and disinhibition, but not executive dysfunction, increased as a function of depression severity.Conclusions There are differences in how patients with PD and caregivers perceive neuropsychiatric behaviors and the extent to which depressive symptoms influence their perceptions. Shared neuropathology and negative response biases likely contribute to these relationships.

Objective: The generation and maintenance of goal-directed behavior is subserved by multiple brain regions that receive cholinergic inputs from the cholinergic nucleus 4 (Ch4). It is unknown if Ch4 degeneration contributes to apathy in Parkinson's disease (PD). Method: We analyzed data from 106 pre-surgical patients with PD who had brain MRIs and completed the Frontal Systems Behavior Scales (FrSBe). Eighty-eight patients also completed the Beck Depression Inventory-2nd Edition. Cholinergic basal forebrain grey matter densities (GMD) were measured by applying probabilistic maps to T1 MPRAGE sequences processed using voxel-based morphometry methods. We used linear and hierarchical regression modelling to examine the association between Ch4 GMD and the FrSBe Apathy subscale scores. We used similar methods to assess the specificity of this association and potential associations between Ch4 target regions and apathy. Results: Ch4 GMD (p = .021) and Ch123 GMD (p = .032) were significantly associated with Apathy subscale scores on univariate analysis. Ch4 GMD, but not Ch123 GMD, remained significantly associated with apathy when adjusting for age, sex, levodopa equivalent doses, and disease duration. Centromedial amygdala GMD, which receives cholinergic inputs from Ch4, was also associated with apathy. Ch4 GMD was not associated with depression or disinhibition, nor was it associated with executive dysfunction when adjusting for clinical and demographic variables. Conclusions: Ch4 GMD is specifically associated with apathy in PD. Ch4 degeneration results in cholinergic denervation of multiple cortical and limbic regions, which may contribute to the cognitive and emotional-affective processing deficits that underlie the behavioral symptoms of apathy.

as many professional development and networking opportunities.