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Growing Up With Dyslexia: Cognitive And Psychos... 'LINK'

The most common core difficulty in developmental reading problems such as dyslexia is a problem with phonological processing. Children with phonological processing difficulties struggle to manipulate parts of oral and written language, including identifying and segmenting the individual sounds and blends within words. Children who struggle to read fluently often have difficulty with rapidly naming letters and objects. Developmental reading problems, however, may occur in the context of other core cognitive problems. Psycho-educational testing, therefore, is essential to determining how to remediate developmental reading problems for an individual student.

Growing up with Dyslexia: Cognitive and Psychos...

The leading author of the study Dr. Isabel Morales-Muñoz, from the University of Birmingham's Institute for Mental Health and the Finnish Institute for Mental Health, in Helsinki, commented: "Our study highlights the potential impact of childhood cognitive deficits on young people's mental health, suggesting specific associations with certain conditions. Prevention strategies focussed on easing these specific cognitive issues could help to reduce the likelihood of such children developing linked mental health problems in adolescence and early adulthood."

Neuropsychological testing is used in persons with documented changes in cognitive function to differentiate neurologic diseases (i.e., one of the types of dementia) or injuries (e.g., traumatic brain injury, stroke) from depressive disorders or other psychiatric conditions (e.g., psychosis, schizophrenia) when the diagnosis is uncertain after complete neurological examination, mental status examination, and other neurodiagnostic studies (e.g., CT scanning, MR imaging). The clinician presented with complaints of memory impairment or slowness in thinking in a patient who is depressed or paranoid may be unsure of the possible contribution of neurological changes to the clinical picture. Neuropsychological testing may be particularly helpful when the findings of the neurological examination and ancillary procedures are either negative or equivocal. The differential diagnosis of incipient dementia from depression is a casein point, particularly when computed tomography (CT) fails to yield definitive results.

Neuropsychological testing may be indicated in persons with epilepsy or hydrocephalus. Neuropsychological testing is used in these patients to monitor the efficacy and possible cognitive side effects of drug therapy (e.g., new anti-convulsant drug therapy) by comparing baseline performance with subsequent testing performance. Neuropsychological testing is also used to assess post-surgical changes in cognitive functioning to guide further treatment services. Preferably, these tests should be administered by a certified psychologist trained to conceptualize the neuro-anatomical and the neuro-behavioral implications of the diagnostic entities under consideration and who is capable of interpreting patterns of test scores in view of principles of lateralization and localization of cerebral function.

Neuropsychological testing is used for initial evaluation of cognitive deterioration associated with acquired immunedeficiency syndrome (AIDS), and for re-evaluation of persons with AIDS who show further deterioration, to distinguish between organic-based deterioration and deterioration from depression of chonic illness, in order to direct appropriate treatment.

Psychological and neuropsychological testing has been used to assess of the neurotoxic effects of alcohol and/or drug abuse or dependence. Chronic alcohol abuse can result in cognitive and memory defects which resolve to a varying degree depending on the duration of abstinence and the extent of neuronal loss or atrophy. However, it is inappropriate to perform psychological and neuropsychological testing in a patient to assess the neurotoxic effects of alcohol or drug abuse or dependence during the detoxification period or within the early period of abstinence from the offending drug. The results of psychological and neuropsychological assessment are unreliable when an individual is actively abusing alcohol or drugs and for some period of time after the acute phase of alcohol or drug withdrawal.

Psychological and neuropsychological testing has been used in the educational context in children with suspicion of a learning disorder leading to changes in school performance, so as to differentiate between mental subnormality, emotional disturbance, and the specific learning disabilities in speech and reading (e.g., dyslexia). Psychological and neuropsychological testing are also used to develop a specialized treatment plan to help the child improve the performance of these cognitive functions leading to a better performance in school, work, and personal relationships. However, psychological and neuropsychological testing for educational reasons is not covered, as standard Aetna benefit plans exclude educational testing. In addition, psychological and neuropsychological testing performed for educational reasons is not considered treatment of disease. This testing is usually provided by school systems under applicable state and federal rules.

While neuropsychological testing may be useful to distinguish cognitive decline due to dementia from cognitive decline due to depression, its use in patients with chronic fatigue syndrome (CFS) has yet to be established. Current evidence-based guidelines on chronic fatigue syndrome include no recommendation for neuropsychological testing in CFS.

Michiels and Cluydts (2001) reviewed the current status of neurocognitive studies in patients with CFS. The authors concluded that the current research shows that slowed processing speed, impaired working memory and poor learning of information are the most prominent features of cognitive dysfunctioning in patients with CFS. Furthermore, to this date no specific pattern of cerebral abnormalities has been found that uniquely characterizes CFS patients. There authors stated that there is no overwhelming evidence that fatigue is related to cognitive performance in CFS, and researchers agree that their performance on neuropsychological tasks is unlikely to be accounted solely by the severity of the depression and anxiety.

Claypoole et al (2007) noted that variable reports of neuropsychological deficits in patients with CFS may be partly attributable to methodological limitations. In this study, these researchers addressed these limitations by controlling for genetic and environmental influences and by assessing the effects of co-morbid depression and mode of illness onset. Specifically, these researchers performed a co-twin control study of 22 pairs of monozygotic twins, in which 1 twin met strict criteria for CFS and the co-twin was healthy. Twins underwent a structured psychiatric interview as well as comprehensive neuropsychological assessment evaluating 6 cognitive domains. Results indicated that twin groups had similar intellectual and visual memory functioning, but fatigued twins exhibited decreases in motor functions (p = 0.05), speed of information processing (p = 0.02), verbal memory (p = 0.02), and executive functioning (p = 0.01). Major depression did not affect neuropsychological functioning among fatigued twins, although twins with sudden illness onset demonstrated slowed information processing compared with those with gradual onset (p = 0.01). Sudden onset CFS was associated with reduced speed of information processing. If confirmed, these findings suggested the need to distinguish illness onset in future CFS studies and may have implications for treatment, cognitive rehabilitation, and disability determination.

Binder et al (2004) reviewed several illnesses that expressed somatically, but do not have clearly demonstrated pathophysiological origin and are associated with neuropsychological complaints. Among them are CFS, non-epileptic seizures, fibromyalgia, Persian Gulf War unexplained illnesses, toxic mold and sick building syndrome, and silicone breast implant disease. Some of these illnesses may be associated with objective cognitive abnormalities, but it is not likely that these abnormalities are caused by traditionally defined neurological disease. Instead, the cognitive abnormalities may be caused by a complex interaction between biological and psychological factors.

Gil-Gouveia and colleagues (2016) noted that evidence of attack-related cognitive dysfunction in migraine is growing. Controversy exists on whether cognitive dysfunction, mainly executive, may persist between attacks. Measuring the impact of cognitive function is gaining importance in clinical and research settings in migraine. These investigators compared the performance of inter-ictal migraine patients to controls in an assembled neuropsychological battery focused on executive functions and studied the practice effect of its repeated applications. Assembly of the battery that was then applied twice within 6 weeks to inter-ictal migraineurs and matched healthy controls. Migraine patients (n = 24) and controls (n = 24) had similar performance in both applications of the battery. There was a slight practice effect between the first and second evaluation, significant in Stroop Interference test (p = 0.002, multiplicity corrected); a meaningful score change was determined for each raw test scores. The authors concluded that inter-ictal migraineurs and controls performance was identical in a brief cognitive battery focused on executive functions; and repeated applications produced a practice effect that was quantified.

Wojcik and colleagues (2019) noted that the proliferation of computerized neuropsychological assessment devices (CNADs) for screening and monitoring cognitive impairment is increasing exponentially. Previous reviews of computerized tests for multiple sclerosis (MS) were primarily qualitative and did not rigorously compare CNADs on psychometric properties. These investigators systematically reviewed the literature on the use of CNADs in MS and identified test batteries and single tests with good evidence for reliability and validity. They search of 4 major online data-bases for publications related to computerized testing and MS. Test-retest reliability and validity coefficients and effect sizes were recorded for each CNAD test, along with administration characteristics. These researchers identified 11 batteries and 33 individual tests from 120 peer-reviewed articles meeting the inclusion criteria. CNADs with the strongest psychometric support include the CogState Brief Battery, Cognitive Drug Research Battery, NeuroTrax, CNS-Vital Signs, and computer-based administrations of the Symbol Digit Modalities Test. The authors identified several CNADs that are valid to screen for MS-related cognitive impairment, or to supplement full, conventional neuropsychological assessment. The necessity of testing with a technician, and in a controlled clinic/laboratory environment, remains uncertain. They opined that CNADs are quite good at measuring cognitive processing speed in MS, and their sensitivity and validity in other domains merit further investigation. The authors concluded that several computerized tests of cognition are available and applied in MS research. As they currently stand, most CNAD batteries and individual tests do not yet demonstrate adequate reliability and validity to supplant well-established conventional neuropsychological procedures such as MS Cognitive Endpoints battery (MS-COG), BICAMS (Brief International Cognitive Assessment for MS), or MACFIMS (Minimal Assessment of Cognitive Function in MS). However, some tests (e.g., certain subtests of the CDR, CBB, NeuroTrax, CNSVS, C-SDMT, PST, and CSCT) possess psychometric qualities that approach or maybe even exceed conventional, person-administered tests and can serve as useful screening tools or supplements to full assessments. Further investigations of these CNADs, especially as they relate to ecological measures and patient-relevant outcomes, are needed before widespread implementation with an MS population. 041b061a72

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