bluuebunny/crossref_metadata_2025_split huggingface dataset:
A - 77 Case Study of Bilateral Thalamic Infarction with Persistent Cognitive and Behavioral Symptoms
Authors: Matyi Joshua , O'Hara John , Castellon Marco Gonzalez , Phatak Vaishali 
Published: October 2023

Abstract

Objective
Bilateral thalamic infarction due to artery of Percheron (AOP) occlusion is rare (0.01–2% of all ischemic strokes) and neuropsychological sequelae are not well-defined. We present the case of a 50-year-old, right-handed, Caucasian woman, with 12 years of education, who presented with cognitive and behavioral symptoms following AOP stroke.

Method
Following AOP stroke, the patient experienced seven-day hospitalization and one-month subacute rehabilitation. Symptoms after discharge from the latter included vertical gaze palsy, mild balance difficulties, impulsivity, and amnesia (retrograde and anterograde). Compared to neuroimaging five days after stroke, follow up imaging at three months revealed bilateral thalamic encephalomalacia (Figure 1), as well as small bilateral cerebellar infarcts. Neuropsychology was consulted six months post-stroke to evaluate persistent cognitive and emotional/behavioral symptoms.

Results
(Test results in Table 1). Test results demonstrated average estimated premorbid functioning, amnesia (anterograde and retrograde) and executive dysfunction (including emotional lability, stimulus bound behaviors), which interfered with performances on processing speed and verbal fluency tasks. Attention, working memory, and core language/visuospatial skills were spared. These symptoms contributed to difficulty navigating/exacerbation of psychosocial stress and necessitated external support for daily functions. Neuropsychological evaluation data were used to identify strategies to optimize patient coping and reduce caregiver burnout. At 16-months post-stroke, persistent amnesia and reduced emotional lability were reported by her family.

Conclusions
This case highlights the presence and need to characterize cognitive and behavioral deficits following bilateral thalamic infarction. Additionally, this case demonstrates the role of neuropsychology in characterization of cognitive and neuropsychiatric sequelae, including identification of relevant interventions/recommendations to inform treatment planning.
A - 80 The Role of Adverse Childhood Events and Personality Traits Among Individuals with Functional Neurological Symptom Disorder (FND).
Authors: Carns Danielle , Orr Stephen , Jain Rishabh , Israel Alex , Rupert Petra 
Published: October 2023

Abstract

Objective
There is an established link between early life trauma and avoidant and anxious attachment in patients with FND.1,2,3 These attachment styles are linked to histrionic (HPD), avoidant (APD), borderline (BPD), and dependent personality disorders (DPD)0.5 The current study seeks to explore the relationship between adverse childhood experiences and personality characteristics among individuals diagnosed with FND.

Methods
A retrospective analysis of patients diagnosed with FND who completed neuropsychological evaluation was conducted. The outcome measures include the Adverse Childhood Experiences Scale (ACES) and Minnesota Multiphasic Personality Inventory, 3rd Edition (MMPI-3). Composite scores for the ACES and BPD, HPD, APD, and DPD were obtained by calculating equally weighted sum of predetermined component scores on the MMPI-3 based on the DSM-5.6 Spearman correlations were calculated to determine the association between ACES and PD composites.

Results
Analysis was conducted with 21 patients, 86% were female, 71% identified as white, and mean sample age was 41.59 years (SD = 12.48). 57.14% had elevated ACES score. Mean composite PD scores were BPD – 55.97 (SD = 7.58), HPD – 53.93 (SD = 9.17), APD – 59.26 (SD = 9.71), and DPD – 59.75 (SD = 10.80). The correlations were positive and statistically significant (p &lt; =0.05) across all four PD for ACES Q1 (emotional abuse) and Q4 (unsupportive environment).

Conclusions
The results highlight that the ACES can be beneficial in identifying patients with FND who may have, or are at risk, of developing PD. These results also provide targets for treatment including maladaptive attachment styles.
A - 82 Perceived Social Support Is Associated with Cognition but Not Physical Functioning in Older Adults with and without Multiple Sclerosis
Authors: Cohen Hannah R , Holtzer Roee 
Published: October 2023

Abstract

Objective
To examine the association between perceived social support, cognition, and physical functioning in older adults with and without Multiple Sclerosis (MS).

Method
Participants were dementia-free older adults with MS (N = 89; M age = 64.75, SD + 4.25 years; 66.3% female) and community-residing older adults (N = 102; M age = 68.74, SD + 7.12 years; 62.7% female). The medical outcomes study modified social support survey (MSSS), oral symbol digit modalities test (SDMT) and timed-25-foot-walk-test (T25FW) served as outcome measures. Linear regressions stratified by group status assessed the associations between PSS, cognition, and physical functioning.

Results
Higher total MSSS scores were associated with higher SDMT scores in the MS group (β = 0.24, p = 0.02) and in the control group (β = 0.26, p = 0.005). Positive social interaction (β = 0.27, p = 0.011) was associated with SDMT performance in the MS group. Emotional/informational support (β = 0.27, p = 0.003) and positive social interaction (β = 0.25, p = 0.007) were associated with SDMT performance in the control group. Depression scores attenuated associations between perceived social support and SDMT performance in the MS group (p &gt; 0.05) but not the control group. In contrast, higher MSSS scores were not associated with higher T25FW scores in either group.

Conclusions
Among older adults with and without MS, perceived social support was associated with cognition but not physical functioning. Depressive symptoms attenuated associations between perceived social support and cognition in the MS group only.
A - 85 Neuropsychological and Cultural Elements in the Assessment of Competency to Stand Trial
Authors: O'Connell Olivia , O'Connell Michael 
Published: October 2023

Abstract

Objective
Research has highlighted how key cognitive functions underlie abilities within the construct of Competency to Stand Trial (CST). This case study examines the impacts of Mild Neurocognitive Disorder and culture on a physician found incompetent to stand trial.

Method
A 62-year-old African-born male physician charged with Health Fraud who was referred for an examination of his CST. His attorneys raised concerns about his rational understanding of the proceedings and his ability to collaborate constructively with them. The client underwent comprehensive forensic, neuropsychological and neurological assessment.

Results
Neuropsychological testing revealed low-average intellectual abilities which likely reflected a decline from estimated premorbid levels. Contrary to expected performance given cultural factors, nonverbal intellectual abilities were markedly lower than verbal intellectual abilities. Compromises in multiple domains of cognition including memory were also noted. A referral to neurology revealed moderate atrophy and a mass in the right temporal fossa, in line with a diagnosis of Mild Neurocognitive Disorder with Multiple Etiologies. A causal connection between his cognitive deficits (e.g., compromised reasoning) and competence-relevant abilities (e.g., capacity to waive constitutional rights) was established. The subject was adjudicated incompetent to stand trial and, largely due to neurologic findings, unlikely to attain competency (i.e., non-restorable).

Conclusions
This study demonstrates the value of neuropsychological assessment in both the clinical recognition of brain pathology and cognitive dysfunction in the setting of complex legal and cultural issues. Guidelines to address complex competency cases that warrant comprehensive assessment are needed.
A - 86 Using Virtual Reality Driving Simulation to Determine Cognitive Correlates of Turning Behaviors among Drivers with and without Multiple Sclerosis
Authors: Dheer Suhani , Ang Jocelyn , Devlin Kathryn , Schultheis Maria 
Published: October 2023

Abstract

Objective
This study uses a virtual reality driving simulator (VRDS) to 1) compare turning behavior between adults with or without MS; 2) identify cognitive correlates of turning behavior.

Method
64 community-dwelling adult drivers, including 38 people with MS (PwMS) and 26 healthy controls (HCs) (ages 21–60, 78% women, 69% White), completed neuropsychological and VRDS assessments. Key VRDS turning variables were lane position, speed, acceleration, and braking. Cross-sectional analyses included 1) analysis of variance and chi-square tests; 2) Pearson and Spearman’s correlations.

Results
HCs took sharper left turns than PwMS (p &lt; 0.05, η2 = 0.08). There were no other between-group differences. Weaker visuospatial functioning [r = −0.301, 95% CI = (−0.512,-0.050), p = 0.018], and slower gait [r = 0.0328, CI = (0.063,0.55), p = 0.014], manual motor speed [r = 0.378, CI = (0.130,0.582), p = 0.03], and psychomotor speed [r = −0.334, CI = (−0.545,-0.077), p = 0.011] were associated with greater lane position variability. Greater relative acceleration before the turn was linked to worse performance in psychomotor speed [r = 0.397, CI = (0.148,0.593), p = 0.002], time-based working memory [r = 0.452, CI = (0.221,0.631), p &lt; 0.001], and visuoperceptual judgment time [r = −0.482, CI = (−0.660,-0.244), p &lt; 0.001]. Slower cognitive/motor speed and poorer visuospatial abilities/memory were associated with slower driving and more braking (all p &lt; 0.05).

Conclusion
Drivers with and without MS exhibited similar turning behavior, but PwMS were more cautious during left turns, possibly reflecting a compensatory strategy. Despite few group differences, several cognitive domains commonly affected by MS were associated with turning behaviors. Slower cognitive/motor speed and worse visuospatial abilities were associated with less smooth control of spatial position and less safe turn preparation, but slower driving. Future studies will include larger samples and other clinical populations and may inform clinical driving recommendations.
A - 87 A Neuropsychological Case Study of Primary Progressive Apraxia of Speech Versus Agrammatic Primary Progressive Aphasia
Authors: Erani Fareshte , Espinal Elizabeth , Minniti Nancy 
Published: October 2023

Abstract

Objective
Primary progressive apraxia of speech (PPAOS) is a lesser-known neurodegenerative disorder characterized by progressive speech production loss, affecting word articulation. Apraxic speech commonly occurs in primary progressive aphasias (PPAs) and as a result, is often misdiagnosed as agrammatic PPA (aPPA). The current case highlights the importance of neuropsychological evaluations and behavioral observations in delineating PPAOS from aPPA.

Method
The patient is a 71-year-old right-handed White female who presented with a 2-year history of language difficulties beginning with a lisp and progressing to an inability to produce words. MRI of the brain showed moderate white matter disease.

Results
Her neurocognitive profile was notable for primary deficits in expressive language, including oral/written production, verbal fluency, and repetition. Milder deficits were observed in aspects of executive functioning. Observed spontaneous speech was notable for impaired and effortful articulation with syllabically segmented prosodic speech patterns, some distortions and prosody alterations, and slow rate. All other cognitive domains were intact.

Conclusions
Patients with PPAOS and aPPA typically score in the impaired range on tests that depend on rate and accuracy of speech. Apraxia was her most salient feature reported and observed on testing. We did not find learning and memory difficulties, which are more common in aPPA. Moreover, she had trial-and-error articulatory attempts, groping, and distorted substitutions, which are more commonly seen in PPAOS. Her speech was also devoid of grammatical errors which is another distinguishing feature. While subtle and confounded by her alcohol use and orthopedic injuries, her profile altogether appeared most consistent with PPAOS.
A - 92 Neuropsychological Testing and Cognitive Outcomes in Autoimmune Encephalitis
Authors: Grezmak Tiffany , Swetlik Carol , Abbatemarco Justin , Kunchok Amy , Galioto Rachel 
Published: October 2023

Abstract

Objective
This review examines the use and outcomes of neuropsychological tests (NPT) in adults with autoimmune encephalitis (AE) with the objective of providing recommendations for NPT for clinical practice, observational research, and clinical trials.

Data Selection
PubMed search from inception to February 2023 yielded 8858 results which were screened for inclusion/exclusion criteria: ≥ one comprehensive NPT with comparison/normative reference value available of individual NPT scores, NPT reported within specific neuronal antibody group, English manuscript available, and sample size &gt;5 (no case reports). 24 were included and involved anti-NMDA-R (k = 11), anti-LGI-1(k = 9), anti-GABAB-R (k = 2), anti-GAD-65 (k = 4), and anti-CASPR2 (k = 2). Data extracted included neuronal antibody, follow up time, sample size, and NPT.

Data Synthesis
List learning, figural memory, digit span, processing speed, response inhibition and semantic fluency tasks were most commonly administered. Impairments were most common in attention/working memory, processing speed, aspects of executive functions and episodic (60–100%). Differences emerged between antibody groups. For example, list learning impairments were common in anti-LGI-1(100%) and anti-NMDA-R (87.5%) but less common in other groups, while 67% of anti-LGI-1 studies showed impaired phonemic fluency compared to 0% of anti-NMDA-R studies, while rates of semantic fluency impairment were similar between those two groups (50–60%). Other group differences will be discussed.

Conclusions
We outline the most commonly administered and most impaired NPT in AE patients. Differences appeared in cognitive outcomes between antibody groups. Further use of NPT may better characterize these antibody-specific differences and support inclusion of standardized measures for clinical trial outcomes.
A - 94 A Case of New Onset Refractory Status Epilepticus (NORSE) Associated with COVID-19
Authors: Hromas Gabrielle , Morgan Lola , Werry Amy 
Published: October 2023

Abstract

Objective
New Onset Refractory Status Epilepticus (NORSE) is a rare condition of prolonged medication-refractory seizures potentially due to elevated inflammatory molecules in the brain. NORSE can be triggered by a viral infection and is a documented neurologic consequence of COVID-19.

Method
A 74-year-old, left-handed, Hispanic male was in his usual state of health until experiencing 1–2 weeks of speech decline, which culminated in an episode of altered mental status (disorientation and mumbling speech). He presented to the Emergency Department with drowsiness and complaints of a “funny feeling” on the left side of his head. Upon arrival, he was found to be COVID-19 positive and hyperglycemic with normal CT, MRI, lumbar puncture, and bloodwork. An EEG showed “focal temporal activity” and he was diagnosed with non-convulsant status epilepticus. Hospitalization and medical sedation lasted 2 months followed by 8 months of inpatient rehabilitation. The patient was discharged shortly before presenting for neuropsychological evaluation.

Results
Neuropsychological evaluation showed weaknesses in learning and free recall, visuospatial skills (due to disorganization and poor attention to details), processing speed, and executive functioning. The patient reported elevated anxiety symptoms. Collateral report indicated severe declines in executive organizational abilities, as well as mild memory and divided attention declines.

Conclusions
Results suggest frontal cortical and subcortical impairments affecting multiple areas of cognition and functional decline consistent with a diagnosis of major neurocognitive disorder. Similar to the literature, status epilepticus was attributed to inflammatory meningoencephalitis triggered by the prior COVID-19 infection. Interdisciplinary care was an integral factor in this case.
A - 96 Advocacy for Neuropsychological Services in pre-Surgical fMRI Procedures for the Treatment of Patients with Brain Tumors
Authors: Kdeiss Bianca , McCuddy William Travis 
Published: October 2023

Abstract

Objective
Functional magnetic resonance imaging (fMRI) has become an essential tool in presurgical language and motor mapping for patients with brain tumors. Despite being theoretically well suited for delivering all aspects of a clinical fMRI service, a recent large survey found neuropsychologists were less likely to be involved than radiologists and MR technologists (Benjamin et al., 2018). This review aimed to explore the involvement of neuropsychologists in clinical fMRI.

Data Selection
A systematic review of articles published within the last decade was conducted using PubMed, ScienceDirect, and Google Scholar to identify literature addressing the role of neuropsychology in clinical fMRI with brain tumor populations. Boolean logic was employed to search key words: clinical fMRI, awake craniotomy or direct cortical stimulation, neuropsychology, presurgical, evaluation, and brain tumor. The search returned 1917 articles: We subsequently removed duplicates, gray literature, book chapters, and conference proceedings then searched abstracts and full text accordingly for mention of neuropsychology and fMRI. The final analysis included 33 articles.

Data Synthesis
The majority of articles did not mention involvement of neuropsychologists in the administration of neurofunctional tasks during fMRI (n = 22) while others mentioned alternate disciplines conducting the assessment (n = 2). Comparatively, traditional pre- (n = 14) and post-surgical (n = 11) neuropsychological testing services appear more commonly utilized. No specific barriers limiting the use of neuropsychologists were identified.

Conclusions
Neuropsychologists are underused in pre-surgical fMRI language and motor mapping despite possessing specialized knowledge and skills to conduct such procedures. Potential explanations, including availability of neuropsychologists and a lack of specific training in clinical fMRI, are discussed.
A - 101 A Neuropsychological Case Study of Progressive Bulbar Palsy
Authors: Kysor-Itri Sarah E , Sekunda Victoria-Maria 
Published: October 2023

Abstract

Objective
There has been limited literature regarding cognitive dysfunction associated with progressive bulbar palsy. This case study presents the neuropsychological profile of a 66-year-old White male diagnosed with progressive bulbar palsy (evolving primary lateral sclerosis) with speech production difficulties.

Method
The patient was referred by his neurologist for a neuropsychological evaluation of progressively worsening cognitive changes over the past two years, including difficulties with reading directions, spelling, structuring sentences, thinking of words to write down, and counting. He also described progressively worsening speech production difficulties. During the evaluation, the patient communicated solely through written means. Available MRI results demonstrated subtle evidence of anterior temporal atrophy bilaterally. Additional relevant history includes chronic obstructive pulmonary disease and a remote history of recreational opioid use.

Results
Given the patient’s speech production difficulties, measures were selected to include those that did not require verbal responses. For the few measures that did require verbal responses, administration was adjusted to allow him to provide written responses. On evaluation, he demonstrated intact orientation, processing speed, receptive language, and visuospatial functioning. In contrast, he demonstrated relative weaknesses on measures of attention, executive functioning (i.e., problem solving and cognitive flexibility), and free recall of information (with intact recognition). Behavioral features were also noted during the evaluation, including impulsivity and disorganization.

Conclusions
The case provides preliminary data regarding possible cognitive profiles associated with progressive bulbar palsy, including possible areas of cognitive strengths and weaknesses. This case also highlights the need for further investigation of cognitive profiles of the condition which may assist with treatment planning.
A - 102 Neuropsychological Findings in a Patient Diagnosed with Wernicke’s Encephalopathy Due to Chemoradiation and Malnutrition: a Case Presentation
Authors: Laique Aamir , Breting Leslie Guidotti 
Published: October 2023

Abstract

Objective
Wernicke’s Encephalopathy (WE) is a rare neuropsychiatric syndrome caused by thiamine deficiency. WE is characterized by inattention, incoherence, confusion, eye-movement disorders, and ataxia. However, scarce information exists on neurocognitive outcomes, particularly stemming from oncology-related etiologies, (e.g., malnutrition caused by chemoradiation). In hopes of elucidating consequential deficits, a case presenting the neurocognitive profile of WE in a 71-year-old female cancer survivor is reported.

Method
Patient underwent standard chemoradiation for squamous cell carcinoma of the oropharynx in 2021 followed by frequent nutritional deficiency resulting from decreased appetite, mouth sores, and nausea/vomiting. She developed increased weakness, confusion, difficulty walking, nystagmus, and altered mental state. Completion of chemoradiation and onset of WE saw her experience altered mental status, confusion, gait instability, dysarthric speech, and memory difficulties. Imaging indicated a linear chronic infarct in the left cerebellar hemisphere and frontal predominant brain volume loss.

Results
Patient was referred for neuropsychological evaluation after beginning treatment for WE and psychotherapy to assess barriers to improving nutrition. Primary deficits were observed on verbal learning and memory, verbal fluency, executive functioning, attention, and visuomotor functioning. Comprehension and visual memory skills were intact. Both basic and higher order cognitive processes were impacted resulting in declining quality of life and activities of daily living.

Conclusion
This study highlights the need to consider chemoradiation as an etiological risk factor for the development of WE and associated neurocognitive sequelae. Neuropsychological dysfunction is an important consideration given the acute nature of this life-threatening disease. The key elements in treatment involve thiamine replacement, nutrition, appropriate rehabilitation, and medical follow-up.