Return on Investment and Value Research in Neuropsychology: A Call to Arms†.

There is substantial empirical evidence to support the clinical value of neuropsychological evaluation and the incremental value of neuropsychological assessment, suggesting such evaluation is beneficial in the prediction and management of clinical outcomes. However, in the cost-conscious and evolving era of healthcare reform, neuropsychologists must also establish the economic value, or return on investment, of their services. There is already a modest body of literature that demonstrates the economic benefits of neuropsychological evaluation, which is reviewed in the current paper.

Integrative Care Models in Neuropsychology: A National Academy of Neuropsychology Education Paper.

Although collaborative, and more specifically, integrated models of care have existed for years, the 2010 Patient Protection and Affordable Care Act expanded their use, and Medicare has adopted a value-based payment system that further emphasizes service provision within the collaborative health care setting. Neuropsychology as a field is well-situated to work within the integrated health care setting, which presents both opportunities and challenges for clinical neuropsychologists. This education paper details how different neuropsychology clinical practice settings fit into an integrated care framework; discusses challenges to service delivery and fiscal viability in such settings and other health care related settings; and examines future directions for the role of neuropsychology within a dynamic health care system.

Classification accuracy of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2)-Restructured form validity scales in detecting malingered pain-related disability.

The symptom reports of individuals with chronic pain are multidimensional (e.g., emotional, cognitive, and somatic) and significantly contribute to increased morbidity and lost work productivity.

Test-retest reliability and practice effects for the ANAM General Neuropsychological Screening battery.

Objective: As the use of computer-based neurocognitive assessment is rapidly expanding, the need to systematically study and document key psychometric properties of these measures has become increasingly more salient. To meet this aim, this study examined test-retest reliability and practice effects for the Automated Neuropsychological Assessment Metrics General Neuropsychological Screening battery (ANAM GNS) in a sample of 94 community dwelling adults.

Method: ANAM GNS was administered and then repeated (alternate form) after 30 days.

Validation of ANAM for cognitive screening in a mixed clinical sample.

The Automated Neuropsychological Assessment Metrics (ANAM) is a library of computer based tests designed to measure cognitive function at a single time-point or longitudinally for detection of cognitive change. This study sought to validate ANAM as a cognitive screening tool for presence of confirmed neuropsychological diagnosis in an outpatient setting. Retrospective data analysis was conducted for 139 patients referred for outpatient neuropsychological assessment.

Cognitive Screening Tests Versus Comprehensive Neuropsychological Test Batteries: A National Academy of Neuropsychology Education Paper†.

The American Medical Association Current Procedural Panel developed a new billing code making behavioral health screening a reimbursable healthcare service. The use of computerized testing as a means for cognitive screening and brief cognitive testing is increasing at a rapid rate. The purpose of this education paper is to provide information to clinicians, healthcare administrators, and policy developers about the purpose, strengths, and limitations of cognitive screening tests versus comprehensive neuropsychological evaluations.

Cognitive changes and dementia risk after traumatic brain injury: implications for aging military personnel.

Traumatic brain injury (TBI) is recognized as an important risk factor for the long-term cognitive health of military personnel, particularly in light of growing evidence that TBI increases risk for Alzheimer's disease and other dementias. In this article, we review the neurocognitive and neuropathologic changes after TBI with particular focus on the potential risk for cognitive decline across the life span in military service members. Implications for monitoring and surveillance of cognition in the aging military population are discussed.

Initial clinical validation of an embedded performance validity measure within the automated neuropsychological metrics (ANAM).

The measurement of effort and performance validity is essential for computerized testing where less direct supervision is needed. The clinical validation of an Automated Neuropsychological Metrics-Performance Validity Index (ANAM-PVI) was examined by converting ANAM test scores into a common metric based on their relative infrequency in an outpatient clinic sample with presumed good effort. Optimal ANAM-PVI cut-points were determined using receiver operator characteristic (ROC) curve analyses and an a priori specificity of 90%.

Evidence for added value of baseline testing in computer-based cognitive assessment.

Context: Large-scale baseline cognitive assessment for individuals at risk for concussion is a common part of the protocol for concussion-surveillance programs, particularly in sports. Baseline cognitive testing is also being conducted in US military service members before deployment. Recently, the incremental validity of large-scale baseline cognitive assessment has been questioned.

Cognitive change associated with self-reported mild traumatic brain injury sustained during the OEF/OIF conflicts.

Traumatic brain injury (TBI) has received much attention due to high rates of this injury in Service Members returning from the Iraq/Afghanistan conflicts. This study examined cognitive performance in Service Members tested with ANAM prior to and following deployment. The sample was divided into a control group (n=400) reporting no TBI injury prior to or during most recent deployment, and a group who self-reported a TBI injury (n=502) during most recent deployment.

Functional magnetic resonance imaging of working memory and response inhibition in children with mild traumatic brain injury.

The current pilot study examined functional magnetic resonance imaging (fMRI) activation in children with mild traumatic brain injury (mTBI) during tasks of working memory and inhibitory control, both of which are vulnerable to impairment following mTBI. Thirteen children with symptomatic mTBI and a group of controls completed a version of the Tasks of Executive Control (TEC) during fMRI scanning. Both groups showed greater prefrontal activation in response to increased working memory load.

Collaboration between neuropsychologists and speech-language pathologists in rehabilitation settings.

Objective: The purpose of this study was to understand the barriers and facilitators of communication and collaboration between speech-language pathologists (SLPs) and neuropsychologists (NPs) in rehabilitation settings.

Method: Focus groups were held at 3 rehabilitation hospitals. Participants were a convenience sample and were considered representatives of acquired brain injury rehabilitation teams that include SLPs and NPs.

Children with heavy prenatal alcohol exposure demonstrate deficits on multiple measures of concept formation.

Background: Children with heavy prenatal alcohol exposure have documented impairments in executive functioning (EF). One component of EF, concept formation, has not been well studied in this group.

Methods: Children (8 to 18 years) with histories of heavy prenatal alcohol exposure, with and without fetal alcohol syndrome (FAS), were compared to typically developing controls on 2 measures of concept formation and conceptual set shifting: the Wisconsin Card Sorting Test and the Card Sorting Test from the Delis-Kaplan Executive Functioning System.

Use of computerized assessment to predict neuropsychological functioning and emotional distress in patients with systemic lupus erythematosus.

Objective: Cognitive dysfunction and neuropsychiatric disturbance are common in systemic lupus erythematosus (SLE). This study addressed the ability of the Automated Neuropsychological Assessment Metrics (ANAM), a computerized cognitive testing battery consisting of cognitive subtests, a sleepiness rating scale, and a mood scale, to predict neuropsychological status in patients with SLE.

Methods: Sixty individuals with SLE and no overt neuropsychiatric symptoms were administered ANAM to determine its validity as a screening measure of cognitive dysfunction and emotional distress in SLE.

Implicit strategy affects learning in children with heavy prenatal alcohol exposure.

Background: Learning and memory deficits are commonly reported in children with heavy prenatal alcohol exposure. Our recent work suggested that children with heavy prenatal alcohol exposure retained information as well as controls on a verbal learning test but not on a test of nonverbal learning and memory. To better understand the cause of this differential pattern of performance, the current study re-analyzed data from our previous study to determine if the presence of an implicit learning strategy may account, at least in part, for the finding of spared retention.

Bimanual coordination in alcohol-exposed children: role of the corpus callosum.

The corpus callosum (CC) is one of several brain structures affected in children prenatally exposed to alcohol. This structure plays a major role in coordinating motor activity from opposite sides of the body, and deficits in bimanual coordination have been documented in individuals with agenesis of or damage to the CC, particularly when the task is performed without visual feedback. The Bimanual Coordination Test was used to assess speed and accuracy on a task where both hands must coordinate to guide a cursor through angled pathways providing measures of interhemispheric interaction or the ability of the two hemispheres to coordinate activity via the corpus callosum.