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Objective: This paper describes the BNI Screen for Higher Cerebral Functions (BNIS) and reviews studies that comment on its reliability, validity, and clinical and research utility. The ability of the BNIS to assess non-cognitive higher brain functions is also described., Methods: We reviewed the original administration manual, studies published in the BNI Quarterly of the Barrow Neurological Institute, and peer-reviewed studies on the BNI Screen identified by an academic database, PubMed and Google Scholar. Thirty-two studies were reviewed that describe normative data, psychometric properties, sensitivity and specificity estimates, the relationship of demographic factors to test performance, and its research utility., Results: The BNIS is a time efficient screening test often taking no longer than 12-18 minutes. In addition to cognitive functioning, it aids in assessing conation, awareness of memory impairment, and affects expression and perception. Sensitivity estimates ranged from 80% to 92.3%. Specificity estimates ranged from 38.9% to 90%. Its construct, concurrent, and predictive validity have been supported by a series of international studies using different language translations of the test., Conclusion: The BNIS is a useful screening test for identifying patients with underlying brain disorders that uniquely measures domains of functioning not sampled by other existing screening tests.

Introduction: The Barrow Neurological Institute (BNI) Screen for Higher Cerebral Functions (BNIS) has been translated into several languages and found useful in evaluating multiple domains of cognitive and affective dysfunction, particularly in neuro-rehabilitation settings. Normative data from countries with high literacy rates have reported strikingly similar mean level of performance scores on this test, with age typically correlating higher with total score performance than education. In the present study, we obtain convenience sample normative data from a native Brazilian population on a Portuguese translation of the BNIS (i.e., BNIS-PT)., Method: The BNIS was translated into Portuguese by two native speaking Portuguese neuropsychologists who were also fluent in English. It was then administered to 201 normally functioning native Brazilian individuals who varied considerably in age and formal educational training., Results: The mean BNIS total score was similar to what previous studies reported, but primarily in younger adults with at least 12 years of formal education. In this Brazilian sample, the correlation of educational level and BNIS total score was r = .68, p < .001. The correlation of age and BNIS total score was r = -.36, p < .001. This is the opposite pattern to that observed in previous standardization studies. The strong correlation of education with performance in various subtests was observed in all age groups (ages ranging from 15 to 85 years)., Conclusion: This standardization study provides guidelines for calculating expected average performance levels on the BNIS-PT for Brazilian individuals with varying degrees of age and education. Educational level positively correlated with test performance on the BNIS-PT and was repeatedly observed to overshadow the effects of age, suggesting its important role in the development of higher cerebral functions in multiple domains in a Brazilian sample of normally functioning individuals.

Objective: The purpose of this study was to investigate the contribution of executive functions (EF) components and episodic and working memory variables, as well as clinical and demographic factors, to awareness of cognitive ability in traumatic brain injury (TBI)., Methods: Sixty-five TBI patients (mild: n = 26; moderate/severe: n = 39) took part in the study. Independent stepwise regression models were calculated for EF and memory predictors, with awareness being measured by patient/informant discrepancy in the Patient Competency Rating Scale., Results: Models with EF variables indicated that semantic verbal fluency and age are the best predictors of awareness, whereas models including mnemonic functions suggested verbal delayed episodic recall and TBI severity as predictors., Conclusions: These results are discussed in relation to clinical implications, such as the need to focus efforts of rehabilitation in the cognitive abilities related to awareness, and theoretical models.

Many patients with epilepsy caused by hypothalamic hamartomas (HHs) have cognitive impairments during the course of the disease or following neurosurgical treatment. The purpose of this study was to assess cognitive function in these patients, as well as factors influencing preoperative cognitive performance and cognitive outcome after neurosurgical treatment. Using the two largest and most detailed neuropsychology datasets on HH and epilepsy from two centers, we retrospectively report on cognitive functions in 48 patients with structural epilepsy due to HH (mean age ± standard deviation [SD] 20 ± 12 years, range 5-53 years, median 16 years; disease duration mean 17 ± 11 years). Intelligence, verbal learning and recall, and speed and executive functions (processing speed and cognitive flexibility) were assessed before and on average 19 (±11) months after surgery (interstitial radiosurgery: N = 22; neurosurgical resection/disconnection: N = 26). Prior to neurosurgical treatment, 52% of patients showed impaired executive and 62% showed reduced verbal memory functions. A trend for a detrimental effect of higher drug load on cognitive functioning was found. After neurosurgical treatment, intellectual functions for the entire cohort tended to increase. This correlated with improved seizure frequency and decreased number of antiepileptic drugs (AEDs). However, postoperative outcomes for individual patients were highly variable, with significant deteriorations in 17% (processing speed) to 34% (cognitive flexibility and verbal learning), and performance increases in 17% (intellectual functioning) up to 39% (processing speed) of the patients. Higher levels of presurgical performance were significant predictors of cognitive decline after surgery. These results are highly relevant for patient consultation and may help with therapeutic decisions., (Wiley Periodicals, Inc. © 2017 International League Against Epilepsy.)

A nondemented, 55-year-old woman with a 20-year history of relapsing-remitting multiple sclerosis (MS) recently began having significant difficulties performing her job after several years of successful employment. While the patient acknowledged that others considered her job performance as being below standards, she did not subjectively experience any change in her cognitive functioning that would negatively impact job performance. She had no explanation as to why her job performance was now considered unsatisfactory. She also appeared to be in no distress over her situation. Was the patient's unawareness a form of anosognosia or psychological denial of her clinical condition? We provide neuropsychological, neuroimaging, and behavioral descriptions of the patient that suggest that the underlying disturbance appeared to be a neuropsychologically based, impaired self-awareness (ISA). Clinical suggestions are provided for distinguishing between ISA and denial of disability (DD) in MS patients.

Background: Holistic approaches to neuropsychological rehabilitation have progressively been recognized as an important form of rehabilitative care for persons who have a history of moderate to severe traumatic brain injury., Objective: After providing historical and contemporary perspectives, identify challenges and opportunities facing the field of neuropsychological rehabilitation., Methods: Selective literature review from neuropsychological rehabilitation, neurosciences, learning theory, cognitive neuropsychology, and psychotherapy that highlight challenges to the development of holistic neuropsychological rehabilitation., Results: Ten challenges and associated opportunities that face the field of holistic neuropsychological rehabilitation are identified. Illustrations of these challenges and opportunities are provided., Conclusions: Effectively addressing the challenges that face holistic neuropsychological rehabilitation will result in greater advances for this field of care for both children and adults.

Objective: To obtain normative data using a French translation of the BNI Screen for Higher Cerebral Functions (BNIS) administered to French-speaking individuals., Methods: Recruitment and administration of the BNIS to a convenience sample of 167 French-speaking individuals between the ages of 15-84 years., Results: Mean BNIS total score for a French sample was within 1 point of what was observed in the original standardization study using 200 English-speaking controls. Age and education correlated significantly with BNIS scores in a manner reported by other studies., Conclusion: The French translation of the BNIS appears to be a reliable method of assessing higher cerebral functioning in French-speaking individuals.

Background: This study investigated impaired self-awareness of motor deficits in nondemented, nondepressed Parkinson's disease (PD) patients during a defined clinical on state., Methods: Twenty-eight PD patients were examined. Patients' self-ratings and experts' ratings of patients' motor performance were compared. Patient-examiner discrepancies and level of impairment determined severity of impaired self-awareness. Motor exam assessed overall motor functioning, hemibody impairment, and 4 motor phenotypes. Neuropsychological tests were also conducted., Results: Signs of impaired self-awareness were present in 17 patients (60.7%). Higher severity of impaired self-awareness correlated significantly with higher postural-instability and gait-difficulty off scores (r = .575; P = .001), overall motor off scores (r = .569; P = .002), and higher left hemibody off scores (r = .490; P = .008). In multiple linear regression analyses, higher postural-instability and gait-difficulty off scores remained as the only significant predictor of impaired self-awareness severity., Conclusions: Postural instability and gait difficulties, disease severity, and right hemisphere dysfunction seem to contribute to impaired self-awareness., (Copyright © 2012 Movement Disorder Society.)

Subjective and objective assessments of cognitive and affective functioning of patients admitted to the EMU with epileptic (ES, n=22) and psychogenic nonepileptic (NES, n=23) seizures were compared. It was hypothesized that the patients with NES would overestimate their cognitive impairments and underestimate their affective disturbances relative to those with ES. Results revealed that the patients with NES reported greater word-finding difficulty than those with ES (P=0.02), but performed better than the patients with ES on the Boston Naming Test (BNT, P=0.03), suggesting a tendency to overestimate word-finding difficulty. Patients with NES and ES did not otherwise differ in subjective ratings of cognitive functions or emotional state; however, patients with NES performed worse on a test of affect expression/perception compared with those with ES (P=0.02). For patients with NES, only performance on memory tests was significantly correlated with their anxiety level. Obtaining both subjective ratings and objective test findings of cognitive and affective functioning may help further differentiate between patients with NES and those with ES.

Hypothalamic hamartoma (HH) syndrome comprises the clinical triad of epilepsy, developmental retardation, and central precocious puberty. A predominant opinion has been that the acquired cognitive and behavioral disorders observed in children with this syndrome are a direct effect of their seizure activity. A review of the recent literature suggests that this opinion needs to be revised because it is only partially supported by the data. The size of the HH and its anatomic attachment/location, in addition to the seizure history, appear to contribute to the cognitive and behavioral disturbances in children with HH. Small sample sizes and the inability to use standard neuropsychological testing scales in more severely affected HH patients complicate the study of causality. The present literature, however, suggests that multiple factors contribute to the cognitive and behavioral problems of these children.

Patients with moderately severe to severe traumatic brain injury (TBI) can demonstrate disturbances in self-awareness several months or years after injury. Patients may underreport cognitive and behavioral difficulties, which are the true residuals of their brain injury. Increasingly, research indicates that the residuals of these disturbances in consciousness greatly affect the process and outcome of rehabilitation. A recent model for conceptualizing disturbances of self-awareness after various forms of brain injury is reviewed.

This study examined cognitive and affective disturbances in patients with complicated (presence of space occupying lesion) vs uncomplicated (absence of space occupying lesion) mild traumatic brain injury (TBI). It was predicted that the complicated group would perform worse in both domains compared to the uncomplicated group. Participants were 28 patients admitted to an inpatient neurorehabilitation unit with mild TBI and assessed within 40 days of their injury. The complicated group (n = 14) was matched to the uncomplicated group (n = 14) on Glasgow Coma Scale score and compared to 14 normal controls on the BNI Screen for Higher Cerebral Functions (BNIS). The complicated group showed greater cognitive disturbances than the uncomplicated and control groups, while both TBI groups performed worse on affective measures. These findings document the role of affective disturbances in mild TBI. They also highlight the importance of early intervention strategies for improving affective communication in patients with mild TBI.

Objective: To demonstrate that the Barrow Neurological Institute (BNI) Screen for Higher Cerebral Functions (BNIS) can be used to briefly assess cognitive and affective disturbances during the acute stages after traumatic brain injury (TBI)., Design and Outcome Measures: People with TBI were administered the BNIS during the first 60 days after injury and their performance compared to a convenience sample of control subjects used in the standardization of the BNIS., Setting: Inpatient units of a neurological institute and medical center., Subjects: Forty-two individuals with moderate-to-severe TBI and 21 control subjects., Results: Compared to patients with TBI, control subjects performed significantly better on the BNIS total and all subtest scores. TBI patients were best classified by poor performance on measures of affect disturbance and impaired awareness. Stepwise discriminant analysis identified disturbances in memory, awareness, and affect as contributing most to the classification of an individual as having TBI., Conclusions: Both cognitive and affective disturbances can be directly assessed during the early stages after significant TBI. The BNIS can be used for this purpose and help document that TBI specifically affects memory, awareness, and affect during its early stages and should be addressed in rehabilitation.

Sixty-four traumatically brain injured patients were divided into three groups. Patients in Group I overestimated their behavioral competencies. Patients in Group II showed behavioral ratings similar to relatives' reports concerning behavioral competencies. Patients in Group III underestimated their behavioral competencies. Group I patients had greater evidence of bilateral and multiple-site lesions than group II and III patients. Speed of left-hand finger tapping was also worse in Group I than groups II and III, but other standard neuropsychologic test findings failed to separate the groups. Specific brain lesion sites were not related to group membership. Impaired awareness of behavioral limitations after traumatic brain injury may be related to neuropsychologic changes not measured by standard tests. Bilateral impairment of heteromodal cortex may be important to this phenomenon when it exists several months or years postinjury.