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Background: An emerging body of research suggests that noncentral nervous system cancer may negatively impact the brain apart from effects of cancer treatment. However, studies assessing cognitive function in newly diagnosed cancer patients cannot exclude selection bias and psychological effects of cancer diagnosis. To overcome these limitations, we investigated trajectories of cognitive function of patients before cancer diagnosis.Methods: Between 1989 and 2013, a total of 2059 participants from the population-based Rotterdam Study were diagnosed with noncentral nervous system cancer. Cognitive assessments were performed every 3 to 5 years using a neuropsychological battery. The general cognitive factor was composed of individual cognitive tests to assess global cognition. Using linear mixed models, we compared change in cognitive function of cancer case patients before diagnosis with cognitive change of age-matched cancer-free control subjects (1:2). In addition, we performed sensitivity analyses by discarding assessments of control subjects 5 years before the end of follow-up to exclude effects from potential undiagnosed cancer. All statistical tests were two-sided.Results: The Word Learning Test immediate recall declined faster among case patients than among control subjects (-0.05, 95% confidence interval = -0.09 to -0.01 vs 0.01, 95% confidence interval = -0.01 to 0.03; P for difference = .003). However, this difference was not statistically significant in sensitivity analyses. Furthermore, no statistically significant differences were observed in change of other individual cognitive tests and of the general cognitive factor.Conclusions: In this study, we evaluated cognitive function in a large group of cancer patients prior to diagnosis, thereby excluding the psychological impact of cancer diagnosis and biased patient selection. In contrast to previous studies shortly after cancer diagnosis, we found no difference in change of cognitive function between cancer patients and control subjects. [ABSTRACT FROM AUTHOR]

Objective Culturally and linguistically appropriate neuropsychological assessments for the large number of primary Spanish speakers in the United States remain imperative to serve the needs of this underserved population. As part of a larger co-norming project, we generated demographically adjusted norms for the Brief Visuospatial Memory Test-revised (BVMT-R) and the Hopkins Verbal Learning Test-revised (HVLT-R) for use with native Spanish speakers from the U.S.-Mexico border regions. Participants and Method Participants were 202 healthy native Spanish speakers recruited in San Diego, CA and Tucson, AZ, ages 19 to 60, with education ranging from 0-20 years, and 59% women. Test stimuli for the HVLT-R and instructions for both tests were adapted into Spanish by a team of native Spanish speakers from multiple countries using standard procedures (Cherner et al. 2007). Raw scores for the various learning and delayed recall outcomes were converted to T-scores using fractional polynomial equations accounting for effects of education, age, and sex. We then computed the rates of impairment that would be obtained when applying the original published norms for these two tests, and compared these results to the expected rate of impairment of -1SD (around 16%) derived from the normal distribution of T-scores in our new, demographically corrected norms. Results Results showed significant overestimation of impairment when applying the original norms for non-Hispanic English speakers to our Spanish-speaking sample, ranging from 35-38% for HVLT-R and 25-26% for BVMTR. As expected, these overestimations of impairment were greater for individuals with lower education, but our demographically corrected norms reduced the rate of impairment for all levels of education. Conclusions These findings highlight the urgent need to account for demographic effects on neuropsychological performance in order to improve the diagnostic accuracy of our measures when applied to US-dwelling Spanish speakers. References Cherner, M. Suarez, P. Lazzaretto, D. Fortuny, L. A. I. Mindt, M. R. Dawes, S.... & HNRC group. (2007). Demographically corrected norms for the Brief Visuospatial Memory Test-revised and Hopkins Verbal Learning Test-revised in monolingual Spanish speakers from the US–Mexico border region.  Archives of Clinical Neuropsychology ,  22 (3), 343-353. [ABSTRACT FROM AUTHOR]

Objective Soroxchi/Acute Mountain Sickness (AMS) is a condition that can result in cerebral and pulmonary hypoxia. Neuropsychological research on AMS is minimal and the long-term effects on cognition and behavior are unclear. AMS is associated with cognitive impairments in processing speed, attention, and executive functions as well as neurobehavioral symptoms. This case study delineates the neuropsychological and neurobehavioral changes secondary to bilateral globus pallidus (GP) lesions associated with AMS. Case Description Patient is a 51-year old, primarily Spanish-speaking, male of Mexican descent with 9 years of education, and who had traveled to La Paz, Bolivia (4,070 MASL) for work. Upon arrival, fatigue and dizziness led to hospitalization to treat acute pulmonary edema and hypoxia. Brain MRI revealed hyperintense bilateral GP lesions. Medical history was notable for hyperlipidemia. Psychiatric history was unremarkable. Neuropsychological assessment 4 months post-AMS revealed impairments in visuo-conceptual and speeded complex visuospatial abilities, executive functions, and confrontation naming. Cognitive improvements were noted in delayed recall of non-contextual verbal information and confrontation naming ten months post-AMS. Significant mood and personality changes were reported; patient endorsed anhedonia, fatigue, alexithymia, avolition, and sleep difficulties. Family described patient as depressed, apathetic, and socially withdrawn. Pharmacological and psychotherapy treatments were recommended and initiated. Diagnostic Impressions and Outcomes Findings were consistent with a diagnosis of Mild Neurocognitive Disorder. His family denied neurobehavioral improvements post interventions. Discussion This case study is the first to characterize the long-term neuropsychological and neurobehavioral changes following bilateral GP lesions secondary to AMS. Declines in visual-conceptual abilities reveal a new finding for this type of cerebral incident. [ABSTRACT FROM AUTHOR]

Context Most studies on medical expertise research have focused on diagnostic performance, whereas patient management has been largely ignored. According to knowledge encapsulation theory, applying encapsulated knowledge is a characteristic of expert doctors’ diagnostic reasoning, but it is unclear whether or not encapsulated knowledge also plays a prominent role when processing a clinical case with a management focus. Methods The participants were 40 medical students (20 in Year 4 and 20 in Year 6) and 20 expert doctors (internists). Participants were asked to study the cases with either a diagnostic (Dx) or a management (Mx) focus. Subsequently, participants were asked to write down what they remembered from the case. Results In both conditions, experts recalled fewer propositions and used more high-level inferences than medical students. Furthermore, they processed the cases faster and more accurately than medical students, but no significant difference between Mx and Dx conditions was found. Year 4 students also showed no significant differences in recall and processing speed between conditions. By contrast, Year 6 students recalled more in a Dx than in an Mx condition, but there was no significant difference in processing speed between conditions. Conclusions In both conditions, findings indicate that the experts’ and Year 4 students’ performance was not affected by processing focus. The fact that only Year 6 students were affected by processing focus might be explained by the assumption that their diagnostic knowledge and management knowledge are not fully integrated yet, a process that has already taken place in the expert’s knowledge structure. [ABSTRACT FROM AUTHOR]

There is a high rate of medical and psychiatric comorbidities in the HIV population (Kilbourne et al, 2001), many of which complicate the clinical picture, especially with respect to cognitive functioning (Milanini & Valcour, 2017). It is important to be aware of the impact multiple disorders can have on formulating impressions and treatment planning. We reviewed the records of 35 consecutive patients with HIV seen in our neuropsychology clinic in a county hospital. The 30 men and 5 women had a mean age of 49 (SD = 13.7), with mean education of 13.5 years (SD = 2.0). Average age of HIV diagnosis was 33 (SD = 9.3). Patients had an average of eight major comorbid medical and psychiatric diagnoses, including ADHD (45%), mood disorders (62%), developmental disorders (11%), substance abuse or dependence (45%), sleep apnea (11%), TBI (31%), stroke (14%), cardiovascular disease (51%), and hepatitis (20%). Neuropsychological data were available for 33 patients. Performance on CVLT Trial 5 and Delayed Recall, Rey-Ostereith Copy, WAIS-IV Information and Digit Span, as well as Trail Making A and B were used to measure memory and executive functioning. 21% of the sample obtained one score that was >2 SD below the normative means, and 45% obtained 2 or more scores >2 SD below the mean.In this clinical sample referred for evaluation of cognitive functioning, there was a high rate of comorbid diagnoses. This review highlights the point that comorbid diagnoses are a common presentation and must be considered when discussing etiology of cognitive impairment and treatment planning. [ABSTRACT FROM AUTHOR]

Purpose Traditional "paper and pencil" neuropsychological tests and computerized test batteries have been employed in the assessment of sports-related concussion (SRC). Each type of test has inherent strengths and weaknesses. The NHL has constructed a "hybrid" battery of tests that uses both traditional and computerized measures in the evaluation of its players suspected of SRC. The purpose of this paper is to use factor analytic techniques to examine the relationships among the measures that comprise this battery. Methods Post-injury neuropsychological test data using the hybrid battery were obtained from 343 NHL players following their first concussion while playing in the league. ImPACT was used as the computer test battery. The traditional battery included: Hopkins Verbal Learning Test, Brief Visuospatial Memory Test, Color Trails, PSU Cancellation, Symbol Digits Modalities Test (including incidental memory), and Verbal Fluency. Results Five factors were extracted explaining 64.55% of the variance. The factor labels and the measures principally loading on each factor were as follows: Factor 1, Verbal Learning and Memory (HVLT Total and Delayed Recall); Factor 2, Processing Speed (Color Trails A/B, PSU Cancellation, and SDMT-Total); Factor 3, Visual Memory (BVMT- Total and Delayed); Factor 4, Cued Memory (ImPACT-Visual and Verbal Memory Composites); and Factor 5, Reaction Time (ImPACT Reaction Time and Visual Motor Speed composites). Conclusion These data underscore the unique contributions of traditional and ImPACT neuropsychological measures to the evaluation SRC in a sample of professional hockey players. It appears that both approaches measure different aspects of cognitive functioning. The next logical step is to use these data in evaluating the diagnostic utility of these measures as part of a combined battery. [ABSTRACT FROM AUTHOR]

Inadvertent ingestion of foreign bodies is a common condition within clinical practice. It rarely produces any symptoms. The diagnosis is difficult since most patients do not recall having swallowed any object. Needles, pins, keys, nails and bones are among the most commonly ingested foreign bodies. Severe complications are uncommon, but if present they can put patients' lives at risk. Although extremely rare, the ingested foreign body may end lodging in the appendix, posing a challenge for the clinical team. Once the exact location of the object is confirmed, the extraction of the foreign object must be performed to avoid complications. The present report describes a case of a young adult patient, who presented to the emergency room after a routine medical examination. A 30 mm metallic nail was discovered in the tip of the appendix. After a failed endoscopic approach an appendectomy was performed, and the patient underwent a complete recovery. [ABSTRACT FROM AUTHOR]