Journal of the International Neuropsychological Society最新文献

{"title":"Marital status, brain health, and cognitive reserve among diverse older adults.","authors":"Ji Hyun Lee, Kiana A Scambray, Emily P Morris, Ketlyne Sol, Jordan D Palms, Afsara B Zaheed, Michelle N Martinez, Nicole Schupf, Jennifer J Manly, Adam M Brickman, Laura B Zahodne","doi":"10.1017/S1355617724000638","DOIUrl":"10.1017/S1355617724000638","url":null,"abstract":"<p><strong>Objective: </strong>Being married may protect late-life cognition. Less is known about living arrangement among unmarried adults and mechanisms such as brain health (BH) and cognitive reserve (CR) across race and ethnicity or sex/gender. The current study examines (1) associations between marital status, BH, and CR among diverse older adults and (2) whether one's living arrangement is linked to BH and CR among unmarried adults.</p><p><strong>Method: </strong>Cross-sectional data come from the Washington Heights-Inwood Columbia Aging Project (<i>N</i> = 778, 41% Hispanic, 33% non-Hispanic Black, 25% non-Hispanic White; 64% women). Magnetic resonance imaging (MRI) markers of BH included cortical thickness in Alzheimer's disease signature regions and hippocampal, gray matter, and white matter hyperintensity volumes. CR was residual variance in an episodic memory composite after partialing out MRI markers. Exploratory analyses stratified by race and ethnicity and sex/gender and included potential mediators.</p><p><strong>Results: </strong>Marital status was associated with CR, but not BH. Compared to married individuals, those who were previously married (i.e., divorced, widowed, and separated) had lower CR than their married counterparts in the full sample, among White and Hispanic subgroups, and among women. Never married women also had lower CR than married women. These findings were independent of age, education, physical health, and household income. Among never married individuals, living with others was negatively linked to BH.</p><p><strong>Conclusions: </strong>Marriage may protect late-life cognition via CR. Findings also highlight differential effects across race and ethnicity and sex/gender. Marital status could be considered when assessing the risk of cognitive impairment during routine screenings.</p>","PeriodicalId":49995,"journal":{"name":"Journal of the International Neuropsychological Society","volume":" ","pages":"1-10"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11957939/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retest reliability and reliable change of community-dwelling Black/African American older adults with and without mild cognitive impairment using NIH Toolbox-Cognition Battery and Cogstate Brief Battery for laptop.","authors":"Taylor Rigby, Voyko Kavcic, Sarah R Shair, Tanisha G Hill-Jarrett, Sarah Garcia, Jon Reader, Carol Persad, Arijit K Bhaumik, Subhamoy Pal, Benjamin M Hampstead, Bruno Giordani","doi":"10.1017/S1355617724000444","DOIUrl":"10.1017/S1355617724000444","url":null,"abstract":"<p><strong>Objective: </strong>With the increased use of computer-based tests in clinical and research settings, assessing retest reliability and reliable change of NIH Toolbox-Cognition Battery (NIHTB-CB) and Cogstate Brief Battery (Cogstate) is essential. Previous studies used mostly White samples, but Black/African Americans (B/AAs) must be included in this research to ensure reliability.</p><p><strong>Method: </strong>Participants were B/AA consensus-confirmed healthy controls (HCs) (n = 49) or mild cognitive impairment (MCI) (n = 34) adults 60-85 years that completed NIHTB-CB and Cogstate for laptop at two timepoints within 4 months. Intraclass correlations, the Bland-Altman method, <i>t</i>-tests, and the Pearson correlation coefficient were used. Cut scores indicating reliable change provided.</p><p><strong>Results: </strong>NIHTB-CB composite reliability ranged from .81 to .93 (95% CIs [.37-.96]). The Fluid Composite demonstrated a significant difference between timepoints and was less consistent than the Crystallized Composite. Subtests were less consistent for MCIs (ICCs = .01-.89, CIs [-1.00-.95]) than for HCs (ICCs = .69-.93, CIs [.46-.92]). A moderate correlation was found for MCIs between timepoints and performance on the Total Composite (<i>r</i> = -.40, <i>p</i> = .03), Fluid Composite (<i>r</i> = -.38, <i>p</i> = .03), and Pattern Comparison Processing Speed (<i>r</i> = -.47, <i>p</i> = .006).On Cogstate, HCs had lower reliability (ICCs = .47-.76, CIs [.05-.86]) than MCIs (ICCs = .65-.89, CIs [.29-.95]). Identification reaction time significantly improved between testing timepoints across samples.</p><p><strong>Conclusions: </strong>The NIHTB-CB and Cogstate for laptop show promise for use in research with B/AAs and were reasonably stable up to 4 months. Still, differences were found between those with MCI and HCs. It is recommended that race and cognitive status be considered when using these measures.</p>","PeriodicalId":49995,"journal":{"name":"Journal of the International Neuropsychological Society","volume":" ","pages":"42-52"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11957938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142865886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differentiating the neurobiological correlates for reading gains in children with reading difficulties with and without attention-deficit/hyperactivity disorder using fMRI.","authors":"Keri S Rosch, Masa Khashab, Sanad Ghanaiem, Rola Farah, Tzipi Horowitz-Kraus","doi":"10.1017/S1355617724000717","DOIUrl":"10.1017/S1355617724000717","url":null,"abstract":"<p><strong>Objective: </strong>Reading difficulties (RD) frequently co-occur with attention-deficit/hyperactivity disorder (ADHD), and children with both RD + ADHD often demonstrate greater challenges in reading and executive functions (EF) than those with RD-only.</p><p><strong>Methods: </strong>This study examined the effect of a 4-week EF-based reading intervention on behavioral and neurobiological correlates of EF among 8-12 y.o. English-speaking children with RD + ADHD (n = 19), RD-only (n = 18), and typically developing children (n = 18). Behavioral and resting-state fMRI data were collected from all participants before and after 4 weeks of the EF-based reading computerized program. Group (RD + ADHD, RD-only, typical readers) x Test (pre- and post-intervention) repeated measures ANOVAs were conducted for reading, EF, and brain functional connectivity (FC) measures.</p><p><strong>Results: </strong>Across groups, reading (fluency, comprehension) and EF (inhibition, speed of processing) behavioral performance improved following the intervention. Exploratory subgroup comparisons revealed that children with RD + ADHD, but not RD-only, showed significant gains in reading comprehension, whereas inhibition improved in both RD groups, but not among typical readers. Furthermore, across groups, FC between the frontoparietal (FP) and cingulo-opercular (CO) networks decreased following the intervention. Exploratory subgroup comparisons revealed that children with RD + ADHD, but not RD-only, showed a significant decrease in FC of FP-CO and FP-dorsal attention network.</p><p><strong>Conclusions: </strong>These results support the differential response to an EF-based reading intervention of children with RD with and without comorbid ADHD at brain and behavioral levels.</p>","PeriodicalId":49995,"journal":{"name":"Journal of the International Neuropsychological Society","volume":" ","pages":"75-85"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11957940/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuropsychiatric symptoms predict rate of change in executive function in Alzheimer's disease and related dementias.","authors":"Grace J Goodwin, D A Briley, Katie Singsank, Denise Tanner, Myjae Maloy-Robertson, Samantha E John","doi":"10.1017/S1355617724000730","DOIUrl":"10.1017/S1355617724000730","url":null,"abstract":"<p><strong>Objective: </strong>Neuropsychiatric symptoms (NPS) are considered diagnostic and prognostic indicators of dementia and are attributable to neurodegenerative processes. Little is known about the prognostic value of early NPS on executive functioning (EF) decline in Alzheimer's disease and related dementias (ADRD). We examined whether baseline NPS predicted the rate of executive function (EF) decline among older adults with ADRD.</p><p><strong>Method: </strong>Older adults (<i>n</i> = 1625) with cognitive impairment were selected from the National Alzheimer's Coordinating Center database. EF was estimated with a latent factor indicated by scores on Number Span Backward, Letter Fluency, and Trail Making-Part B. A curve of factors (CUFF) latent growth curve model was estimated to examine rate of change over four years. Baseline NPS severity was entered as a predictor in the model to examine its influence on the rate of change in EF over time.</p><p><strong>Results: </strong>The CUFF models exhibited good fit. EF significantly declined over four waves (slope = -.16, <i>p</i> < .001). Initial visit NPS severity predicted decline in EF (slope = .013, <i>p</i> < .001), such that those with greater baseline NPS severity demonstrated a more rapid decline in EF performance over time. Presence of 2 NPS significantly predicted EF decline, and those with medium total NPS severity (NPS score of 2-4) at baseline exhibited a sharper decline in EF.</p><p><strong>Conclusions: </strong>Findings underscore the importance of targeting NPS early across ADRD syndromes to minimize EF decline, offering novel insights into how early NPS treatment may alter cognitive trajectories. We provide an innovative, user-friendly web-based application that may be helpful for personalized treatment planning.</p>","PeriodicalId":49995,"journal":{"name":"Journal of the International Neuropsychological Society","volume":" ","pages":"22-31"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the factor structure and construct validity of the NIH toolbox in older adults, with a focus on cognitive normalcy and amnestic mild cognitive impairment: considerations for diversity, including insights from persons over 85 years of age and Black older Americans.","authors":"Savannah Rose, Allyson Gergoire, Subhamoy Pal, Jonathan Reader, Arijit Bhaumik, Jerry Slotkin, Emily Ho, Cindy J Nowinski, Carol C Persad, Amanda Cook Maher, Sandy Weintraub, Richard Gershon, Bruno Giordani","doi":"10.1017/S1355617724000699","DOIUrl":"10.1017/S1355617724000699","url":null,"abstract":"<p><strong>Objective: </strong>Validated computerized assessments for cognitive functioning are crucial for older individuals and those at risk of cognitive decline. The National Institutes of Health (NIH) Toolbox Cognition Battery (NIHTB-CB) exhibits good construct validity but requires validation in diverse populations and for adults aged 85+. This study uses data from the Assessing Reliable Measurement in Alzheimer's Disease and cognitive Aging study to explore differences in the factor structure of the NIHTB-CB for adults 85 and older, Black participants versus White participants, and those diagnosed as amnestic Mild Cognitive Impairment (aMCI) vs cognitively normal (CN).</p><p><strong>Method: </strong>Subtests from the NACC UDS-3 and NIHTB-CB were administered to 503 community-dwelling Black and White adults ages 55-99 (367 CN; 136 aMCI). Confirmatory factor analyses were used to investigate the original factor structure of NIHTB-CB that forms the basis for NIHTB-CD Index factor scores.</p><p><strong>Results: </strong>Factor analyses for all participants and some participant subsets (aMCI, White, 85+) substantiated the two anticipated factors (Fluid and Crystallized). However, while Black aMCI participants had the expected two-factor structure, for Black CN participants, the List Sorting Working Memory and Picture Sequence tests loaded on the Crystallized factor.</p><p><strong>Conclusions: </strong>Findings provide psychometric support for the NIHTB-CB. Differences in factor structure between Black CN individuals and Black aMCI individuals suggest potential instability across levels of cognitive impairment. Future research should explore changes in NIHTB-CB across diagnoses in different populations.</p>","PeriodicalId":49995,"journal":{"name":"Journal of the International Neuropsychological Society","volume":" ","pages":"53-58"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11957923/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing the predictive validity of four MCI definitions for incident dementia in demographically diverse community-dwelling individuals: Results from the Einstein Aging Study (EAS).","authors":"Katherine H Chang, Cuiling Wang, Jiyue Qin, Mindy J Katz, Desiree A Byrd, Richard B Lipton, Laura A Rabin","doi":"10.1017/S1355617724000729","DOIUrl":"10.1017/S1355617724000729","url":null,"abstract":"<p><strong>Objective: </strong>Research examining (MCI) criteria in diverse and/or health-disparate populations is limited. There is a critical need to investigate the predictive validity for incident dementia of widely used MCI definitions in diverse populations.</p><p><strong>Method: </strong>Eligible participants were non-Hispanic White or Black Bronx community residents, free of dementia at enrollment, with at least one annual follow-up visit after baseline. Participants completed annual neurological and neuropsychological evaluations to determine cognitive status. Dementia was defined based on DSM-IV criteria using case conferences. Cox proportional hazard models assessed predictive validity for incident dementia of four specific MCI definitions (Petersen, Jak/Bondi, number of impaired tests, Global Clinical Ratings) at baseline, controlling for age, sex, education, and race/ethnicity. Time-dependent sensitivity and specificity at 2-7 years for each definition, and Youden's index were calculated as accuracy measures.</p><p><strong>Results: </strong>Participants (N = 1073) ranged in age from 70 to 100 (mean = 78.4 ± 5.3) years at baseline. The sample was 62.5% female, and educational achievement averaged 13.9 ± 3.5 years. Most participants identified as White (70.0%), though Black participants were well-represented (30.0%). In general, MCI definitions differed in sensitivity and specificity for incident dementia. However, there were no significant differences in Youden's index for any definition, across all years of follow-up.</p><p><strong>Conclusions: </strong>This work provides an important step toward improving the generalizability of the MCI diagnosis to underrepresented/health-disparate populations. While our findings suggest the studied MCI classifications are comparable, researchers and clinicians may choose to consider one method over another depending on the rationale for evaluation or question of interest.</p>","PeriodicalId":49995,"journal":{"name":"Journal of the International Neuropsychological Society","volume":" ","pages":"32-41"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic accuracy of the Montreal Cognitive Assessment in screening for cognitive impairment in initially hospitalized COVID-19 patients: Findings from the prospective multicenter NeNeSCo study.","authors":"Simona Klinkhammer, Esmée Verwijk, Gert Geurtsen, Annelien A Duits, Georgios Matopoulos, Johanna M A Visser-Meily, Janneke Horn, Arjen J C Slooter, Caroline M van Heugten","doi":"10.1017/S1355617724000675","DOIUrl":"10.1017/S1355617724000675","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the prevalence and nature of cognitive impairment among severely ill COVID-19 patients and the effectiveness of the Montreal Cognitive Assessment (MoCA) in detecting it.</p><p><strong>Method: </strong>We evaluated cognition in COVID-19 patients hospitalized during the first wave (March to June 2020) from six Dutch hospitals, nine months post-discharge, using a comprehensive multi-domain neuropsychological test battery. Test performance was corrected for sex, age, and education differences and transformed into <i>z</i>-scores. Scores within each cognitive domain were averaged and categorized as average and above (<i>z</i>-score ≥ -0.84), low average (<i>z</i>-score -1.28 to <i>-</i>0.84), below average (<i>z</i>-score -1.65 to -1.28), and exceptionally low (<i>z</i>-score < -1.65). Patients were classified with cognitive impairment if at least one domain's <i>z</i>-score fell below -1.65. We assessed the MoCA's accuracy using both the original cutoff (<26) and an \"optimal\" cutoff determined by Youden's index.</p><p><strong>Results: </strong>Cognitive impairment was found in 12.1% (24/199) of patients, with verbal memory and mental speed most affected (6.5% and 7% below -1.65, respectively). The MoCA had an area under the curve of 0.84. The original cutoff showed sensitivity of 83% and specificity of 66%. Using the identified optimal cutoff of <24, maintained sensitivity while improving specificity to 81%.</p><p><strong>Conclusions: </strong>Cognitive impairment prevalence in initially hospitalized COVID-19 patients is lower than initially expected. Verbal memory and processing speed are primarily affected. The MoCA is a valuable screening tool for these impairments and lowering the MoCA cutoff to <24 improves specificity.</p>","PeriodicalId":49995,"journal":{"name":"Journal of the International Neuropsychological Society","volume":" ","pages":"59-66"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determining associations between Big Five personality traits and executive function in an undergraduate student sample.","authors":"Emma Quarles, Samuel J West, Larry Keen","doi":"10.1017/S135561772400047X","DOIUrl":"10.1017/S135561772400047X","url":null,"abstract":"<p><strong>Objective: </strong>The present study sought to determine the associations between executive functioning and Big Five personality traits in an undergraduate sample.</p><p><strong>Method: </strong>Participants included 200 undergraduates (73% women), with a mean age of approximately 21 years. Participants completed the Big Five Inventory-44 and a psychological assessment battery, which included the Trail Making Test and the Semantic Fluency Test.</p><p><strong>Results: </strong>Results from multiple regression analyses suggested agreeableness was negatively associated with Semantic Fluency - Animals (β = -0.310, <i>p</i> < 0.001). Moreover, conscientiousness was positively associated with Trail Making Test B-A (β = 0.197, <i>p</i> = 0.016), but negatively associated with Trail Making Test A (β = -0.193, <i>p</i> = 0.017).</p><p><strong>Conclusions: </strong>Overall results identified that executive function association with personality varies by construct. Given conscientiousness' differential associations within the executive function task performances, future research should examine the conscientious threshold that would result in psychological symptomatology associated with extreme lows and highs in conscientiousness.</p>","PeriodicalId":49995,"journal":{"name":"Journal of the International Neuropsychological Society","volume":" ","pages":"67-74"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11957935/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quick-reference criteria for identifying multivariate cognitive change in older adults with mild cognitive impairment and dementia: An ADNI study.","authors":"Jeremy G Grant, Amanda M Wisinger, Hilary F Abel, Jennifer M Hunter, Glenn E Smith","doi":"10.1017/S1355617724000407","DOIUrl":"10.1017/S1355617724000407","url":null,"abstract":"<p><strong>Objective: </strong>To establish quick-reference criteria regarding the frequency of statistically rare changes in seven neuropsychological measures administered to older adults.</p><p><strong>Method: </strong>Data from 935 older adults examined over a two-year interval were obtained from the Alzheimer's Disease Neuroimaging Initiative. The sample included 401 cognitively normal older adults whose scores were used to determine the natural distribution of change scores for seven cognitive measures and to set change score thresholds corresponding to the 5^th percentile. The number of test scores that exceeded these thresholds were counted for the cognitively normal group, as well as 381 individuals with mild cognitive impairment (MCI) and 153 individuals with dementia. Regression analyses examined whether the number of change scores predicted diagnostic group membership beyond demographic covariates.</p><p><strong>Results: </strong>Only 4.2% of cognitively normal participants obtained two or more change scores that fell below the 5^th percentile of change scores, compared to 10.6% of the stable MCI participants and 38.6% of those who converted to dementia. After adjusting for age, gender, race/ethnicity, and premorbid estimates, the number of change scores below the 5^th percentile significantly predicted diagnostic group membership.</p><p><strong>Conclusions: </strong>It was uncommon for older adults to have two or more change scores fall below the 5^th percentile thresholds in a seven-test battery. Higher change counts may identify those showing atypical cognitive decline.</p>","PeriodicalId":49995,"journal":{"name":"Journal of the International Neuropsychological Society","volume":" ","pages":"944-953"},"PeriodicalIF":2.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disturbances in higher order consciousness encountered in neuropsychological rehabilitation and assessment.","authors":"George P Prigatano","doi":"10.1017/S1355617724000705","DOIUrl":"10.1017/S1355617724000705","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this invited paper was to summarize my clinical research on disturbances of higher order consciousness (i.e., primarily on self-awareness but including anosognosia and impaired awareness of another person's cognitive/emotional state) that contributed to my receiving the Distinguished Career Award from the International Neuropsychology Society.</p><p><strong>Methods: </strong>I reviewed my early clinical encounters with disturbances in higher order consciousness and then a series of studies performed with various colleagues over the last 45 years to better understand the nature of these disturbances. The findings obtained are also discussed within the context of other researchers' observations during this time frame.</p><p><strong>Results: </strong>Disturbances in higher order consciousness include classic anosognosia, impaired self-awareness, denial of disability, and denial of ability. Proposed diagnostic features of each of these disturbances are outlined and a model for understanding their complex relationships suggested. Different treatment/rehabilitation approaches for these disturbances are also summarized.</p><p><strong>Conclusion: </strong>Disturbances in higher order consciousness are often revealed when exploring with the person their subjective experiences of their neurological and neuropsychological functioning following different brain disorders. These subjective experiences have diagnostic value and lead to different rehabilitation approaches. The neuropsychological investigation of disturbances in higher order consciousness should include integrating knowledge from the neurosciences with nonbiological understandings of how cultural and personality features of the person may also influences their subjective experiences associated with a known or suspected brain disorder.</p>","PeriodicalId":49995,"journal":{"name":"Journal of the International Neuropsychological Society","volume":" ","pages":"913-922"},"PeriodicalIF":2.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}