International Neuropsychological Society
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International Neuropsychological Society
42nd Annual Meeting

February 12-15, 2014
Sheraton Seattle Hotel
Seattle, Washington

Program Chair: Jennifer Vasterling
Continuing Education Chair: Raul Gonzalez

 

In keeping with the rich clinical science emphasis of INS, the theme for the 42nd Annual Meeting will be
Translating Evidence into Practice.

Keynote Addresses:
Laurence Steinberg, Ph.D.

Birch Lecture:  “A Social Neuroscience Perspective on Adolescent Risk-Taking”

Many forms of risky and reckless behavior are more common during middle and late adolescence than before or after. Conventional psychological explanations of this age trend have not held up to empirical test. This course will review recent findings from studies of adolescent brain development and illustrate the significance of this body of work for understanding adolescent risk-taking. The course first presents a model of adolescent risk-taking that links the behavior to a developmental mismatch between a highly aroused incentive processing system and a still maturing cognitive control system. Second, a program of empirical research in support of this model will be presented. Third, research showing how adolescents’ inclinations toward risky behavior are exacerbated by the presence of peers will be presented. Finally, the implications of this work for policy and practice will be discussed.

Jennie Ponsford, Ph.D.

INS Presidential Lecture: " Traumatic Brain Injury - The Challenge to Improve Outcome"

Traumatic brain injury (TBI) presents a number of unique challenges. It occurs most often in young people who are still establishing their independence and relationships and completing educational or vocational training, and who may have pre-existing social or psychiatric problems.  It has diffuse and variable effects on the brain. Outcome studies show good independence in mobility and activities of daily living, but persisting difficulties with complex community-based activities, employment, study and personal and social relationships. Underpinning these difficulties are impairments of memory, attention, executive functions and behavioural control, with fatigue, sleep disturbance, anxiety and depression also associated with poor participation.  In order to improve patient outcomes it is essential that we develop evidence-based methods of addressing each of these problems, whilst also focusing on individually meaningful goals and maximising family adjustment. Intervention studies addressing each of these core problems will be discussed.

John Whyte, M.D., Ph.D.

“Toward the Development of a Rehabilitation Treatment Taxonomy: a Conceptual Framework”.

Treatments must be clearly defined to be subjected to efficacy research, to allow replication of positive findings, and to facilitate dissemination of proven treatments to clinical practitioners. Yet, outside of pharmacologic treatments, there is no accepted system for defining and classifying treatments. Attempts to define rehabilitation sometimes settle simply for measures of quantity of contact (e.g., hours of “neuropsychological rehabilitation”) without regard to the activities conducted during that contact time. Alternatively, treatments may be defined by the goal they are intended to achieve (e.g., “memory remediation treatment”) potentially mixing vastly different treatment approaches as long as they hope to achieve a similar outcome. Neither of these approaches serves the above purposes. In this presentation I will discuss the work of a project attempting to develop a rehabilitation treatment classification system that is based on known of hypothesized active ingredients and, thus, aims to ultimately map onto empirical data about efficacy or inefficacy of those ingredients. The presentation will summarize the need for such a system, the many conceptual challenges that arise in attempting to develop an ingredients-based taxonomy, and the current state of attempts to address those challenges. Although the proposed approach aims to provide an organizing framework for rehabilitation treatment definition generally, specific challenges relevant to neuropsychological rehabilitation – where many of the relevant constructs are hypothetical and indirectly measurable – will be emphasized.

Glenn Smith, Ph.D.

"Mild Cognitive Impairment Comes of Age”

Recently, the American Psychiatric Association published new criteria for minor neurocognitive disorder and National Institute on Aging-Alzheimer’s Association task forces released their proposed new criteria for Mild Cognitive Impairment (MCI) due to Alzheimer’s disease. The American Psychological Association’s updated its guidelines for the assessment of cognitive aging and dementia specifically references MCI.  Early detection of Lewy Body disease, frontotemporal dementia and vacular cognitive impairment is increasingly possible.  The concept of MCI has clearly been embraced in research and practice.  Nevertheless, discrepancies still exist about the incidence, prevalence, rates of progression, and the utility of diagnosing the MCIs.  This talk will discuss actors that contribute to the discrepancies.   In addition, the utility of MCI as an opportunity for early intervention will be discussed.

Simon Baron-Cohen, Ph.D.

“Why is Autism More Common in Males?”

Autism affects males much more often than females. In classic autism it is about 4:1 (male: female) whilst in Asperger Syndrome (AS) it is about 9:1. Under-diagnosis of females with AS due to better imitation and language skills, and greater social motivation to ‘camouflage’, may mean the true sex ratio in AS is closer to 4:1, but the male-bias needs an explanation. Hormones (e.g., the steroid hormones that brain development) and/or genetics (e.g., X-linked genes, or genes regulating and regulated by the steroid hormones) are strong candidate factors. Here I summarize work from our lab suggesting one steroid hormone, testosterone, measured in the womb is associated with individual differences in typical children’s language and social skills, attention to detail and narrow interests, autistic traits, and later brain structure and function. A new large-scale study in collaboration with Denmark is testing if elevated prenatal steroids are associated with autism itself. Finally, evidence of steroid hormone dysregulation in autism and their family relatives is reviewed. A baby’s sex steroid hormones are a key part of the puzzle of autism.

Michael McCrea, Ph.D.

“Update on Acute Effects and Early Recovery after Mild TBI:  Lessons  from Sports Concussion Research”

The diagnosis and treatment of mild traumatic brain injury (mTBI) have historically been hampered by an incomplete base of scientific evidence to guide clinicians. Fortunately, the science of mTBI has advanced more in the last decade than in the previous 50 years, and now reaches a maturity point to drive an evidence-based approach to clinical assessment, management, and rehabilitation.   Sport-related concussion has proven to be a valuable laboratory for the study of mTBI, yielding many seminal findings that have advanced our clinical and scientific understanding of mTBI.  Collectively, findings from clinical and basic science now establish a foundation on which to build integrative theories and testable hypotheses around a comprehensive model of mTBI recovery.  This symposium will summarize the latest evidence on the natural time course of acute clinical and physiological effects and recovery after mTBI, as well as integration of the evidence toward a neurobiopsychosocial model of mTBI. Discussion will focus on the translational significance of findings from the sports concussion research model to our broader scientific understanding of mTBI.  

Andrew Saykin, Psy.D.

“Age-Related Memory Decline:  New Insights from Imaging, Genetics and Biomarkers”

Recent evidence indicates that Alzheimer’s disease (AD) develops over 1-2 decades prior to diagnosis. Although there is clearly heterogeneity, in the canonical case there is likely to be an asymptomatic phase, followed by subjective cognitive decline, mild cognitive impairment and ultimately dementia. Advances in neuroimaging, biomarkers and genetics are rapidly contributing to progress in understanding the neural basis of prodromal cognitive changes in those at risk for AD. The combination of multi-modality imaging (MRI and PET) with genetics, fluid biomarkers (blood, CSF) and cognitive assessment, especially in a longitudinal framework, has proven to be a powerful research paradigm. The Alzheimer’s Disease Neuroimaging Initiative (ADNI) and related large scale studies provide extraordinary opportunities to longitudinally examine the relationship between memory and other cognitive domains with MRI, PET, fluid and genetic biomarkers. Selected examples using structural, functional and molecular biomarker data as quantitative phenotypes to probe the role of genetic variation in age-related memory changes will be presented including candidate gene, genome-wide association studies (GWAS) and exome sequencing. ADNI just completed whole-genome sequencing (WGS) on over 800 participants and there are major conceptual and computational challenges related to extracting the most important information from such “big data” sets. There are also controversies regarding return of research results to individuals (what, when & how). In the future personalized medicine of aging and cognitive health, feedback on cognitive function will likely be accompanied by analysis of imaging, biomarkers, genetic risk and tailored therapeutic options. Multidisciplinary expertise will be required and we all need to be ready.

Invited Symposia:  
Chair: Deirdre Dawson, Ph.D.
Participants:
Elizabeth Bromley, Thomas Marcotte, Maureen Schmitter-Edgecomb,
                          Thomas Parsons

"Ecologically Valid Methods of Assessment in Neuropsychology"

Traditional measures of assessment in neuropsychology typically require discrete responses to single events and are conducted in carefully, controlled environments thus limiting their ecological validity (generalizability and representativeness).   This problem gives rise to the question of where a ‘better’ set of assessments might come from.   This course begins by proposing a set of characteristics for ecologically valid assessment.  Second, current research from multi-disciplinary perspectives will be discussed that has aimed to address the problem of developing ecologically valid assessment from four different perspectives: naturalistic assessments (e.g., the Multiple Errands Test), video ethnography, virtual reality (e.g., the Edinburgh Virtual Errands Test) and ‘smart’ environments. Presenters will address the strengths and weaknesses of these approaches in relation to their ability to characterize the impact of cognitive impairment on everyday life and discuss how different cognitive functions contribute to everyday multi-tasking. 

Chair: Sureyya Dikmen, Ph.D.
Participants: Kathleen Bell, Dawn Ehde, Jesse Fann, Nancy Temkin, Charles Bombardier

“Clinical Trials  of Behavioral Interventions in  Neurologic Patients : Developing Evidence”

Symposium Description: While much is known about impairments and disabilities in cognition, emotional health and   functional limitations associated with diseases and insults to the brain, much less is known about how successful cognitive behavioral interventions are in these populations.  In addition, such interventions are outside the reach of many patients due to cost, distance from health care providers, and transportation difficulties.  Tele-health has proven effective in providing medical care but its success in delivering psychological interventions has not been well studied. In this symposium we present four randomized clinical trials primarily delivered by phone. Ehde will present the results of a trial involving treatment of chronic pain in subjects with MS and spinal cord injuries. The other three trials involved subjects with traumatic brain injuries. Fann will present the results of a trial for depression.  Two of the other trials involved patients with moderate to severe traumatic brain injury, treated post acutely and targeting a broad range of difficulties. Dikmen will present the results of the single site and Bell that of the multisite trial.
The results of these studies highlight a number of considerations for future studies of cognitive-behavioral interventions.  Our discussants Charles Bombardier (Psychologist) and Nancy Temkin (Biostatistician) will address the role of non-specific effects and therapeutic relationships in controlled trials, inter-therapist and inter-site variability, and study design issues including choice of comparison treatments and of subjects as well as outcome measures and data analysis approaches. With the current emphasis on evidence-based medicine, we need to learn how to better evaluate treatments that could potentially improve the lives of so many people who have survived traumas and diseases of the brain and are living with their sequelae.

Chair: Raul Gonzalez, Ph.D.
Participants:
Igor Grant, Krista Lisdahl, Susan Tapert, Thomas Marcotte

“Sifting through the Smoke: Uncovering the Impact of Marijuana Use on Neurocognition”

Marijuana use has been on the rise in recent years, accompanied by a rapidly changing legal landscape. Twenty U.S. states have enacted medical marijuana laws, 15 have passed laws that decriminalize marijuana use, and two (Colorado & Washington) have legalized marijuana for recreational use. Several other states are considering changes to their current marijuana laws. Despite potential wide-ranging public health implications, science has not kept pace, but progress in understanding the neurocognitive impact of marijuana use is being steadily made. Thus, it is critically important for clinicians and researchers to understand how marijuana use may affect the neurcogntive functioning of their patients and research participants. This symposium will present cutting-edge findings from several laboratories studying the neurocognitive effects of cannabis use, and will include data collected from adolescents and adults, both when cannabis has been used recreationally or administered in a clinical context (including among persons living with HIV). Dr. Gonzalez will introduce the symposium and lead a presentation on the influences of neurocognitive functioning on symptoms of cannabis addiction and engagement in risky sexual behaviors among emerging adults; Dr. Tapert, will present on neurocognitive consequences of chronic marijuana use specifically among adolescents; Dr. Lisdahl will present on various moderators of marijuana’s neurocognitive effects, including age of onset, gender, lifestyle, and genetics; Dr. Marcotte will present on the neurocognitive and functional impact (e.g., driving performance) of marijuana use when applied in a medical context. The symposium will end with a discussion from Dr. Igor Grant, which will broach the implications of the emerging evidence and future directions.

Featured Debate:  

Moderator: John Whyte, M.D., Ph.D.
Panelists:  Tessa Hart, Jim Malec, Michael Marsiske, Catherine Mateer
                     Leslie Gonzalez-Rothi, Barbara Wilson

“Best Practices for Enhancing Cognitive Recovery: Restoration, Compensation, and can we tell the difference?”

Researchers and clinicians have debated for years the relative merits of attempts to restore impaired cognitive function vs. attempts to provide clients with ways to compensate for those impairments in order to achieve important functional goals. Restorative approaches hold out the promise of a more general benefit, since the restored process, arguably, would result in improvement in a wide range of activities that were formerly limited by the cognitive impairment being treated. Yet many are skeptical that such approaches are effective at all. In contrast, compensations provide more obvious and direct evidence of efficacy (the task that could not be performed before treatment now can be completed), but raise the concern that almost as many compensations may be needed as there are tasks to be performed. Further complicating this debate is the fact that many treatments are difficult to classify clearly as restorative or compensatory. Thus, their efficacy or inefficacy doesn’t clearly settle the controversy. In this debate, 6 clinical and research experts in neuropsychological rehabilitation will address the pros and cons of restorative vs. compensatory approaches to cognitive impairment, as well as the thorny definitional confusion that limits a clear resolution of this issue.


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