2.5 CE Credits: JINS Special Issue: INS 50th Anniversary - Neurological Disorders (JINS 23:9-10, 2017): CE Bundle 2

apa-logo_white_screenThe International Neuropsychological Society is approved by the American Psychological Association to sponsor continuing education for psychologists. The International Neuropsychological Society maintains responsibility for this program and its content.
Educational Objectives
  1. Discuss major changes in the neuropsychology of epilepsy over the last several decades.
  2. Describe major scientific advances in research on traumatic brain injury (TBI)
  3. Describe underlying pathophysiology and biomarker techniques to detect Alzheimer’s disease in its earliest stages.
  4. Describe current knowledge in the neuropsychological assessment and treatment of cognitive dysfunction in adult and pediatric MS patients.

Course Information
Target Audience:Intermediate
Availability:Date Available: 2018-03-19
You may obtain CE for this JINS package at any time.
Offered for CEYes
CostMembers $25
Non-Members $37.50
Refund PolicyThis JINS package is not eligible for refunds
CE Credits2.5


The International Neuropsychological Society is celebrating its 50th anniversary (1967-2017). Over the course of these 50 years, members of the society have made great strides in advancing our knowledge of the workings of the human brain both in health and in disease. For the past 2 decades, many of these advances have appeared in the society’s flagship scientific outlet, the Journal of the International Neuropsychological Society. To commemorate the INS 50th anniversary, the two previous JINS editors, Igor Grant and Kathleen Haaland, joined the current editor, Stephen Rao, in organizing this special double issue of JINS. We have invited some of our leading senior investigators, most of whom have served in leadership positions in the INS, to write reviews in their areas of expertise. These reviews are designed to highlight scientific discoveries that have contributed to progress in the field of neuropsychology over the past 50 years. The authors were instructed to selectively discuss landmark discoveries that have had a lasting impact in advancing scientific knowledge rather than to provide comprehensive literature reviews. In addition, the authors were asked to provide their predictions regarding scientific directions of their field over the coming decade.

The papers reflect in a remarkable way the evolution of neuropsychology over the past 5 decades. There is a movement from viewing neurocognitive change from a static anatomic perspective to one that embraces the notion of functional connectivity within neural circuits, and considers how imbalances in circuitry crosstalk may be reflected in the kinds of processes that we neuropsychologists study, for example, executive function, components of memory and attention, and so forth. The field of neuropsychology now interacts with technological advances in structural and functional brain imaging, electrophysiological methods, fluid biomarkers (e.g., cerebral spinal fluid), and genetics, to name a few. The increased emphasis on observational longitudinal designs has provided a more comprehensive understanding of the evolution of neuropsychological disorders. Finally, while neuropsychology has traditionally focused on assessment, each of these reviews also highlight advances made in the treatment of neuropsychological disorders.

We have organized this special issue into four sections: Brain Systems and Assessment, Neurological Disorders, Neuropsychiatric Disorders, and Pediatric Disorders. In the following sections of this introduction, we highlight some of the key take-home messages from these scholarly reviews. It is important to note that all of these invited reviews were peer reviewed and required multiple revisions before acceptance. Another caveat is that we do not pretend to have covered the entire scope of the scientific underpinnings of neuropsychology and we are sure that we have omitted several key research areas in our diverse field. Likewise, we recognize that only a small percentage of our thought leaders in neuropsychology were able to be invited to contribute to this special issue.

Brain Systems And Assessment

In this section, Corballis emphasizes that hemispheric asymmetry exists in great apes as well as humans (although to a lesser extent in the former), is characterized by significant individual variability and complex genetic influences, and encompasses a broader range of functions and associated neural networks than initially thought before more recent neuroimaging studies.

McDonald emphasizes significant developments in our understanding of emotion, including delineation of the neuroanatomical substrates for different aspects of emotion, the influence of emotion on cognitive processes, and the clinical implications of emotion, which necessitate the need to directly examine emotion clinically using newly developed normative procedures.

Verfaellie and Keane discuss a shift toward a more nuanced understanding of the medial temporal lobes (MTL) in human memory and amnesia over the past 30 years. On the one hand, this body of evidence has highlighted that not all types of memory are impaired in patients with MTL lesions. On the other hand, this research has made apparent that the role of the MTL extends beyond the domain of long-term memory, to include working memory, perception, and future thinking.

Dronkers and Baldo emphasize that the study of language has had a major impact on our understanding of brain-behavior relationships. This paper highlights well-known historical case studies with updates using structural MRI and functional imaging in group studies which show that language, like other complex cognitive processes, is dependent upon neural systems rather than single cortical loci.

Stuss and Burgess review how our knowledge of prefrontal functions in the context of neuropsychological assessment has been transformed over the past 50 years with key themes, including development of theoretical frameworks that address the role of prefrontal systems in the organization of human cognition, the importance of naturalistic tests, the emerging integration of functional imaging into clinical practice, and how we might develop new ways to measure executive function to fill existing gaps.

Haaland, Dum, Mutha, Strick, and Troster, a multidisciplinary group of experts in movement and movement disorders, summarize the influence of animal and human studies in showing that the corticospinal tract includes projections from multiple premotor regions as well as the motor cortex, that cognition strongly impacts even what appear to be simple motor skills, and that differential connectivity among cortical, cerebellar, and striatal regions influences normal movement and impairment with movement disorders and cortical lesions.

Casaletto and Heaton identify historical pioneers and their approaches to neuropsychological assessment as well as factors that have influenced neuropsychological interpretation (e.g., normative standards, cultural considerations, quantifying longitudinal change). They also emphasize the importance of enhancing ecological validity and ways that technological advances have impacted assessment.

Neurological Disorders

Hermann, Loring, and Wilson discuss five major paradigm shifts that have occurred within the neuropsychology of epilepsy, including departure from syndrome-specific pathophysiology, bidirectional comorbidities, quality of life, surgical outcomes, and iatrogenic treatment effects. Unlike most other disorders evaluated by neuropsychologists, surgical interventions have played an important role. This review focuses on the neuropsychological consequences of different surgical interventions and the re-emergence of electroencephalography as an important research tool for probing cognitive dysfunction.

Yeates, Levin, and Ponsford highlight progress made through studies of traumatic brain injury in adults and children. The study focuses on contributions of advances in neuroimaging in characterizing the pathophysiology of traumatic brain injury, the impact of non-injury factors on outcomes (pre-morbid factors), and medical and non-medical interventions to improve outcomes.

Bondi, Edmonds, and Salmon survey historical advances in Alzheimer’s disease, beginning with studies profiling the neuropsychological deficits associated with AD and its differentiation from other dementias, identification of specific cognitive mechanisms affected by neuropathological substrates, the shift in focus to the study of prodromal stages of neurodegenerative disease (mild cognitive impairment), and the rise of imaging and other biomarkers to characterize preclinical disease before the development of significant cognitive decline.

Benedict, DeLuca, Enzinger, Geurts, Krupp, and Rao highlight advances made in the areas of neuropathology, neuroimaging, diagnosis, and treatment that pertain to the neuropsychological aspects of multiple sclerosis (MS). This review focuses on the discovery that MS produces pathological lesions of gray matter that have consequences for cognitive functions, the use of multimodal imaging that integrates structural and functional imaging methods to better understand cognitive test performance and functional reserve, screening and comprehensive assessment of cognitive disorders including pediatric MS, and outcome studies in cognitive rehabilitation.

Neuropsychiatric Disorders

Sullivan shows us how early careful observations of neuropsychological patterns in alcoholism led to modern neuroimaging confirmations and deepening understanding not only of the structural neuroanatomy underlying alcoholism, but also to new appreciation of functional connectivity disruptions. Ongoing studies now hope to relate such functional connectivity changes not only to specific cognitive profiles but also to related deficits in self-regulation, impulse control, and reward processing that are linked to such neurocognitive deficits.

Saloner and Cysique summarize the progress from earliest reports of neurocognitive changes, first reported in 1987, to the delineation of the specific syndromes of HIV-associated neurocognitive disorders (HAND). The authors demonstrate that neuropsychology has led the way in appreciating that the brain continues to be affected by the HIV process despite good control of virus by modern antiretroviral treatments; and they note that the consequences of these persisting mild cognitive disorders include disturbance in quality of life and everyday functioning in those affected by HIV.

Waters and Mayberg present depression as a failure in the coordination of distributed frontal networks, and discuss how differential functional brain responses to different therapies, for example, pharamacotherapy versus cognitive behavioral therapy (CBT), provide for a better understanding of the component elements of depression. They suggest that increases in adaptive functionality of dorsal frontal networks controlling attention and executive function may be specifically targeted by CBT, whereas antidepressant drugs may reduce the hyper-reactivity of ventral corticolimbic structures.

Seidman and Mirsky note that the view of schizophrenia has shifted from one of “functional psychosis” (i.e., with no known brain substrate) to that of a neurodevelopmental disorder. Neuropsychological deficits, once viewed as the result of psychosis, are now thought to be a prodrome of the disorder, since they are found many years before the onset of symptoms and occur in biological relatives who never develop psychosis. They note a steady increase in convergence of neuropsychological, structural, and functional brain mapping toward understanding of the neurodevelopmental events that lead to these symptoms, such as perinatal insults, abnormal neural network organization, faulty pruning, and genetic alterations.

Gonzalez, Pacheco-Colón, Duperrouzel, and Hawes address progress in the field of cannabis use, which was just being born 50 years ago when the INS was founded. The earliest reports were a few experimental cognitive studies and case reports. Now, there is a vast neuropsychological literature and, as with studies on alcoholism and depression, an increased emphasis on structural-functional brain correlates and their relation to neurodevelopmental outcomes. While they note that evidence for persisting adverse effects of moderate marijuana use by adults is inconclusive, there is increasing concern that marijuana may not be so benign in children, adolescents, and extremely heavy cannabis users.

Pediatric Disorders

Fein and Helt indicate that the pace of research in autism has accelerated moving from an initial focus on behavior and cognition to advances associated with the incorporation of imaging and genetics. Despite these recent advances, a coherent picture of the syndrome at either a phenotypic or biological level has not emerged. They provide a roadmap for future progress, in which studies include individuals defined by social impairment without regard to repetitive behaviors to form narrowly defined subtypes, focus on characteristics that are less influenced by environmental factors, study children as early as possible thereby minimizing environmental influence, emphasize the longitudinal course, examine the relationship between specific subtypes and environmental risk factors, distinguish between what participants can do and what they typically do, and aggregate large data sets across sites.

Mahone and Denckla review the key literature pertaining to the neuropsychology of attention-deficit hyperactivity disorder (ADHD) over the past 35 years. These include the evolution of the diagnosis, influential theories, landmark treatment studies, and advances in brain mapping techniques, including anatomic, task activation and resting state fMRI, and diffusion tensor imaging. Challenges associated with studying and treating a heterogeneous neurodevelopmental disorder such as ADHD are described, along with an emphasis on associated disorders and conditions and special populations.

Fletcher and Grigorenko make the case that experimental trials of interventions focused on improving academic skills and addressing comorbid conditions are most effective for diagnosing and treating learning disabilities with a particular focus on reading disability. They conclude that neuropsychological assessment needs to move away from a focus on delineation of cognitive skills toward performance-based assessments of academic achievement and comorbid conditions, along with intervention responses that lead directly to evidence-based treatment plans. Finally, they emphasize that the path to further understanding learning disabilities will be strongly influenced by interdisciplinary research that includes the neuropsychologist and links data from cognitive neuroscience with assessment and treatment of these disorders.

Upon reflection of the articles contained within this special issue, we believe members of the INS will be proud of the many scientific accomplishments that have occurred over the past 50 years of our society’s existence. We are also assured that the future will see even greater scientific innovation in the field of neuropsychology. We think you will agree.

On a closing sad note, Larry Seidman, an Associate Editor of JINS and a co-author of the review on schizophrenia in this special issue, died unexpectedly in September 2017. We will miss this valued friend and colleague, who has made such important discoveries in the neuropsychology of mental health research.

Individual Titles, Authors, and Articles:

Paradigm Shifts in the Neuropsychology of Epilepsy
  • Bruce Hermann | Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison Wisconsin
  • David W. Loring | Departments of Neurology and Pediatrics, Emory University School of Medicine, Atlanta Georgia
  • Sarah Wilson | Department of Psychology, Melbourne University, Melbourne, Australia



This article reviews the major paradigm shifts that have occurred in the area of the application of clinical and experimental neuropsychology to epilepsy and epilepsysurgery since the founding of the International Neuropsychological Society. The five paradigm shifts discussed include: 1) The neurobiology of cognitive disordersin epilepsy – expanding the landscape of syndrome-specific neuropsychological impairment; 2) pathways to comorbidities: bidirectional relationships and their clinicalimplications; 3) discovering quality of life: The concept, its quantification and applicability; 4) outcomes of epilepsy surgery: challenging conventional wisdom;and 5) Iatrogenic effects of treatment: cognitive and behavioral effects of antiepilepsy drugs. For each area we characterize the status of knowledge, the key developmentsthat have occurred, and how they have altered our understanding of the epilepsies and their management. We conclude with a brief overview of where we believe the fieldwill be headed in the next decade which includes changes in assessment paradigms, moving from characterization of comorbidities to interventions; increasing developmentof new measures, terminology and classification; increasing interest in neurodegenerative proteins; transitioning from clinical seizure features to modifiable riskfactors; and neurobehavioral phenotypes. Overall, enormous progress has been made over the lifespan of the INS with promise of ongoing improvements in understandingof the cognitive and behavioral complications of the epilepsies and their treatment. (JINS, 2017, 23, 791–805)

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The Neuropsychology of Traumatic Brain Injury: Looking Back, Peering Ahead
  • Keith Owen Yeates | Department of Psychology, Hotchkiss Brain Institute, & Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
  • Harvey S. Levin | Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, and the Michael E. De Bakey Veterans Affairs Medical Center, Houston, Texas
  • Jennie Ponsford | School of Psychological Sciences, Monash University & the Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Victoria, Australia

E-mail address | kyeates@ucalgary.ca

The authors have no conflicts of interest to report.


The past 50 years have been a period of exciting progress in neuropsychological research on traumatic brain injury (TBI). Neuropsychologists and neuropsychological testinghave played a critical role in these advances. This study looks back at three major scientific advances in research on TBI that have been critical in pushing the fieldforward over the past several decades: The advent of modern neuroimaging; the recognition of the importance of non-injury factors in determining recovery from TBI;and the growth of cognitive rehabilitation. Thanks to these advances, we now have a better understanding of the pathophysiology of TBI and how recovery from the injuryis also shaped by pre-injury, comorbid, and contextual factors, and we also have increasing evidence that active interventions, including cognitive rehabilitation,can help to promote better outcomes. The study also peers ahead to discern two important directions that seem destined to influence research on TBI over the next 50years: the development of large, multi-site observational studies and randomized controlled trials, bolstered by international research consortia and the adoptionof common data elements; and attempts to translate research into health care and health policy by the application of rigorous methods drawn from implementation science.Future research shaped by these trends should provide critical evidence regarding the outcomes of TBI and its treatment, and should help to disseminate and implementthe knowledge gained from research to the betterment of the quality of life of persons with TBI. (JINS, 2017, 23,806–817)

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Alzheimer’s Disease: Past, Present, and Future
  • Mark W. Bondi | Department of Psychiatry, University of California San Diego, School of Medicine, La Jolla, California, Veterans Affairs San Diego Healthcare System, San Diego, California
  • Emily C. Edmonds | Department of Psychiatry, University of California San Diego, School of Medicine, La Jolla, California, Veterans Affairs San Diego Healthcare System, San Diego, California
  • David P. Salmon | Department of Neurosciences, University of California San Diego, School of Medicine, La Jolla, California

E-mail address | mbondi@ucsd.edu

The other authors report no disclosures.


Although dementia has been described in ancient texts over many centuries (e.g., “Be kind to your father, even if his mind fail him.” – Old Testament: Sirach 3:12), ourknowledge of its underlying causes is little more than a century old. Alzheimer published his now famous case study only 110 years ago, and our modern understandingof the disease that bears his name, and its neuropsychological consequences, really only began to accelerate in the 1980s. Since then we have witnessed an explosionof basic and translational research into the causes, characterizations, and possible treatments for Alzheimer’s disease (AD) and other dementias. We review this lineageof work beginning with Alzheimer’s own writings and drawings, then jump to the modern era beginning in the 1970s and early 1980s and provide a sampling of neuropsychologicaland other contextual work from each ensuing decade. During the 1980s our field began its foundational studies of profiling the neuropsychological deficits associatedwith AD and its differentiation from other dementias (e.g., cortical vs. subcortical dementias). The 1990s continued these efforts andbegan to identify the specific cognitive mechanisms affected by various neuropathologic substrates. The 2000s ushered in a focus on the study of prodromal stages ofneurodegenerative disease before the full-blown dementia syndrome (i.e., mild cognitive impairment). The current decade has seen the rise of imaging and other biomarkersto characterize preclinical disease before the development of significant cognitive decline. Finally, we suggest future directions and predictions for dementia-relatedresearch and potential therapeutic interventions. (JINS, 2017, 23, 818–831)

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Neuropsychology of Multiple Sclerosis: Looking Back and Moving Forward
  • Ralph H.B. Benedict | Department of Neurology, University of Buffalo, Buffalo, New York
  • John DeLuca | Kessler Foundation, West Orange, New Jersey; Rutgers New Jersey Medical School, Newark, New Jersey
  • Christian Enzinger | Research Unit for Neuronal Repair and Plasticity, Department of Neurology, Medical University of Graz, Austria
  • Jeroen J.G. Geurts | Department of Anatomy & Neurosciences, VU University Medical Center, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
  • Lauren B. Krupp | NYU Langone Multiple Sclerosis Comprehensive Care Center, Department of Neurology, New York University Langone Medical Center, New York, New York
  • Stephen M. Rao | Schey Center for Cognitive Neuroimaging, Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio

E-mail address | raos2@ccf.org

Dr. Benedict has received honoraria, royalties or consulting fees from Abbvie, Biogen, EMD Serono, Genentech, Genzyme, Novartis, Psychological Assessment resources, Roche, Sanofi, Consortium of MS Centers, International Neuropsychological Society and research funding from the National Multiple Sclerosis Society, Biogen, Accorda, Genzyme, and Novartis. Dr. DeLuca has received honoraria, royalties or consulting fees from Biogen, EMD Serono, Consortium of Multiple Sclerosis Centers, International Neuropsychological Society and research funding from the National Institutes of Health, U.S. Department of Defense, National Multiple Sclerosis Society, Consortium of Multiple Sclerosis Centers, and Biogen. Dr. Enzinger has received funding for travel and speaker honoraria from Biogen, Bayer Schering Pharma, Merck Serono, Novartis, Shire, Genzyme and Teva Pharmaceutical Industries Ltd./sanofi-aventis; received research support from Merck Serono, Biogen, and Teva Pharmaceutical Industries Ltd./sanofi-aventis; and serves on scientific advisory boards for Bayer Schering Pharma, Biogen, Merck Serono, Novartis, Roche and Teva Pharmaceutical Industries Ltd./sanofi-aventis. Dr. Geurts has received honoraria, research grants and/or consulting fees from Biogen, Genzyme, Novartis, the Dutch MS Research Foundation, National MS Society, Canadian MS Society, and the Dutch Royal Society of the Arts & Sciences. M Dr. Krupp has received honoraria, royalties or consulting fees from Abbvie, Eisai, Biogen, Merck, Novartis, Pfizer, Redhill pharmaceuticals, Reata, Sanofi, Gerson Lehman, and research funding from the U.S. Department of Defense, National Multiple Sclerosis Society, Novartis, Biogen and the Lourie Foundation. Dr. Rao has received received royalties from the Cleveland Clinic for licensing Multiple Sclerosis Performance Test-related technology, which includes the Processing Speed Test; honoraria, royalties or consulting fees from Biogen, Genzyme, Novartis, American Psychological Association, International Neuropsychological Society; and research funding from the National Institutes of Health, U.S. Department of Defense, National Multiple Sclerosis Society, CHDI Foundation, Biogen, and Novartis.


The neuropsychological aspects of multiple sclerosis (MS) have evolved over the past three decades. What was once thought to be a rare occurrence, cognitive dysfunctionis now viewed as one of the most disabling symptoms of the disease, with devastating effects on patients’ quality of life. This selective review will highlight majorinnovations and scientific discoveries in the areas of neuropathology, neuroimaging, diagnosis, and treatment that pertain to our understanding of the neuropsychologicalaspects of MS. Specifically, we focus on the recent discovery that MS produces pathogical lesions of gray matter (GM) that have consequences for cognitive functions.Methods for imaging these GM lesions in MS are discussed along with multimodal imaging studies that integrate structural and functional imaging methods to providea better understanding of the relationship between cognitive test performance and functional reserve. Innovations in the screening and comprehensive assessment ofcognitive disorders are presented along with recent research that examines cognitive dysfunction in pediatric MS. Results of innovative outcome studies in cognitiverehabilitation are discussed. Finally, we highlight trends for potential future innovations over the next decade. (JINS, 2017, 23,832–842)

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