Keynote address: Alex Troster

CHALLENGES AND OPPORTUNITIES FOR NEUROPSYCHOLOGY IN A WORLD OF NEW TECHNOLOGIES

Rapid neuroscience and technological advances herald a departure of some of neuropsychology’s traditional roles in health care but opens many new opportunities. Just as clinical neuropsychology has thrived decades after its use for determining the presence and location of a brain lesion faded with the advent of modern neuroimaging, so will neuropsychology thrive in an era when test administration is largely automated and its roles will likely increasingly involve early cognitive change detection, evaluation of therapies’ safety and efficacy, and selection of candidates for various treatments. Activities such as brain mapping for surgery and determination of language dominance are likely to remain neuropsychologist activities for some time. New roles will include participation in clinical trials design, behavioral medicine interventions for patients with cognitive compromise (e.g., medication adherence, exercise promotion to reduce risk of vascular disease), and incorporation of genetics and biomarkers into understanding of brain-behavior relationships and cognitive processes. Challenges facing clinical neuropsychology have traditionally centered around the availability and reimbursement for services and, in the US,  the assumption of testing roles by technicians/psychometrists and computers; neuropsychologists have become quite adept at dealing with these issues and examples of collaboration with payers and development of testing guidelines will be described. New challenges will be to train a new generation of neuropsychologists with technological, biological, and clinical expertise relevant to a new world technology and public health and health care cost reduction. The academician will have many new tools to test cognitive theories and to participate in translational research, adapting animal findings to bedside. To highlight some of these roles, examples of applications of neuropsychology to neurotherpeutic technology will be selected from studies in movement disorders.

Cognitive Impairments in Movement Disorders: Alex Troster

Alex Troster will be presenting the following 3-hour workshop at our conference in November.

COGNITIVE IMPAIRMENTS IN MOVEMENT DISORDERS

Much research continues to be devoted to the early diagnosis and treatment of the most common dementia, Alzheimer’s disease. In the last two decades, however, increasing attention has been paid to what were traditionally referred to as “subcortical dementias,” Parkinson’s disease (PD) dementia (PDD) and the rarer dementia associated with Huntington’s disease (HD). The first part of this workshop will deal with the rarer HD and atypical parkinsonian syndromes such as progressive supranuclear palsy, corticobasal degeneration, and multiple system atrophy. In the case of HD, particular emphasis will be placed on preclinical neuropsychological characteristics and recent questions about the implications of an “indeterminate” number of CAG repeats. Recent AAN treatment guidelines will also be summarized. For each atypical parkinsonian disorder recent advances in understanding the neural substrates of the disorder (including neuroimaging findings) and treatments are discussed. The neuropsychological differentiation of tauopathies from alpha synucleinopathies, and atypical from typical parkinsonian syndromes will be highlighted. Neuropsychological profiles of some clinical cases will be discussed. The second half of the workshop deals with PD and, consistent with recent research, emphasis is placed on mild cognitive impairment, potential imaging and biomarkers (e.g., beta amyloid and phosphorylated tau), and outcomes of treatments such as gene therapy and deep brain stimulation. The neuropsychological features associated with early dopaminergic deficits are described and differentiated from those probably related to other neurotransmitter abnormalities. Recent diagnostic criteria for PD MCI, and the special emphasis of neuropsychology in them, will be described.