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提高神经心理学评估的精度:弥合经典纸笔测试与认知神经科学范式之间的差距。

Improving precision in neuropsychological assessment: Bridging the gap between classic paper-and-pencil tests and paradigms from cognitive neuroscience.

机构信息

a Radboud University, Donders Institute for Brain, Cognition and Behaviour , Nijmegen , the Netherlands.

b Department of Medical Psychology , Radboud University Medical Center , Nijmegen , the Netherlands.

出版信息

Clin Neuropsychol. 2019 Feb;33(2):357-368. doi: 10.1080/13854046.2018.1518489. Epub 2018 Nov 5.


DOI:10.1080/13854046.2018.1518489
PMID:30394172
Abstract

OBJECTIVE: In cognitive neuroscience, well-controlled and highly specific paradigms have been developed to measure cognitive processes over the last decades, often using computer-assisted presentation and response registration. This approach is in contrast with the traditional paper-and-pencil tests used in clinical neuropsychology, which typically assess cognitive function in a less specific manner, often even at the level of a cognitive domain. As a result, important aspects of cognitive (dys)function may be missed during a neuropsychological assessment. This paper focuses on the main challenges that need to be overcome in order to successfully integrate experimental paradigms from cognitive neuroscience into the clinical practice of neuropsychologists. METHOD: Six challenges are discussed: (i) experimental paradigms are often lengthy and may be overly specific; (ii) technical limitations even today hamper their application in clinics; (iii) the psychometric properties of methods used in cognitive neuroscience are under-examined or poor; (iv) many paradigms from cognitive neuroscience rely on reaction times rather than accuracy, limiting their use in the many brain-injured patients with processing speed deficits; (v) the predictive and ecological validity of these paradigms often unclear; (vi) technological progress (e.g. Moore's law) seriously affects the continuous availability of experimental computerized assessment methods. CONCLUSION: Both cognitive neuroscientists and clinical neuropsychologists should work together to develop and validate novel paradigms for use in clinical assessments that are platform-independent, reliable and valid, user friendly and easy to use in clinical practice.

摘要

目的:在认知神经科学领域,过去几十年来已经开发出了许多经过良好控制且具有高度特异性的范式,这些范式通常使用计算机辅助呈现和响应注册来测量认知过程。与传统的纸笔测试相比,这种方法在临床神经心理学中使用得较少,传统的纸笔测试通常以不太特定的方式评估认知功能,甚至在认知域的水平上也是如此。因此,在神经心理学评估中可能会错过认知(功能障碍)的重要方面。本文重点讨论了将认知神经科学中的实验范式成功整合到神经心理学家的临床实践中需要克服的主要挑战。

方法:讨论了六个挑战:(i)实验范式通常很长,可能过于具体;(ii)即使在今天,技术限制也阻碍了它们在临床中的应用;(iii)认知神经科学中使用的方法的心理计量学特性研究不足或较差;(iv)许多来自认知神经科学的范式依赖于反应时间而不是准确性,这限制了它们在许多因处理速度缺陷而导致脑损伤的患者中的应用;(v)这些范式的预测和生态有效性通常不清楚;(vi)技术进步(例如摩尔定律)严重影响了实验计算机化评估方法的持续可用性。

结论:认知神经科学家和临床神经心理学家都应该共同努力,开发和验证用于临床评估的新范式,这些范式应该具有平台独立性、可靠性和有效性、用户友好性和易于在临床实践中使用。

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