This debate considers the fundamental issues with respect to developing and using a neuropsychological test across cultures. Can such a test exist? Can it validly assess fundamental cognitive abilities in peoples with vastly differing cultural experiences. Would such a test provide valid outcomes for the people who are assessed?

Research on cognitive rehabilitation in acquired neurological conditions such as stroke, traumatic brain injury, and multiple sclerosis has flourished in the last decade, with evidence accumulating for a range of intervention types. However, demonstrating the real-world, everyday impact of cognitive rehabilitation interventions for individuals and families remains challenging. Ideally, measures to evaluate the outcomes of cognitive interventions should be meaningful and relevant to client goals, as well as reliable and valid. Within the World Health Organisation’s International Classification of Functioning framework, this means that even if the intervention targets an impairment (i.e., the Bodily Functions and Structures level of the framework), the outcomes of the intervention should also be measured at the levels of activity and participation. However, while impairment-based outcome measures (e.g., performance on cognitive tests) are well established and frequently used, there are fewer options to measure activity and participation outcomes in a manner that is both valid and relevant to the intervention target. Additionally, the more distal the outcome being measured is from the specific target of the intervention, the smaller the likely treatment effect and therefore the larger the sample size required to demonstrate that effect. This is often not feasible when working with clinical populations without the support of a difficult-to-obtain large grants. Measuring goal attainment, for example using Goal Attainment Scaling (GAS), is a clinically useful way to capture progress on personally meaningful outcomes, but can be difficult to rate objectively and reliably.

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These issues have led to high variability in the outcome measures used across cognitive rehabilitation trials. In turn, this has complicated the process of evidence synthesis, which means that clinical guidelines often result in weak or consensus-based recommendations. While efforts have been made by researchers to compile lists of recommended outcome measures to use when evaluating neuropsychological interventions, these tend to be specific to a particular condition (e.g., traumatic brain injury), and not consistently applied by researchers. In this roundtable discussion, we aim to i) identify the key issues to be considered in selecting outcome measures for cognitive rehabilitation trials across different acquired neurological conditions, ii) work towards consensus in recommending meaningful, valid outcome measures that are most likely to detect treatment effects of interest, and iii) identify strategies for implementing more consistent use of recommended outcome measures in future cognitive rehabilitation trials and clinical practice.

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Forgetting is an integral part of memory that should not be conceived as the opposite of learning but should be given the dignity of independent cognitive function. However, determining whether people with different levels of acquisition forget material at a different rate once it has been acquired varies according to the adopted method of scoring. This is a problem both for theories and clinical assessment.

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Dr Katrin Seeher is a Mental Health Specialistworking in WHO’s Brain Health Unit. Originally trained as psychologist, she hasbeen working with people with dementia and their families prior to joining WHOin 2016. 

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At WHO, Katrin is responsible for theimplementation of the global action plan on the public health response todementia 2017-2025 and its monitoring framework, the Global DementiaObservatory (GDO). She is the focal point for data and measurement within theBrain health unit and led the development of WHO’s recent report on measuringbrain health in early life.  She also coordinated the development of WHO’sposition paper on optimizing brain health across the life course and has beenassisting Member States in developing comprehensive national responses todementia and other neurological disorders since 2016.

With the global push towards implementing values of diversity, inclusion and equity, this panel discussion will engage with the audience on the application of these principles to neuropsychology research and practice. It will focus on the phenomenal experience and systemic undercurrents of equity, diversity and inclusion in the field. The panel will cover a breadth of topics, including gender diversity, implicit biases and interrogating top-down and bottom-up approaches. In addition, we will adopt a co-design framework whereby we encourage input from the participants. This panel is led by early career psychologists (ECPs) from historically underrepresented groups who are Editorial Fellows for the American Psychological Association journal Neuropsychology. Members include: Ashley Danguecan, Michelle Chen, Anthony Correro, Sahba Besharati, Naddley Desire, Tomiko Yoneda.

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In this symposium, we will review example topics in psychiatry and neuropsychiatry where cognitive/neuropsychological approaches can make important contributions to understanding. Michael Connors will review cognitive approaches to delusions, arising in schizophrenia and other psychiatric disorders. He will consider one-factor and two-factor theories, noting the key assumptions and limitations of these approaches. He will propose a cognitive account based on a model of belief formation, illustrated by reference to clinical cases and the broader literature. Natalia Ojeda del Pozo will examine ‘negative’ and cognitive symptoms in schizophrenia by reference to findings in a large investigation of rehabilitation. She will argue that this study provides evidence for the efficacy of integrative cognitive remediation on both negative symptoms and creativity, with implications for epidemiology and therapeutic approaches. Stephen Jackson will consider cognitive and neurobiological aspects of urges-for-action. Unwanted, involuntary thoughts and actions are observed in a wide range of neuropsychological and neurodevelopmental conditions, including tic disorders, Tourette syndrome, obsessional compulsions, and perhaps the ‘controlled’ volitions, actions, and affect sometimes occurring under the label of schizophrenia. There may be a common underlying neuropathology and functional anatomy for such urges-to-action, and the talk will provide an overview of such neuropsychology and pathophysiology. Finally, Michael Kopelman will describe a large study of psychogenic amnesia (aka. ‘dissociative’ or ‘functional’ amnesia). This investigation adopted a neuropsychological approach to the assessment, follow-up, and conceptualisation of different varieties of the disorder. An explanatory account will be postulated, which incorporates the best of older and contemporary theory.

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Acquired brain injury (ABI) represents a major global health concern and the public health burden is disproportionally high in children. Ensuring best-practice rehabilitation for children and adolescents with ABI relies on implementing up-to-date research evidence into everyday clinical practice. However, there are persisting challenges to delivering evidence-informed care across paediatric rehabilitation services. Integrated knowledge translation approaches that actively involve children, families, rehabilitation clinicians, and other partners are increasingly being used to design and implement evidence-informed interventions to improve outcomes for children with acquired brain injury. This symposium will bring together paediatric clinical neuropsychology researchers from Norway, Canada, and Australia. The presenters will share practical examples of how they have used integrated knowledge translation approaches to co-design, implement, and evaluate interventions. They will discuss the strengths of these approaches, as well as the challenges experienced. Ways ahead to improve paediatric rehabilitation for children with ABI will be considered.

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The main objective of the symposia is to integrate researchers from different countries to discuss models of neuropsychological assessment and intervention in social cognition that take into account ethnic, cultural, linguistic, gender, social class and other diversities to promote equity in the field of neuropsychology. The symposium will also address the social determinants associated with adversity and their impact on social cognition abilities through a life span perspective.

The advent of neuroimaging, particularly structural and functional magnetic resonance imaging (MRI), has significantly advanced our understanding of brain-behavior relationships. The last decade has witnessed an exponential growth in the use of structural and functional MRI by neuropsychologists to more accurately characterize the neural correlates of cognitive functioning. These techniques are also increasingly being employed to examine changes in the structural and functional reorganization of the brain following injury, disease, and neurorehabilitation. In this symposium, we will discuss how novel advances in structural and functional MRI technology and analyses can be leveraged to further our understanding of brain-behavior relationships. Throughout the talks in this symposium, we will highlight the role of distributed regions and brain networks in supporting complex cognitive functioning. We will emphasize the need for future neuroimaging studies to include a better representation of minoritized participants to build generalizable models of brain-behavior relationships. Additionally, we will underscore the need for a more systematic integration of structural and functional MRI studies to comprehensively investigate the neural correlates of cognitive functioning.

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