No abstract

By 2050, the US older adult population will have doubled to 83.7 million people from earlier in this century, and the workforce is woefully underprepared to meet the mental health needs of this population. Professional geropsychology has developed comprehensive geropsychology competencies for specialists. Generalists are unlikely to attain full specialty geropsychology competency, however, and there has been little guidance on what core knowledge is key for those who treat a small number of older adults, or how much training is needed. Based on a survey of geropsychology experts, this article presents recommendations for foundational knowledge competencies at the basic “Exposure” level of training for any psychologist who serves older adults along with recommendations for continuing education training time allocation.

Objective We investigated the viability of psychometrically robust executive function measures as markers for premanifest Huntington’s disease (HD). Methods Fifteen premanifest HD subjects and 42 controls were compared on the NIH EXAMINER executive function battery. This battery yields an overall Executive Composite score, plus Working Memory, Cognitive Control, and Fluency Scores that are measured on psychometrically matched scales. The scores were correlated with two disease markers, disease burden and striatal volumes, in the premanifest HD subjects. Results The premanifest HD subjects scored significantly lower on the Working Memory Score. The Executive Composite positively correlated with striatal volumes, and Working Memory Score negatively correlated with disease burden. The Cognitive Control and Fluency Scores did not differ between the groups or correlate significantly with the disease markers. Conclusions The NIH EXAMINER Executive Composite and Working Memory Score are sensitive markers of cognitive dysfunction, striatal volume, and disease burden in premanifest HD.

Background Cerebrospinal fluid (CSF) proteins have become accepted biomarkers for Alzheimer’s disease (AD) in research settings. The extent of their use, perceived utility, and influence on decision making in clinical settings, however, is less well studied. Methods Clinicians who evaluate older adults (N = 193) were randomized to view normal, borderline, AD-consistent, or no CSF information in two vignettes portraying patients with borderline and mild AD symptoms. Clinicians also reported on the use and perceived utility of CSF biomarkers. Results Even though clinicians reported infrequent use and low perceived utility of CSF biomarkers, viewing AD-consistent CSF values made clinicians more likely to make an AD-related diagnosis, increased diagnostic confidence, and led clinicians to initiate treatment more often than clinicians who had no CSF information. Conclusions CSF biomarkers influence decision making depending on the extent to which biomarkers reflect AD pathology, consistency between clinical-pathological information, and the ambiguity of protein values.