Maintenance of Certification: Update on Attitudes of Members of the American Society of Neuroradiology

Emergency Physicians Maintain Performance on the American Board of Emergency Medicine Continuous Certification (ConCert) Examination

Back to table of contents Previous article Next article Education & TrainingFull AccessTime for Recertification? APA Helps You PrepareMark MoranMark MoranPublished Online:18 Mar 2005https://doi.org/10.1176/pn.40.6.00400025Do you need to recertify? You do—every 10 years—if you are a general psychiatrist originally board certified in 1994 or later and you want to maintain your board certification.This year the second class of general psychiatrists to receive their original board certification after the 1994 cutoff will be required to take a closed-book, proctored exam on a computer administered by the American Board of Psychiatry and Neurology (ABPN) to maintain certification.The ABPN does not require general psychiatrists certified prior to 1994 to take the exam to maintain their certification.There are no lifetime certificates for geriatric, forensic, and addiction psychiatry. Time-limited certifications in geriatric psychiatry began in 1991, with the first expirations occurring in 2001; in addiction psychiatry they began in 1993, with the first expirations occurring in 2003.Deborah Hales, M.D., APA's director of Education and Career Development, said the move to require recertification is part of an effort across American medicine to demonstrate the quality and competence of the nation's physicians to policymakers, regulatory agencies, and the public."Failing to recertify in the modern era is likely to be professional suicide," Hales warned. "The entire house of medicine is requiring this as a way to gain back public trust."She said that even psychiatrists who were certified prior to 1994 are not immune from the movement toward "maintenance of certification" since many state boards of medicine may require physicians who do not recertify in their specialty to take a state medical board exam to maintain their licensure."This is coming," Hales said. And, she noted, APA is committed to helping psychiatrists prepare for and pass the exam.In addition to its world-renowned annual meeting, the Association is offering a variety of tools—many of them easily accessible through APA's Web site—to help prepare for recertification. These include "Grand Rounds Online," Focus: A Journal of Lifelong Learning in Psychiatry, and APA's practice guidelines.The 11 practice guidelines published to date represent state-of-the-art understanding about the optimal ways to treat patients with a variety of conditions commonly seen by psychiatrists. Members can access the guidelines online free and earn 3 to 5 CME credits by taking the multiplechoice test that accompanies each. There are also references for additional information on each of the guideline topics.Members already familiar with Focus know it to be a clinical review journal that appears quarterly, with an annual self-assessment examination on the material, also appearing online, at the end of the year. One of the best tools for staying current in psychiatry and preparing for recertification, Focus offers up to 40 CME credits a year.Both the Focus self-assessment exam and the practice guideline CME tests have been approved by the ABPN as part of a "comprehensive lifelong learning and self-assessment program," one of the components of the concept of maintenance of certification being mandated by the American Board of Medical Specialties."Grand Rounds Online" offers another interactive, Web-based vehicle for staying current in psychiatry. Recent courses offered to members via the "Grand Rounds Online" list serve include "From Science to Practice: How to Critically Evaluate the Literature,"" Homophobia," and "Interactions of Physicians and Pharmaceutical Companies." Each program provides free CME for the live or archived discussion.The deadline for this year's recertification exam for general psychiatry has already passed. The deadline for applications for next year's exam—to be held July 31 to August 4, 2006, and August 7 to 11, 2006—is October 1. "APA wants to help our members practice the best medicine possible," said Hales. "And we want to help them pass these exams."APA's CME programs can be accessed online at<www.psych.org/cme/apacme>. Information on the recertification exam and schedules is posted online at<www.abpn.com/recertification/content—psych-recert.html>. Information on maintenance of certification is posted online at<www.abms.org/MOC.asp>.▪ ISSUES NewArchived

Validity Evidence for the General Pediatrics Board Certification Examinations: A Practice Analysis

BackgroundIt has been shown under experimental conditions that cognitive performance, especially working memory, is impaired in type I and type II diabetes during hyperglycemic and hypoglycemic conditions, perhaps due to altered cerebral glucose metabolism. It is not known if patients with neurodegenerative diseases, who also exhibit pathological cerebral glucose metabolism, are affected in a similar manner by their intrinsic plasma glucose levels. We aimed to test if performance on two standard cognitive screening tests is influenced by intrinsic plasma glucose levels in a memory clinic cohort.MethodIn this retrospective study, we included patients from the Copenhagen Memory Clinic Cohort (CMCC) with an available Mini Mental‐State Examination (MMSE) test score and a plasma glucose measurement performed in conjunction with cognitive testing. Patients were included from the inception of the cohort in 2008 till September 2021. We built linear regression models with MMSE and Addenbrooke’s Cognitive Examination (ACE) test scores as the outcome and plasma glucose as the explaining variable and adjusted models for age, sex and diabetes (plasma glucose measurement &gt; 11.1 mmol/L). We explored non‐linear relationships by adding squared terms to the models and by fitting cubic spline regression models.ResultIn total, 2714 patients had an available MMSE score and a plasma glucose measurement. Patients had a mean age of 71.6 years [range 19‐99] and a baseline plasma glucose level of 5.8 mmol/L [range 2.7‐28.1]. A total of 581 of patients had a plasma glucose level outside normal range (&lt;4.2 or &gt;6.3 mmol/L). A total of 31.2% of the cohort studied had a diagnosis of Alzheimer’s disease (AD). MMSE and ACE total scores were not influenced by plasma glucose in a linear nor in a non‐linear fashion, when we adjusted for age, sex and diabetes. Sub‐group analyses in patients with AD and in patients with cerebrovascular disease showed similar results.ConclusionPlasma glucose levels inside normal range were not shown to influence performance on routinely applied cognitive tests and do not need be taken into consideration when interpreting test results from memory clinic patients.

The dementia syndrome encompasses not only cognitive but also functional impairments. This is acknowledged in canonical definitions of dementia (DSM-IV) and major neurocognitive disorder (DSM-5).1 2 However, functional (executive) deficits...

Due to demographic aging, the global prevalence of cognitive disorders is expected to increase significantly over the coming decades. At the same time, migration and globalization are currently changing populations throughout the World. With an increasing number of aging migrants, the prevalence of cognitive disorders will inevitably increase in these populations. This poses challenges to neurological practice, including cross-cultural cognitive examination. In particular, language barriers may pose a complex challenge to cognitive examinations in aging migrants and may necessitate the use of interpreters. Despite the development and implementation of several biomarkers for Alzheimer’s disease and other cognitive disorders, cognitive testing retains a central role in the clinical diagnosis of cognitive disorders. However, many routinely used cognitive tests suffer from both cultural, language, and educational biases which limit their usefulness for the purpose of cross-cultural cognitive examinations. This may be particularly evident in the case of aging migrants with limited schooling and proficiency in the majority language in the receiving country. The use of professional interpreters and cross-cultural tests designed and validated for cognitive examination in aging migrants may help alleviate some of the cultural, language and educational biases. However, several challenges associated with cross-cultural cognitive examination remain unresolved. With increasing demographic aging, migration and globalization, however, researchers and clinicians need to address these challenges, as we must expect experience with cross-cultural cognitive examination to represent an important competence in clinical neurology in the twenty-first century.KeywordsAging migrantsCognitive testingCultureLanguageEducationIlliteracyCross-culturalCognitive disorderDementia

We recently completed an audit on cognitive testing used in routine practice within our Older People Community Mental Health Team in East Dorset, U.K. We measured the frequency of use of the Addenbrooke's Cognitive Examination (ACE) following its introduction as the baseline test for cognition, comparing it to the Mini-mental State Examination (MMSE) (Folstein et al., 1975).

Cognitive screening is recommended in stroke, but test completion may be complicated by stroke related impairments. We described feasibility of completion of three commonly used cognitive screening tools and the effect on scoring properties when cognitive testing was entirely/partially incomplete. We performed a cross-sectional study, recruiting sequential stroke patient admissions from two University Hospital stroke rehabilitation services. We assessed Folstein's mini-mental state examination (MMSE), Montreal cognitive assessment (MoCA) and Addenbrooke's cognitive examination (ACE-III). The multidisciplinary team gave an independent diagnostic formulation. We recorded numbers fully/partially completing tests, assistance and time required for testing. We calculated test discrimination metrics in relation to clinical assessment using four differing statistical approaches to account for incomplete testing. We recruited 51 patients. Direct assistance to complete cognitive tests was required for 33 (63%). At traditional cut-offs, the majority screened "positive" for cognitive impairment (ACE-III: 98%; MoCA: 98%; MMSE: 81%). Comparing against a clinical diagnosis, ACE-III and MoCA had excellent sensitivity but poor specificity. Partial completion of cognitive tests was common (ACE-III: 14/51, MMSE: 22/51; MoCA: 20/51 fully complete); greatest non completion was for test items that required copying or drawing. Adapting analyses to account for these missing data gave differing results; MMSE sensitivity ranged from 0.66 to 0.85, and specificity ranged from 0.44 to 0.71 depending on the approach employed. For cognitive screening in stroke, even relatively brief tools are associated with substantial incompletion. The way these missing data are accounted for in analyses impacts on apparent test properties. When choosing a cognitive screening tool, feasibility should be considered and approaches to handling missing data made explicit. Copyright © 2016 John Wiley & Sons, Ltd.

Taking virtual reality out of the game and into healthcare.

The purpose of this study was to investigate the relationship of light and strenuous exercise, and self-reported change in exercise status, with different components of cognitive function, and gender differences in this relation, in a large, representative sample included in the Swedish National study on Aging and Care (SNAC). Eight-hundred-and-thirteen participants in age-cohorts from 60–96 years completed a wide range of cognitive function tests, the Mini Mental State Exam (MMSE) and survey questions concerning exercise behaviour and exercise change with light or strenuous intensity. ANCOVA, controlling for age, education, depression, functional status and co-morbidity, demonstrated a main effect for light exercise, but not for strenuous exercise, on five of the six cognitive tests and the MMSE, for men but nor for women. A negative change in exercise status was associated with lower MMSE scores for men but not for women. Individuals exercising with light intensity several times a week had the highest cognitive test and MMSE scores and the inactive group had the lowest scores. The results of the study may contribute to increased knowledge in the exercise-mental health relationship for elderly and spawn new research specifically on gender differences in this relation.

The aim of this study was to assess the role of the Addenbrooke's cognitive examination test (ACE-R) in the evaluation of cognitive status in migraineurs interictally. A total of 44 adolescent patients and 44 healthy controls, matched by age and gender, have undergone ACE-R testing. Migraineurs were additionally questioned about migraine aura features and presence of higher cortical dysfunctions (HCD) during an aura. According to the questionnaire results, patients were subsequently divided into HCD and Non-HCD group. ACE-R scores of migraine patients were significantly lower than in healthy controls (93.68±3.64 vs 96.91±2.49; t=4.852, p<0.001). Also, subscores of memory and verbal fluency were significantly higher in the control population. There was no correlation of HCD occurrence with cognitive examination score, although Non-HCD subgroup achieved better score (93.13±3.91 vs 94.29±3.30; t=1.053, p=0.298). Findings have shown that migraineurs get lower ACE-R test scores, with a tendency to have a poorer outcome in more complex aura. Also, our study has revealed that the ACE-R test is an easily administered test for brief assessment of cognitive status in migraineurs. Future perspectives could be further evaluation of ACE-R test in larger sample size and the impact of migraine with aura on cognitive function in adolescents.

Background:Cognitive impairment is common in patients with chronic renal disease and ESRD. Kidney transplantationis considered the treatment of choice in the terminal stage of the disease, but their influence on brain structure and cognitive profile of transplant patients in not well known. Objectives: To evaluate prospectively cognitive function and brain MRI characteristics in patients with ESRD at transplant and after one year of successful transplantation. Material and Methods: We prospectively included 17 patients, evaluated within7 days peri-transplant with brain MRI and cognitive test (MiniMentalTest, Addenbrooke's Cognitive Examination, Scale Wechsler Logical Memory(WMS), Auditory Learning king, Trail Making A and B (TMA and TMB), digit Span, phonological and semantic verbal fluencies, Rey complex figure and Beck Depression Inventory. Both assessment procedures were repeated year after transplantation, each patient being its own control. Results: At the time of transplantation, 81.25% had abnormal MRI images in the first observed no changes on MRI control. The first cognitive assessment showed mild cognitive impairment(MCI) in 64.70% non-amnestic, amnestic MCI at 17.64% and normal cognitive status at 17.64%. Year after transplantation23% had cognitive state average,also evidencing improvement in testsTMB (150.02 ±16.33vs123.54, P = 0.02) and phonological verbal fluency(10.92±1.10vs14.14±1.48, p = 0.02). Conclusions: Although abnormalities in brain MRI persisted one year after successful renal transplantation, some functions such as attention, executive functions and language evolved favorably after the procedure. The data suggest that successful renal transplantation could be considered as a process that would improve certain cognitive domains in individuals with chronic kidney disease.

Addenbrooke’s cognitive examination (ACE) is a cognitive screening tool that has developed through three stages: ACE, ACE-Revised (ACE-R), and ACE-Ⅲ. In addition, mini-Addenbrooke’s Cognitive Examination (M-ACE) and ACE mobile are the additional versions that is derived from ACE-III. ACE and its related versions show better performance than Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) in detecting mild cognitive impairment in different neurological disorders. It has been translated into numerous languages, including Chinese. Through reviewing the history, validity, and comparison with other cognitive tests of Chinese versions of ACE, it aims to facilitate the clinical and scientific use, further development, improvement, and validation of Chinese versions of ACE in various neurological disorders and ultimately promote early identification and management of cognitive impairment in China.

The American Board of Radiology radiation oncology Maintenance of Certification Part 3 Modular Examination: Evaluation of the first administration

There is a need for a cognitive function test that is less burdensome to perform cognitive function tests used to date and can detect mild changes in the cognitive function and mild cognitive impairment (MCI). We developed a cognitive function examination using a virtual reality device (VR-E). The purpose of this study was to verify its usability. Seventy-seven participants (29 males and 48 females, average age 75.1 years old) were classified according to their Clinical Dementia Rating (CDR). To estimate the validity of VR-E in measuring cognitive function, we used the Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment-Japanese version (MoCA-J) scores as benchmarks. The MMSE was performed for all subjects, while the MoCA-J was performed for subjects with an MMSE score ≥20. VR-E scores were highest in the CDR 0 group (0.77±0.15, mean±SD), decreasing for subsequent groups (CDR 0.5: 0.65±0.19, CDR 1-3: 0.22±0.21). The receiver operating characteristic analysis showed that all three methods were able to distinguish CDR groups. For CDR 0 vs. 0.5, the areas under the curve for MMSE/MoCA-J/VR-E were 0.85/0.80/0.70, respectively, and those for CDR 0.5 vs. 1-3 were 0.89/0.92/0.90, respectively. The time required to complete VR-E was approximately 5 minutes. Of the 77 subjects, 12 were difficult to assess using the VR-E due to poor understanding or eye diseases or Meniere's syndrome. The present findings suggested that the VR-E can be used as a cognitive function test that correlates with existing standard assessments for dementia and MCI.