UCLA Neuropsychology of Medical Illness Practicum
2013-2014 Brochure
David Geffen School of Medicine
Department of Psychiatry and Biobehavioral Sciences
Semel Institute for Neuroscience & Human Behavior
About the Neuropsychology of Medical Illness (NMI) Practicum
Recent developments in the neuroscience of HIV/AIDS, cancer, diabetes, and other
disorders have implicated medical illnesses as important contributors to brain-behavior
relationships. The prevalence of chronic illness among vulnerable populations such as the
elderly is increasing, with 80 percent reporting a chronic condition and 50 percent who
have at least two (Center for Disease Control, 2009). Chronic illness is currently the cause
of 7 out of 10 deaths nationwide each year. Heart disease, cancer and stroke account for
more than 50 percent of all deaths each year (CDC, 2009). Neuropsychologists are at the
forefront of diagnosing, describing, and recommending treatments for individuals who
suffer from chronic illness that affects central nervous system (CNS) functioning. The
Neuropsychology of Medical Illness Practicum developed in response to provide
specialized training for students who plan to work in hospital-based settings or with
populations where chronic illness is common.
NMI Program Director: April D. Thames, Ph.D.
NMI Supervisors (2013-2014): Alyssa Arentoft, Ph.D.
Philip Sayegh, Ph.D.
Goals of the Neuropsychology of Medical Illness (NMI)
Practicum
The primary goal of the NMI track is to provide a year of intensive exposure to a wide
variety of assessment experiences. While clinical opportunities are available, NMI is a
research practicum; therefore, less emphasis is placed on patient care. This track is ideal
for students who are just beginning their careers in neuropsychology, as this program is
designed to expose students to a wide-array of commonly used psychiatric and
neuropsychological assessment instruments. Throughout the training year, trainees will be
required to shadow 3 neurological exams from Neurology Clinic.
Because NMI is a track within the larger UCLA Neuropsychology Practica, externs will
have opportunities to attend most didactics that are offered to UCLA interns and
postdoctoral fellows (except courses that are restricted to postdoctoral fellows). The
training is designed to maximize the personal growth of each extern, and is not directed at
specialization, although externs are expected to develop proficiency in an area of interest.
NMI is organized to provide externs with generalized knowledge of the field of
neuropsychology, neuropsychological research – including how to design a research study
with a medically ill population, and gain a deeper understanding of disease processes and
corresponding behaviors.
Structure of the NMI program
Each extern is assigned a supervisor, usually a postdoctoral fellow from UCLA’s
Neuropsychology of HIV/AIDS fellowship track, who is responsible for overseeing
assessments and brief reports. Externs will meet weekly with Dr. April Thames who will
provide supervision about general issues (e.g., training, professional development) and is
responsible for ensuring that externs successfully complete all requirements of the track.
Dr. Thames will meet weekly with supervisors for updates on each externs’ development
in assessment proficiency and competency. Each extern is expected to provide 1 full day (8
hours) of availability for assessment, 1 partial day (4-5 hours) for activities such as scoring,
data management, shadowing, and report-writing. Group supervision will take place with
Dr. Karen Miller on Thursdays (10am-12pm) and mandatory weekly lab meetings with Dr.
Thames will take place Thursdays (1pm-2pm). Individual supervision will be decided
between the trainee and the supervisor.
Since the exposure to, learning in, and thought about research experience is designated as
the first priority, assessment experiences are given priority in the assignment of the
trainee's time. If the extern is interested in gaining opportunities that are made available
through other tracks, this must be scheduled outside of the required activities of NMI and
above the required 15-hour week.
Research Projects through NMI
Below are various ongoing projects within Dr. Thames’ lab that externs will be involved in
largely through psychiatric and neuropsychological assessment activities. Externs will have
opportunities to conduct independent research projects with extant data; however, research
involvement is not considered as part of the 15-hour work week. Requirements for the
externship take precedence over research-related activities.
Neurological, Neurobehavioral and Functional Consequences of HIVinfection (PI: A. Thames)
This is a 5-year cross-sectional study that seeks to determine if specific biomarkers (e.g.,
genotype, white matter neuropathology) can enhance the statistical prediction of “real
world” outcomes among individuals with HIV. Using structural and functional
neuroimaging as objective markers of brain function and organization, relationships
between neurocognitive assessment and neuroimaging will be assessed while considering
potential moderator variables. We expect that a model that factors in potential confounding
variables will increase the validity of neurocognitive testing for measuring brain function
and functional outcomes among diverse ethnic/racial groups with HIV-infection. Using a
multimethod approach will enable us to better characterize both neuropathological and
functional consequences of HIV infection and determine which factors mediate and
moderate the relations between pathology and outcome.
Proinflammatory genotypes and susceptibility to HIV-associated
neurocognitive disorder among African Americans (PI: A. Thames)
An emerging area of study is exploration of the genetic substrate of HIV-associated
neuroinflammation. Research into other inflammatory diseases have found that African
Americans (AAs) possess a higher frequency of allelic variants known to up-regulate
proinflammatory cytokines (Ness et al., 2004; Van Dyke et al., 2009), suggesting that this
ethnic group may be more vulnerable for the development of HIV-associated
neurocognitive disorder. The overall objective of this project is to determine the extent to
which variants within cytokine genes affect cytokine expression in CSF, cognitive
functioning, and disease severity in HIV+ AAs, and to determine the relative importance of
non-genetic factors linked to ethnic minority status (e.g., medical comorbidities, literacy,
past drug abuse/dependence) in AAs and Caucasians.
Cognitive functioning in low-literacy populations with Hepatitis C and HIV
(PI: A. Thames)
This project seeks to evaluate the clinical utility of neuropsychological and functional
assessment for low literacy individuals diagnosed with Hepatitis C (HCV) or HIV/HCV
co-infection by comparing results from these measures with neuroimaging findings. This
project also seeks to evaluate the degree to which specific neuropsychological tests
accurately reflect HIV/HCV brain pathology among individuals with low-literacy.
The impact of antiretroviral regimen neuropenetrance on cognition and
white matter integrity in HIV+ individuals (PI: A. Arentoft)
The goal of the present study is to assess the longitudinal (i.e., 1 year) consequences of
antiretroviral neuropenetrance in recently-infected (i.e., within the past 5 years) HIV+
individuals. This study will examine the predictive utility of neuropenetrance scores in
predicting neural outcomes (assessed via neuroimaging). The longitudinal nature of this
study will allow us to evaluate whether or not higher neuropenetrance is beneficial or
neurotoxic over time.
Evaluations of trainees and supervisors
Trainees, supervisors and advisors submit evaluations of their work together three times
during the year. Evaluations of the trainees provide information to the advisors for
assessing progress made during the year, and ultimately become the basis of a letter to the
director of practicum training, Dr. Karen Miller, each year.
Evaluations of supervisors are designed to provide early, timely feedback in case there are
problems. These evaluations also are considered important sources of information for
ensuring successful training within the NMI program. Trainees need to write an evaluation
of each supervisor in order to view their own evaluations. Supervisors do not see the
trainees’ evaluations until the end of the year.
Three times during the training year the trainees meet with Dr. April Thames to discuss all
aspects of the training program. Dr. Thames and the NMI supervisors want feedback on
what is good about the program and what improvements might be beneficial to the
program. Feedback may occur several ways. Trainees may decide to discuss issues with
supervisor.