DIVERSITY GRAND ROUNDS
Moderator: Marc A. Norman
Discussants: Shelley Peery and Liza San Miguel
Expressive Language Disorder, Attention-deficit/Hyperactivity Disorder, and Bilingualism: A Case Presentation
The evaluation of bilingual children is a complicated endeavor because there are various views of how bilingualism affects brain organization and functioning. Added to that is the challenge of determining language development of Hispanic children living in a monolingual Spanish-speaking home in a Spanish-speaking country, but mostly exposed to English language television programming and, in some cases, English language school curriculum. Our case will review the evaluation process of a 14-year-old Puerto Rican boy with previous diagnoses of expressive language disorder and Attention-deficit/Hyperactivity Disorder (ADHD). The neuropsychological evaluation revealed an IQ within the average range, with significant differences between the perceptual reasoning, verbal comprehension, and processing speed. The case will summarize performance in verbal, executive, and psycho-educational measures with a thorough review of his developmental history and the interpretation of these neuropsychological achievement and behavioral measures in light of other variables influencing his difficulties.
Starting From Zero: Competence to Stand Trial in an Oromo (Ethiopian) Man with Unidentified Cognitive Limitations
Objective: Although competence to stand trial is the most common criminal forensic psychological assessment, there is no significant literature regarding such assessments in non-English speakers in the United States. This case illustrates an approach when the examiner has no pre-existing knowledge of the evaluee's language or culture. Method: A 25-year-old Oromo laborer with 4 years of education was referred for assessment of an unknown cognitive or psychiatric disorder regarding adjudicative competence following eight previous such assessments. Evaluation techniques included an Internet search regarding his culture of origin, records review, consultation with his brothers and the interpreter, interview, limited physical examination, and selected neuropsychological testing. Results: History was congruent with a severe adolescent traumatic brain injury (TBI) and intellectual deficiency due to TBI. The evaluee's vague history was corroborated via family, Internet information, interpreter consultation, physical examination, and neuropsychological testing. Cultural and immigration considerations helped resolve incongruencies. Test of Memory Malingering (TOMM) was normal. Performance Index on Wechsler Adult Intelligence Scale-4th Edition (WAIS-4) was in the 50s. Formal (Woodcock–Johnson Achievement-III, Rey Figure) and informal language and drawing testing in English and Oromiffa were congruent with his history. The Fuld Object Memory Evaluation and 5-Digit Test were congruent with TBI. The Revised Competency Assessment Interview demonstrated little benefit from competency restoration classes. The judge accepted the report as resolving previous conflicting results. Conclusions: When data sources are less than satisfactory, seeking congruence across multiple information sources and types of information can improve confidence in the conclusions, especially when directed to specific referral questions. Testing can play a critical, although limited, role even in unconventional circumstances.
ADULT GRAND ROUNDS
Moderator: Richard Naugle
Discussants: Michael Schoenberg and Kevin Duff
Attention Deficits Suspected to be Secondary to Postural Orthostatic Tachycardia Syndrome: Two Cases Involving Sisters
Objective: The objective of this study was to explore the possibility of attention and executive system deficits in two sisters secondary to postural orthostatic tachycardia syndrome (POTS). POTS is a condition of orthostatic intolerance, where movement from sitting to standing yields tachycardia; this can be accompanied by hypotension, although this is not necessary for diagnosis. POTS may result in, but is not limited to, dizziness, fatigue, syncope, polydipsia, acute hypoperfusion of tissues and organs with chest pain, disorientation, muscle weakness, tremulousness, and headache, and autonomic dysfunction with gastrointestinal problems. Research suggests that a person may experience a decline in cerebral blood flow which can result in anxiety, depression, word-finding problems, and poor concentration. This case will describe two teenage sisters with POTS with similar cognitive profiles. Method: Two Caucasian females of 19 and 22 years old were assessed in a hospital setting. Both women described lifelong difficulties with POTS, syncopal episodes, Ehlers-Danlos Syndrome type III (hyper-reflexia), headaches, GI symptoms, and cognitive deficits such as difficulty organizing thoughts, sustaining attention, impulsivity, and slow processing speed. Archival neuropsychological data, de-identified history, physician report, and neuroimaging will be presented in a case summary. Evaluation procedures included administration, scoring, and interpretation of comprehensive quantitative and qualitative measures. Results: Assessment revealed several areas of mild relative impairment in executive functioning including complex attention, processing speed, and verbal fluency. Conclusion: The patients presented with attention and executive system deficits which may be secondary to cerebral hypoperfusion related to POTS.
Neuropsychological Assessment in Two Cases of Posterior Cortical Atrophy
Objective: Posterior cortical atrophy (PCA) is a rare focal dementia characterized by progressive impairment of visual/visual–spatial functioning. Various neuropathological substrates, including Alzheimer's disease, dementia with Lewy bodies, corticobasal degeneration, and prion disease, have been reported. Some patients may have relatively greater involvement of dorsal (occipito-parietal) pathways involved in the visual control of action or ventral (occipito-temporal) pathways involved in object identification. Method: Case 1 (a 64-year-old man) had a 2-year history of problems with vision. He did not have prosopagnosia. His SPECT scan showed severe posterior parietal and occipital hypoperfusion. Case 2 (a 75-year-old woman) had a 3-year history of visual problems, including prosopagnosia. Her SPECT showed bilateral posterior hypoperfusion extending into the temporal lobes. Results: On neuropsychological assessment, both patients made perceptual errors on the Boston Naming Test (BNT) short form and had difficulty with reading, writing, and all visual–constructional tasks. Tactile naming was relatively better, but patients sometimes had difficulty identifying whole objects due to simultanagnosia. Responsive naming was intact. Compared with Case 2, Case 1 had more difficulty with verbal attention and memory. Case 1 completed the Visual Object and Space Perception Battery (VOSP) and scored in the borderline or impaired range on all subtests, although space perception was slightly better than object perception. Conclusion: Both patients had marked difficulty with visual–perceptual ability. Case 2 appeared to have an occipitotemporal syndrome (alexia, visual agnosia, prosopagnosia) involving disturbance of the ventral pathway. The profile of Case 1 was less clear. More research is needed to link symptom presentations with underlying neuropathology in PCA and other atypical dementias.
Neuropsychological Functioning in a 24-Year-Old Male Status after Multiple Improvised Explosive Device Blasts, One with Brief Loss of Consciousness, 2 Years Post-Blast with Resolution of Posttraumatic Stress Disorder Symptoms: A Case Study
Objective: Blast injuries are the most common cause of war trauma in Iraq and Afghanistan (DVBIC, 2009), but remain a poorly understood form of Traumatic Brain Injury (Agoston et al., 2009). Military members exposed to blasts have demonstrated post-concussive symptoms including headache, vertigo, short-term memory problems, and difficulty multitasking or concentrating (Okie, 2005; Ropper & Gorson, 2007; Ryan & Warden, 2003), as well as increased aggression, impulsivity, anxiety, impaired social interactions, and judgment (Agoston et al., 2009). Multiple mild blasts can also be cumulative, causing long-term effects manifested by memory impairments and abnormal behavior (Taber et al., 2006; Warden, 2006). Whether or not these symptoms are primarily related to the effects of the blast or posttraumatic stress disorder (PTSD) (Hoge et al., 2008) is unclear. This case study hopes to expand on the current literature by describing the neuropsychological presentation in a 24-year-old male (M.G.) exposed to 50–60 improvised explosive device (IED) blasts, one involving brief loss of consciousness (LOC), who also had PTSD that resolved with treatment. Method: M.G. was referred for neuropsychological testing to determine his current cognitive functioning due to persisting attention and memory problems 2 years post-blast. Neuropsychological testing revealed mild residual deficits in speeded verbal fluency, sustained attention, speeded word reading, verbal recognition memory, and left upper extremity motor speed, and weakness in delayed visual retention. Results: Current neuropsychological testing reveals evidence of residual deficits 2 years post-blast despite cognitive rehabilitation and successful PTSD treatment. Conclusion: These findings are consistent with other studies that suggest cognitive compromise due to the primary effects of the blast, which appear to persist despite effective PTSD treatment.
FORENSIC GRAND ROUNDS
Moderator: Robert L. Denney
Discussants: Kyle Boone and James Youngjohn
Neuropsychological Consultation in a Competency-To-Stand Trial Evaluation: Use of the Word “Malingering”
Objective: The patient is a 28-year-old, right-handed, Caucasian man admitted to the forensic unit at a large state hospital to undergo a competency-to-stand trial evaluation. The forensic examiner referred the patient for neuropsychological assessment because of self-reported attention and memory problems. Medical history is significant for a seizure disorder partially controlled with medication, arachnoid cyst on the brainstem, and migraine headaches. Family medical history is significant for seizures. Method: Available medical records were reviewed and neuropsychological testing, including symptom validity testing and the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), was administered to evaluate current functioning and to compare performance to previous results. Results: The patient performed inconsistently on symptom validity measures and appeared to be exaggerating cognitive and psychiatric symptoms. Conclusions: The patient has a complicated medical history that could impact cognition. Use of symptom validity testing enabled the neuropsychologist to document magnification of cognitive deficits. This, coupled with the history and current circumstances of the patient, led her to opine that the patient was malingering cognitive symptoms. However, because of the medical history, the forensic evaluator was uncomfortable stating the patient was volitionally exaggerating symptoms and did not use the word “malingering” in his report. After the court found the patient competent to stand trial, he admitted that he had intentionally tried to appear cognitively impaired on testing. This case highlights the conflict that can arise between practitioners, or even in an individual practitioner, about using the word “malingering” in an evaluation.
Forensic Neuropsychological Evaluation in Moderate-To-Severe Brain Injury: Failed Symptom Validity Measures in the Presence of Credible Personality and Behavioral Changes
Objective: Referral for neuropsychological evaluation was made by subject's attorney following significant traumatic brain injury (TBI) in a motor vehicle accident. Subject was a 22-year-old, Caucasian male, with no history of prior neurologic, psychiatric, or legal concerns. At the scene, he demonstrated initial (non-sedated) Glascow Coma Scale (GCS) of 4 and bilateral decerebrate posturing. Neuroimaging revealed multiple intracranial bleeds, contusions, and diffuse edema, with midline shift requiring right frontal-parietal craniotomy. Significant anger, irritability, interpersonal difficulties, and employment failure were noted by subject and family. He experienced multiple arrests after rehabilitation. Method: After review of extensive background documents, a neuropsychological evaluation was completed which consisted of extended clinical interviews with subject and family members, symptom validity testing, and standard neuropsychological tests. Results: Neuropsychological data were inconclusive and could not be reliably reported due to inconsistent cognitive effort. Psychological assessment revealed emotional, behavioral, and interpersonal dysfunction consistent with patient and family reports. Records and interview revealed a change in behavior with increased impulsivity and disinhibition leading to arrest and prison. Conclusions: Patient did not exert optimal effort on all tasks presented. No conclusions regarding the existence and severity of memory and other cognitive problems could be made based on this evaluation, because exaggeration of cognitive problems can occur in the presence as well as absence of genuine cognitive deficits. However, personality/behavior changes were consistent with known consequences of TBI, particularly the demonstrable structural brain damage sustained in the accident. Given the absence of information, to the contrary, it was determined that the patient was experiencing credible and significant psychological sequelae secondary to this TBI.
PEDIATRIC GRAND ROUNDS
Moderator: Philip S. Fastenau
Discussants: H. Gerry Taylor and T. Andrew Zabel
Atypical Pattern of Cognitive Dysfunction in a Case of Left Temporal/Middle Cranial Fossa Arachnoid Cyst
Objective: Arachnoid cyst (AC) often presents as a functionally quiescent neurological anomaly. Most frequently found in the left temporal/middle cranial fossa (LT/MCF), significant cognitive dysfunction is generally not associated with AC. When cognitive symptoms are present in LT/MCF AC, existing literature suggests that they are generally associated with impaired language and verbal functions. The case in question is a pediatric patient with LT/MCF AC displaying an atypical pattern of neuropsychological impairment not previously described in the literature. Method: Patient is an 8-year-old female with an LT/MCF AC that was imaged clearly on multiple CT scans. She has a history of headache and has been diagnosed with attention deficit/hyperactivity disorder. Results: In contrast to published reports on LT/MCF AC, the patient displayed a pattern of prominent deficits in non-verbal functions with generally intact language functions. Specifically, verbal intellectual functioning was stronger than non-verbal intellectual functioning at a statistically significant level, and verbal memory was substantially stronger than non-verbal memory. Conclusions: Although a lack of cognitive findings is relatively common in cases of AC, existing literature regarding LT/MCF AC cases suggests that, when present, associated cognitive impairments are generally in the areas of language, verbal memory, and other prototypical left temporal functions. This case showed the opposite pattern of dysfunction in spite of unambiguous left hemisphere pathology. Such findings add an additional layer of complexity to the empirical understanding of the relationship between AC and cognitive impairment. Additionally, this case continues to raise the question of whether AC may contribute to atypical organization of cerebral function.
Below Chance Performance on Symptom Validity Testing (SVT) in an 8-Year-Old Girl after Mild Traumatic Brain Injury: A Case Highlighting the Importance of Objectively Evaluating Rsponse Bias in Children
Objective: Limited research has focused on the base rates of suboptimal effort in pediatric populations. However, we recently found that 17% of children presented to an outpatient concussion clinic with non-credible performance (Kirkwood & Kirk, 2010). The current case helps to illustrate why symptom validity tests (SVTs) should be incorporated routinely into neuropsychological batteries with children. Method: An 8-year-old female presented for clinical neuropsychological consultation after she sustained a concussion 1 month earlier. The injury was not associated with unconsciousness, amnesia, or neuroimaging abnormalities. The patient had missed 2 weeks of school and presented with persistent symptoms including difficulty reading, headaches, memory problems, attention difficulties, and increased irritability. Premorbid history was notable for diagnoses of bipolar disorder and attention-deficit/hyperactivity disorder (ADHD). The patient was in the second grade and had a history of school avoidance. No academic concerns had been apparent, and she had not received special education services. Results: The patient's objective test performance was generally poor. She never refused to complete tasks, but demonstrated consistently suboptimal effort, with significantly worse-than-chance performance on the Test of Memory Malingering (TOMM) (Trial 1 = 8, Trial 2 = 8, retention = 9) and Medical Symptom Validity Test (MSVT) (IR = 15%, DR = 15%, CNS = 80%, PA = 0%, FR = 5%). The patient's primary motivation for providing suboptimal effort was judged to be an attempt to avoid school-related work. Follow-up consideration for special education services was recommended. Conclusions: The case provides support to previous studies suggesting that the TOMM and Green's MSVT have value in detecting suboptimal effort in young children. The case also highlights the importance of incorporating SVTs into pediatric neuropsychological evaluations, even in clinical cases when external incentives are not readily apparent.
Hashimoto's Encephalopathy: A Pediatric Case Study with Pre- and Post-Treatment Neuropsychological Testing
Hashimoto's encephalopathy (HE) is a devastating but potentially treatable encephalopathy, which presents with cognitive deterioration and seizures, and is often associated with elevation of anti-thyroid peroxidase antibodies or thyroid dysfunction. In the absence of a gold-standard diagnostic test, improvement in cognitive impairment is an important clinical marker of response to steroid treatment. The purpose of this case study was to demonstrate the utility of repeated neuropsychological testing in the management of a child with HE. The patient is a 14-year-old female who presented with new-onset temporal lobe seizures (recorded on video EEG), auditory hallucinations, mood and behavior changes, and cognitive impairment. Comprehensive medical investigations were normal (including normal neuroimaging), except for elevated anti-thyroid peroxidase antibodies. Premorbid functioning included strong academic achievement. Neuropsychological testing, including a computerized screening battery (CNS Vital Signs), paper-and-pencil tests, and questionnaires, was done before steroid treatment and at follow-up assessments over 6 months. Testing indicated that there was frank, global cognitive impairment at pre-treatment (baseline). After 10 weeks of steroid treatment, there was improvement in some cognitive domains (i.e., visual memory, visual set-switching, and impulse control), as well as improvement in psychological and behavioral functioning. Gradual tapering of steroid medication began at this time. Assessment at 6 months indicated normal psychological, academic, and behavioural functioning, as well as average to above-average cognitive abilities (except for a measure of verbal inhibition and switching). This pediatric case study demonstrates cognitive impairment associated with HE, response to steroid treatment as measured through cognitive functioning, and a viable methodology for tracking cognition over time.
Poster Session A
AGING AND DEMENTIA: ALZHEIMER'S DISEASE
18FDG-PET Correlates of Semantic (SF) and Letter Fluency (LF) in Patients with Dementia
Objective: Both semantic (SF) and letter fluency (LF) deficits are common among patients with dementia. However, patients with Alzheimer's dementia (AD) are thought to have differentially greater SF deficits than patients with frontotemporal dementia (FTD), suggesting that SF and LF may have different neuroanatomic substrates. We examined the relationship between 18FDG-PET metabolism and SF and LF in patients seen for differential dementia evaluation. Methods: Ninety-two patients (age: M = 70.9 ± 7.8) with mild-to-moderate dementia (Mini-mental State Examination; MMSE ≤ 18; M = 24.7 ± 3.2) were evaluated for differential diagnosis of AD versus FTD. Mayo-Older-Adult-Normative-Studies' (MOANS) demographically corrected SF and LF scores were correlated with 24 regional patterns of 18FDG-PET metabolism. Neurostat warped 18FDG-PET images to Talairach space, and averaged peak metabolic values within the 24 regions of interest were normalized to pons and standardized against normal elderly controls. Results: LF showed significant modest correlations (.206–.374) with 18FDG-PET in the bilateral mesial and lateral frontal regions, as well as amygdala. In contrast, SF had stronger and anatomically more widespread 18FDG-PET associations in, predominantly, the left hemisphere. The strongest 18FDG-PET correlates with SF were in the mesial and lateral left frontal (.419–.395), left lateral temporal (.450), and left anterior cingulate (.442) regions. Conclusions: LF and SF appear to have differential patterns of 18FDG-PET metabolism in this clinical sample referred for differential diagnosis of dementia. Whereas LF showed modest bilateral correlates with 18FDG-PET metabolism in the amygdala and frontal regions, and SF was more strongly associated with metabolism in multiple regions, predominantly in the left hemisphere.
18FDG-PET Correlates of Memory in a Sample of Patients with Dementia
Objective: As memory deficits are prominent in many dementias and assessment of memory is a core component of neuropsychological evaluations, the current study examined the associations between memory test scores and brain metabolism via 18FDG-PET. Methods: Ninety-two patients (age: M = 70.7 ± 8.4) with mild-to-moderate dementia (Mini-mental State Examination; MMSE ≤ 18; M = 24.9 ± 3.2) were evaluated for differential diagnosis of Alzheimer's disease versus frontotemporal dementia. Regional patterns of 18FDG-PET metabolism were correlated with performance on four immediate and delayed recall measures (Memory subscale of Dementia Rating Scale (DRS), Wechsler Memory Scale-III (WMS-III) Logical Memory, Hopkins Verbal Learning Test-Revised, Brief Visuospatial Memory Test-Revised). Neurostat warped FDG-PET images to Talairach space, and averaged peak metabolic values within 22 regions of interest were normalized to pons and standardized against normal elderly controls. Results: Across delayed recall measures, statistically significant correlations were observed in the following regions: left lateral temporal (.33 to .40), left lateral parietal (.25 to .42), medial parietal (.23 to .42), left parahippocampal (.32 to .60), and left posterior cingulate (.38 to .47). Smaller correlations were observed between these regions and immediate recall scores. A screening measure of memory (DRS) generated comparable correlations. Few significant correlations were observed between memory scores and frontal brain regions. Conclusions: Despite outward differences in the memory tests examined, they were related to very similar brain regions in this demented sample. Temporal and parietal regions, especially on the left side, were modestly correlated with performance on tests of immediate and delayed recall. Frontal region activity was less strongly related to learning and recall of verbal and visual information.
P50 Auditory Event-Related Potentials Differentiate Mild Alzheimer's Disease from Healthy Older Controls
Objective: Researchers have inconsistently shown that P50 auditory event-related potentials (ERPs) differentiate mild Alzheimer's (AD) patients from older controls. This study aimed to improve methodology by increasing participants and signal-to-noise ratio to test the hypothesis that AD patients exhibit significantly larger P50 amplitude than controls. Methods: Participants included 31 community-dwelling AD patients (17 males, 14 females) and 38 controls (20 males, 18 females) recruited from an outpatient memory clinic. All participants underwent neurological exam; patients met NINCDS-ADRDA criteria for probable AD. Groups were not significantly different in gender, age, or education. Using an oddball paradigm, participants pressed a button in response to infrequent (p = .2) “target” tones (2000 Hz) but not for frequent “standard” tones (2000 Hz). Post-stimulus ERPs were computed and averaged across trials. Amplitude at electrode CZ was analyzed, where P50 amplitude is traditionally strongest. Results: Behaviorally, the controls significantly outperformed the AD group correctly responding to targets and standard tones. A repeated-measures analysis of variance was not significant for stimulus effects that varied by group. Independent sample t-tests revealed AD patients have significantly greater P50 amplitude than controls in response to targets (t(67) = 2.09, p = .004) and standard tones (t(67) = 3.11, p = .003). Conclusions: Larger P50 amplitudes in mild AD patients likely reflect impaired modulation of auditory cortical responses by fronto-central cortical areas responsible for inhibition over auditory cortical responsiveness. Given that P50 amplitude differentiated AD patients early in the disease process from healthy older controls, further research may help develop tests with greater diagnostic sensitivity.
The Alzheimer's Questionnaire (AQ): A Pilot Study for a New Informant-Based Dementia Assessment
Objective: The aim of this pilot study was to determine the feasibility and clinical utility of a brief, informant-based screening questionnaire for Alzheimer's disease (AD) that can be administered in a busy clinical setting. Methods: The Alzheimer's questionnaire (AQ) was administered to 99 patient–informant dyads (20 cognitively normal, 38 mild cognitive impairment (MCI), 41 AD) in 3 dementia clinics at the patients' initial assessment. Total score for the AQ (0–26) is based on the sum of clinical symptom items in which the informant responds as being present. Clinical symptoms which are known to be highly predictive of the clinical AD diagnosis are given greater weight in the total AQ score. Results: The mean time of administration of the AQ was 2.6 ± 0.6 min. analysis of variance (ANOVA) demonstrated statistically significant differences in AQ scores between cognitively normal individuals and mild cognitive impairment (MCI) cases (F = 65.40, [df = 1, 39], p < .0001). A similar result was found when MCI cases were compared against AD cases (F = 32.32, [df = 1, 57], p < .0001). ROC curves for MCI cases versus cognitively normal individuals and MCI versus AD cases yielded AUCs of .98 (.91, 1.00) and .85 (.73, .93), respectively. Conclusion: This pilot study indicates that the AQ is a sensitive measure for detecting cognitive impairment associated with AD and is a short, easily administered tool. The AQ may be helpful to clinicians who must obtain an accurate, informant-based assessment of possible dementia in a short amount of time.
MRI, Cerebrospinal Fluid, and APOE Correlates of Fine Motor Speed in Mild Cognitive Impairment and Alzheimer's Disease
Objective: Decline in speeded ability accompanies aging and neurodegenerative processes. However, the biological substrates of speeded decline are not well understood. The present study investigated the relationship between fine motor speed and biological markers of neurodegeneration in three groups of older adults across the aging continuum: healthy controls (HC), adults with mild cognitive impairment (MCI), and adults with Alzheimer's disease (AD). Method: The study included 109 HC, 66 adults with MCI (30 “pure” amnestic [aMCI] and 36 multiple domain [mdMCI]), and 170 adults with AD. Fine motor speed was measured with three finger tapping tests: (1) dominant hand only, (2) alternating bimanual, and (3) bimanual synchronous. A subset of 96 AD/MCI patients and 45 HC completed biological makers of neurodegenration: volumetric MRI of multiple brain regions, APOE genotyping, and cerebrospinal fluid analysis for amyloid beta 42 and total tau. Results: Controls performed significantly better than the mdMCI and AD groups, but not the aMCI group, on all finger tapping tasks. Multiple regression analyses controlling for age, handedness, and intracranial volume revealed different relationships between finger tapping and biomarkers in AD/MCI patients when compared with HC. For example, in AD/MCI, amyloid beta 42, total tau, and left frontal gray matter volume accounted for 19% of the variance in dominant hand tapping (F(10, 85) = 2.51, p < .05). There was no relationship between finger tapping tasks and any biomarkers in the HC group. Conclusions: Neurodegeneration impacts basic psychomotor speed in MCI and AD.
Cueing Technologies for Assisting Persons with Mild Cognitive Impairment in Instrumental Activity of Daily Living Completion in an Experimenter-Assisted Smart Apartment Environment
This study examined “smart environment” cueing technologies to provide new intervention strategies for persons with mild cognitive impairment (MCI). We were interested in whether individuals with MCI would benefit from the delivery of cues provided within a smart environment when errors were encountered during completion of instrumental activities of daily living (IADLs). Participants were 11 community dwelling individuals with MCI and 22 controls recruited through a university research project and matched on age, gender, and education. Participants completed eight IADLs within a smart environment. Using a graded hierarchy, cues were generated for each step needed to complete the IADLs. Cues were preprogrammed into a computer and delivered when an error in activity completion occured. The hierarchy of cues given began with a verbal indirect cue followed by a verbal direct cue and then a multimodal cue. t-tests showed that MCI participants received more total cues across the eight activities and required more total activity steps be cued than controls (p < .05). There were no significant differences in the average cue level received across the eight activities between MCI and control participants. MCI participants required more cues on activities that had more steps and/or were more cognitively complex. MCI participants showed more errors than controls in IADL completion. Similar to controls, MCI participants generally responded accurately to the indirect cues which helped orient the participant back to task. Individuals with MCI might benefit from receiving cues to assist with IADL completion in a smart environment, particularly for activities that are more cognitively complex.
Caregiver Burden and Costs Associated with Behavioral Disturbance in Alzheimer's Disease
Objective: To evaluate how behavioral disturbance (BD) in patients with probable Alzheimer's disease affects caregiver burden and costs of care. The selected sample had similar characteristics as patients currently enrolled in clinical trials investigating pharmacological management of BD. Method: Participants were recruited from nine clinical practices (N = 133). The sample was limited (n = 70) to community-dwelling adults aged 60 years or greater with Mini-mental State Examination (MMSE) scores ranging from 6 to 24 inclusive. Additional variables included: patient gender, marital status, Cumulative Illness Rating Scale (CIRS), Clinical Dementia Rating (CDR) Scale, Caregiver Burden Scale, and Neuropsychiatric Inventory (NPI-10). NPI score of 10 was used to create two groups. Results: Analysis of variance revealed no group differences regarding gender, marital status, CDR score, and MMSE; however, medical burden (CIRS) was positively associated with BD. Regardless, each of these variables was included in the following multiple regression analyses. BD significantly predicted caregiver objective burden (β = .407, t(63) = 3.672, p < .001) and explained a significant proportion of variance (R2 = .319, F(6, 63) = 6.391, p < .001). Similar results were observed for caregiver subjective burden (β = .382, t(63) = 3.266, p = .002) with R2 = .243, F(6, 63) = 4.693, p = .001. Total cost, including unpaid caregiver time, was associated with BD (β = .390, t(63) = 3.830, p < .001), with R2 = .425, F(6, 63) = 9.504, p < .001. Conclusions: BD has a substantial impact on caregiver burden and caregiving costs. Improved management of BD could provide benefit to the patient and caregiver and reduce the overall financial burden of Alzheimer disease.
Which Cognitive Factors Predict Functional Decline in Older Adults with Alzheimer's Disease?
Objective: This study examined whether language, executive functioning (EF), attention, or visual–spatial skills could predict deficits in financial management, medication management, driving, dressing, grooming, and feeding abilities in Alzheimer's clients. Methods: Participants were 54 older adults, ranging in age from 65 to 93 (M = 78, SD = 5.20); all identified as Caucasian. In this group, 57% were female and 82% were right-handed. Language measures included the Boston Naming Test (BNT). EF measures included the Controlled Oral Word Association test (COWAT) and Trails B; attention measures included Digit Span (Wechsler Adult Intelligence Scale-Third Edition; WAIS-III), and visual–spatial measures included the Rey Complex Figure Test (RCFT) copy. Results: Pearson correlations assessed the abilities of cognitive measures to predict decline in self-care activities. The only measure to yield significant results was the visual–spatial measure. The RCFT was significantly correlated with financial (r = −.39, p < .01), medication (r = −.42, p < .01), driving (r = −.39, p < .01), and dressing (r = −.25, p < .05) abilities. None of the language, EF, or attention measures were significantly correlated to measures of daily functioning. Discussion: Measures of visual–spatial skills appear to be the best predictors of functional decline in individuals in the early stages of Alzheimer's. Although past research has found EF, attention, and language measures to predict declines in daily activities, this study only used individuals in the earlier stages of AD, many of whom have not begun to exhibit deficits in attention, EF, or language. For neuropsychologists attempting to make recommendations for individuals in the earlier stages of AD, it may be more prudent to consider scores on visual-spatial measures than EF, language, or attention measures.
AGING AND DEMENTIA: OTHER
Rey-15 Performance in a Non-Litigating Canadian Geriatric Psychiatry Sample
Objective: To examine the performance of the Rey-15 test in a typical Canadian non-litigating geriatric psychiatry sample. Method: Following approval by the relevant Ethics Boards, chart review was conducted across three hospital-based geriatric psychiatry clinics in Metro Vancouver. Inpatients and outpatients who had completed the Rey-15 test during typical clinical cognitive evaluations were identified. Results: Eighty patients were identified. Patients were older adults (x = 77.7 years, range = 65–92), mostly females (65%), with a secondary education (11.8 years, range = 4–20). Sixty-six patients (82.5%) completed the Mini-mental State Examination (MMSE) (x = 24.4, range = 15–30). The sample was mixed diagnostically (Alzheimer's disease, vascular dementia, fronto-temporal dementia, depression, anxiety, psychosis) and included healthy patients (no diagnosis). None of the patients was involved in ongoing litigation. Additionally, findings of cognitive impairment could lead to outcomes considered undesirable by some patients (e.g., loss of driving privileges). Five patients (6.25%) obtained scores of 15 on the Rey-15 test. Of these, none had a dementia diagnosis. Four had a serious psychiatric diagnosis and the fifth had no diagnosis. The majority of the sample (57%) scored below a score of 9 on the Rey-15 test. The mean score on the Rey-15 test was 7.6 (SD = 3.61, range = 0–15). The median score on the Rey-15 test was 6. MMSE score was not related to Rey-15 performance. Conclusions: In a clinical geriatric psychiatry sample, scores below 9 on the Rey-15 test are typical and should not be considered to be indicators of poor effort during testing.
Comparison of Older and Younger Adults With and Without HIV on Neuropsychological and Everyday Functioning
Objective: Despite the ability of anti-retroviral viral medications to extend life, those aging with HIV may be more vulnerable to cognitive and functional deficits. In this study, we examined the cognitive and functional performance of younger (21–49 years) and older (50+ years) adults with and without HIV. Method: Participants (N = 172) were administered a cognitive battery and the Timed Instrumental Activities of Daily Living test. Analysis of covariance (ANCOVA)s were used to test the main effects of age and HIV status and the interaction, after controlling for gender and education. Results: For psychomotor speed, there was a significant effect of age, with those who are younger performing better. For speed of processing, there was a significant main effect of both HIV status and age for three measures, with those who are older and HIV-positive performing worse. Another speed of processing measure only yielded HIV status as a main effect, and age emerged as a trend (p = .06). For the memory and executive functioning domains, no statistically significant differences across groups were detected. In the Timed Instrumental Activities of Daily Living test, there was an HIV × age interaction, as well as a main effect of HIV status, with those who are older with HIV performing worse on such everyday tasks (e.g., looking up a phone number). Conclusions: The results of this study indicate that those with HIV may be at a risk of poorer cognitive performance compared with their HIV-negative counterparts and this deficit may transfer to performing everyday tasks.
Are We Missing Vascular Cognitive Impairment (VCI)? Retrospective Identification of a Probable VCI Profile in a Memory Clinic Database
Objective: To determine the percentage of patients meeting criteria for a probable VCI profile in a large clinical database and whether a vascular etiology was a primary diagnostic consideration. Method: The initial sample was 345 patients (means: age 73, education 14 years, Mini-mental State Examination [MMSE] 26) presenting to a teaching hospital-based interdisciplinary memory disorders clinic. Of this sample, 20 individuals met criteria for the probable VCI profile proposed by Selnes and Vinters (2006). Probable VCI criteria were: impaired performance (T < 35) on Grooved Pegboard Test and a measure of executive functioning (Digit Span, FAS, Animal Naming, Trails B, or Clock Drawing) and intact performance (T > 40) on Boston Naming Test and Hopkins Verbal Learning Test (HVLT) Recognition Discriminability. The probable VCI group largely mirrored the initial sample (means: age 74, education 14 years, MMSE 28). Results: Six percent of the clinical database matched the proposed VCI profile. Record review of the VCI profile sample revealed the following diagnoses: 60% mild cognitive impairment, 15% possible/probable Alzheimer's disease, 15% vascular dementia, 5% corticobasal degeneration, and 5% frontotemporal dementia. Vascular risk factors were present in 40% of both the overall and probable VCI groups. Conclusions: Results suggest that the proposed probable VCI profile occurs at a low base rate in a memory clinic setting and is found in only a subset of individuals with vascular risk factors. Still, the comparatively low rate of diagnosis of a primary vascular etiology demonstrates that VCI may be underappreciated as a clinical entity, possibly due to the relatively recent emergence and continued evolution of the VCI concept.
Altering Factor Structures of the Repeatable Battery for the Assessment of Neuropsychological Status based on Cortical or Subcortical Dementing Etiologies
Objective: The current study investigated which component solution might arise on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) through exploratory factor analysis within populations of patients with cortical or subcortical dementing presentations. Methods: An archival data set was utilized for the current study. Participants were chosen based on their diagnosis of either a cortical-based (n = 64) or subcortical-based (n = 73) dementia and grouped accordingly. Exploratory factor analysis was run to determine the solutions for the RBANS. Results: Exploratory factor analysis revealed discrepancies between dementing etiologies. In regard to cortical-based dementias, analysis revealed only a two-factor solution. Principal component analysis with promax rotation revealed list learning, story memory, figure copy, coding, semantic fluency, list recall, list recognition, story recall, figure and recall loaded together on Factor 1, whereas line orientation, picture naming, and digit span loading together on Factor 2. In comparison, exploratory factor analysis in subcortical-based dementias corresponded with a three-factor solution with list learning, story memory, semantic fluency, list recall, list recognition, and story recall loading together on Factor 1; figure copy, line orientation, coding, and figure recall loading together on Factor 2; and, picture naming and digit span loading together on Factor 3. Conclusions: Discrepancies in factor solutions between presentations may speak to a greater breakdown of a neurocognitive hierarchy in cortical-based presentations as opposed to subcortical, which leads to aforementioned alterations to the compared component structures. Findings may also suggest a need for differential approaches to RBANS interpretation in these populations that adheres to the altered component structure.
Predictability of Outcomes on the Independent Living Scale (ILS) based on Repeatable Battery for the Assessment of Neuropsychological Status Subtest Performance in a Sample of Patients with Cortical-Based Dementing Disorders
Objective: The current study investigated the extent to which outcomes on the Independent Living Scales (ILS) appear related to and/or dependent upon performance measured by Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) subtests in a sample of patients diagnosed with cortical-based dementing presentations. Method: An archival data set was used for the current study. Participants included 18 individuals diagnosed with a variety of cortical-based dementias who were administered both ILS and RBANS as part of a comprehensive neuropsychological evaluation. RBANS subtest scores and ILS outcome scores were analyzed. Results: Canonical correlation revealed isolated relationships between ILS domains and individual subtest of the RBANS. Those noted included significant relationships between the figure copy (r = .566), line orientation (r = .552), and semantic fluency (r = .511) subtests of the RBANS and ILS-Managing Home & Transportation. An additional significant relationship was noted between ILS-Health & Safety and line orientation (r = .543). No additional correlations met significance. Conclusions: Results are of importance as they appear to contrast those findings of Noggle and Colleagues (2008), which demonstrated a stronger and more robust link between RBANS indices and ILS outcomes. Thus, although current findings demonstrating isolated relationships are interesting, current results are of greater importance in that they suggest that utilization of individual subtests may not be extended to judgments of capacity, rather, as demonstrated by Noggle et al., a broader interpretation of RBANS indices may be more reliable.
Do Frontal Systems Behavior Scale (FrSBe) Scores Differentiate Between Frontotemporal and Alzheimer's Type Dementias?
Objective: Preliminary research (Malloy et al., 2007) suggested that the Frontal Systems Behavior Scale (FrSBe; Grace & Malloy, 2001) and, in particular, the Disinhibition subscale could differentiate between patients diagnosed with Alzheimer's disease (AD) and Frontotemporal dementia (FTD). The current study attempted to replicate this finding by exploring differences between patients with FTD and AD on this instrument. Method: Archival patient data collected as part of an independent research study in a hospital-based dementia specialty clinic was reviewed. Sixteen FTD and 16 AD patients matched for level of cognitive functioning via Mini-Mental State Examination (MMSE) scores were compared on Family FrSBe (Apathy, Disinhibition, Executive, Total Score) ratings. Results: Independent t-tests were calculated to determine whether statistically significant differences existed between the FTD and AD patient FrSBe scores. There were no significant differences (p < .05) between the FTD and AD patient groups on any of the three subscale or total scores either before or after onset of dementia symptoms. Conclusions: There were no statistically significant differences between subscale and total scores on the FrSBe between a matched sample of FTD and AD patients. Scores from the FrSBe may not be useful in differentiating between a diagnosis of FTD or AD. Limitations include the small sample size, and the broad range of dementia severity represented. A larger sample of patients earlier in the disease process may reveal differences in FrSBe profiles which become obscure with increasing illness severity.
DEVELOPMENTAL AND PEDIATRIC: ATTENTION-DEFICIT/HYPERACTIVITY DISORDER
Wechsler Adult Intelligence Scale-Third Edition Performances of Adult Attention-deficit/Hyperactivity Disorder and Clinical Controls
To gain a better understanding of the neuropsychological pattern of adult Attention-deficit/Hyperactivity Disorder (ADHD), the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) performances of individuals presenting for ADHD evaluations were analyzed. Based on clinical observations suggesting better performances on more challenging tests of attention, we hypothesized that on the Digit Span subtest, the clinical controls would perform better on the Digit Span (DS) forward subtest, while showing no difference on DS backward. As part of a comprehensive clinical ADHD evaluation conducted at a University Psychology Clinic, clients were administered the WAIS-III. The scores of 30 individuals who met the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria for ADHD were compared with 15 individuals who did not meet diagnostic criteria. Groups were matched on the WAIS-III Verbal Intelligence Quotient (VIQ; M = 110.56), and as expected the processing speed index (PSI) between the controls (M = 101.29) and ADHD group (M = 92.43) differed at a level approaching significance (t(41) = −17.99, p = .07). Despite the groups not significantly differing overall on the DS subtest, the control group performed significantly better on DS forward (t(41) = −2.73, p < .01), whereas both groups performed similarly on DS backwards (t(41) = .08). No group differences existed on the Letter Number Sequencing (LNS) or the Arithmetic subtests (t < 2.47). Conclusions: The pattern of data suggests that the ADHD group is able to perform as well on more challenging measures of attention and working memory (e.g., LNS, DS backwards, Arithmetic), but may have more difficulty maintaining attention on simpler tasks (DS forward). Future research is needed to explore this hypothesis.
Developmental Pattern of Inhibitory Control Deficits in Attention-deficit/Hyperactivity Disorder
Objective: The present study investigated whether children with Attention-deficit/Hyperactivity Disorder (ADHD) show different patterns of deficits in inhibitory processes depending on age. Method: Participants were 318 ADHD and control childrens, divided into five age groups (6–7, 8–9, 10–11, 12–13, and 14–16). Inhibitory processes were measured using Continuous Performance Test-II (CPT-II), Wisconsin Card Sorting Test (WCST), and Stroop Color-Word. A 2(diagnosis) × 5(age) multivariate analysis of variance (MANOVA) and three 2(diagnosis) × 5(age) analysis of variance (ANOVA)s were implemented. Results: For WCST, there was a main effect for age and diagnosis; the 8–9 group performed significantly better than the 6–7 group. ADHD children made significantly more perseverative errors than the control. For CPT-II, there was a main effect for age; the 12–13 group performed better than the 10–11 group. ADHD children made significantly more commission errors than the control. For Stroop, there was a main effect for diagnosis and Age × Diagnosis interaction. Control was significantly higher than ADHD. For 6–7, controls performed significantly better on WCST and Stroop relative to ADHD. For 8–9, controls performed better on Stroop than ADHD children. For 10–11, normal children performed better on Stroop than ADHD. For 14–16, controls performed better on the Stroop than ADHD. Conclusions: Based on the results, both ADHD and age influence inhibitory controls, suggesting a developmental pattern of inhibitory processes in children with ADHD, which may account for the range of symptoms seen in ADHD. Results indicate that children with ADHD have significant deficits in stopping an ongoing response until approximately age 8 and deficits in interference control through adolescence. Findings emphasize the importance of understanding the developmental changes in children with ADHD.
Gender Differences in Processing Speed in Children with Attention-deficit/Hyperactivity Disorder
Objectives: Differences in cognitive abilities between males and females have been a topic of interest for decades. Although overall performance is similar, there have been variations noted in specific cognitive areas between males and females (Baron-Cohen, 2003; Jarvik, 1975; Jensen, 1998). Processing speed is a narrow-band ability that is affected both by gender (Camarata & Woodcock, 2006) and ADHD (Shanahan et al., 2006). The purpose of this study is to examine the gender differences in processing speed in children with ADHD. Furthermore, this study also examines the developmental effects of these deficits by examining school-aged children and adolescents separately. Method: The school-aged sample consisted of 222 males and 73 females with a mean age of 9.1 years old (SD = 1.6 years), whereas the teenage sample consisted of 172 males and 55 females with a mean age of 14.5 years old (SD = 1.6 years). Both groups were matched based on non-significant Levene's test. Results: Results from independent sample t-tests suggest similar results to a previous gender difference study using normals (Camarata & Woodcock, 2006). These results suggest that there is a significant gender differences in processing speed among teenagers with ADHD (p = .05). Although the school-aged group found boys performing slower than girls, no significant results were found (p = .128). Implications: This may suggest that with development, the gap widens between males and females with ADHD, with females performing faster on visual processing tasks.
DEVELOPMENTAL AND PEDIATRIC: OTHER
Neuropsychological Evaluation of Symptomatic and Asymptomatic Adrenoleukodystrophy: Case Study Comparison
Objective: Adrenoleukodystrophy (ALD) is an X-linked recessive metabolic disorder that results in progressive neurologic deterioration based on cerebral white matter demylination and adrenal insufficiency. Research on the neuropsychological impact is sparse, but individuals with childhood-onset ALD can experience progressive impairment of cognition, behavior, sensory, memory, and motor function (Shapiro et al., 1995). The neuropsychological criteria that signals early neurological deterioration is defined as decline of 1 SD in either IQ, visual processing or memory, or one domain of neuropsychological functioning. Methods: Neuropsychological testing was conducted with two 9-year-old males diagnosed with ALD, both within 3 months time. MRI revealed white matter abnormalities in the occipital and parietal lobes and corpus callosum in one individual who was treated with a bone marrow transplant. The other was placed on corticosteroids, as MRI revealed no white matter abnormalities. Results: Comparison of the data indicated that despite disparate neuroimaging results, testing revealed average language, visuospatial processing, and adaptive skills, with low average Full Scale IQ and little variance between Verbal Comprehension Index (VCI) and Perceptual Reasoning Index (PRI). Although both demonstrated similar weaknesses in attention and executive functioning, the individual with observed demylination exhibited deficits to a greater extent in visuomotor integration, visual perception, memory, and emotional regulation. Conclusion: Consistent with past research of ALD, early signs of disease manifest in attention and executive dysfunction, with progressive disease displaying more significant visual, memory, and emotional regulation deficits. These results support the importance of neurocognitive assessment and close monitoring of asymptomatic patients with ALD.
Rare Parietal Opercular Morphology and Lowered Reading Abilities in Children with Average Intelliegence and Dyslexia and/or Attention-deficit/Hyperactivity Disorder
Objective: Brain structure has been associated with underlying neural circuitry. The few small studies assessing parietal opercular morphology all found Type II to be relatively rare and associated with dyslexia. Therefore, the goal of our study was to determine whether Type II is associated with dyslexia in a larger sample. Method: Children, aged 8–12 years, with dyslexia (n = 27), ADHD (n = 39), both (n = 20), or controls (n = 50) participated in NIH/NICHD funded projects in one of the two laboratories (R03HD048752, R01HD26890). Neuropsychological testing utilized the Wechsler Intelligence Scale for Children (WISC) or Wechsler Abbreviated Scale of Intelligence (WASI), Woodcock Johnson Test-III (WJ-III), Test of Non-verbal Intelligence (TONI), Visual-Motor Integration (VMI), Comprehensive Test of Phonological Processing (CTOPP), and Children's Memory Scale (CMS). MRI scans were classified using the Steinmetz system [Type I: the typical morphology; Type II: absence of the Posterior Ascending Ramus (PAR); Type III: an additional gyrus between the post-central sulcus (POCS) and the PAR; Type IV: PAR merging with the POCS]. Results: Chi square revealed no group differences in the frequency of the typologies. However, Type II occurred in only 6% of the sample. It was found only in the left hemisphere and only in the clinical groups. Type II had poor word identification (t(15.55) = 2.42, p < .05), word attack (t(72) = 2.04, p < .05), passage comprehension (t(71) = 2.37, p < .05), and orthographic choice (t(71) = 3.04, p < .01) compared with Type I. They also had below-average phonological awareness and learning of rote word lists. Performance on the rest of the measures was average. Conclusion: Absence of a PAR (Type II) is associated with poor reading abilities despite average intellect in children with dyslexia and/or ADHD. Deficits appear limited to phonological awareness, orthographics, and rote verbal learning.
Memory and Attention Constructs in Children with Attention Deficits
Objective: The purpose of this study was to ascertain the relationship between measures of memory and attention in children and adolescents with attention deficits. Method: Participants included 49 children and adolescents with a previous diagnosis of Attention-deficit/Hyperactivity Disorder (ADHD), including 34 males and 15 females. The sample was primarily Caucasian. The average age was 8.59 (SD = 2.86) and the average years of education was 2.65 (SD = 2.50). This study compared memory measures from the Wide Range Assessment of Memory and Learning-2 (WRAML-2) (Picture Memory, Design Memory, Story Memory, and Verbal Memory, the Screening Memory Index, Working Memory Index, Verbal Memory Index, Visual Memory Index) with measures of attention. Results: The Continuous Performance Test (CPT) Commission score was correlated with the Verbal Memory Index (r(34) = −.281, p = .05), Screening Memory Index (r(22) = −.349, p = .05), and Working Memory Index (r(12) = −.5, p < .05). The correlation between Commission Errors and the Picture Memory subtest on the WRAML-2 yielded r(34) = −.292 and p < .05. Perseverative Errors were significantly correlated with the Verbal Memory Index (r(33) = −.312, p < .05) and the Picture Memory subtest (r(26) = .399, p < .05). Hit rate, omission errors, variability, and the clinical ADHD percentage were not significantly correlated with any indices or individual subtests on the WRAML-2. Conclusions: The most significant correlations were found between measures of commission and memory. Commission errors appear to be more significant in their memory implications in children with known attentional problems. These results indicate that neuropsychologists should use caution when interpreting low memory indices in children and adolescents with attention deficits as these indices all appear to be impacted by attention.
A Complicated Case of Hypothalamic Neuropsychiatric Syndrome
Objective: Hypothalamic injury has well-documented effects on biological drives including hunger, thirst, and circadian rhythms. However, little is known about the detrimental effects on emotional control and cognitive functioning associated with this type of injury. Lesions of specific areas of the hypothalamus have been associated with severe behavioral disturbances because of disrupted connections with frontal regions and amygdaloid structures (Zillmer, Spiers, & Culbertson, 2008). Method: A 15-year-old boy was diagnosed with a hypothalamic chiasmatic pilocytic astrocytoma at 7 years of age. The tumor was partially resected and after recurrence, 1 year of chemotherapy was administered. MRI clearly illustrates frontal craniotomy with an anterior transcallosal approach to resection as well as pre- and post-treatment changes. Tumor remained stable but psychiatric symptoms (e.g., hallucinations, aggression, impulsivity), narcolepsy with possible psychogenic components, and memory problems emerged. Neuropsychological evaluations were completed 6-year and 8-year post-diagnosis. Results: Neurocognitive impairments were observed in the areas of memory, visual perception, attention, and speed, and inferential processing. Interestingly, narcoleptic/cataplexic incidents were observed during visually complex tasks that were obviously difficult for the patient during both evaluations. Overall, the patient exhibited general improvements at re-evaluation. Conclusions: Characteristics of this neuropsychological/psychiatric profile provide insight into the importance of the connectiveness among the hypothalamic region and other associated brain structures such as the frontal cortices and the medial temporal lobe.
Predictive Discriminative Analysis of Diagnostic Factors in Pediatric Attention-deficit/Hyperactivity Disorder and Pervasive Developmental Disorders
Objective: Clinical differentiation between pediatric ADHD and PDD is difficult due to similar symptoms and presentation on cognitive tests. Both groups struggle academically, experience social communication problems, and display poor impulse control. This study investigated the most optimal combination of neuropsychological tests using the predictive discriminative analysis. Method: The groups included 530 ADHD and 104 PDD patients. Patients were administered the Woodcock Johnson Tests of Cognitive Abilities-III (WJ-III COG) and the Dean-Woodcock Neuropsychological Battery (DWNB), which is a standardized measure of sensory and motor functions. Three predictive discriminant analyses (PDAs) were conducted to gain an estimation of predictive abilities of the sensory-motor tasks, cognitive tasks, and combined sensory-motor and cognitive tasks. The validation method selected for the analysis was the jackknife technique. The goal was to examine how well the selected tests predicted the group membership into the ADHD and PDD groups. Results: Cognitive tests correctly determined 49% of group membership of ADHD and PDD. Sensory-motor tasks correctly classified 77.9% of cases. The combination of cognitive and sensory-motor tests was able to correctly identify 97.8% of cases. Conclusions: The cognitive subtests poorly determined group membership of ADHD and PDD. This does not come as a surprise as both clinical groups struggle academically and have difficulty with information retention and communication. Considering the results of the first analysis, further investigation was conducted. Results suggest that sensory–motor tasks are more effective than cognitive tests; however, the differential diagnosis of PDD and ADHD is the most accurate when using the fixed battery of combined sensory–motor and cognitive tests.
Neuropsychological Profile of Prenatal Exposure to Crack-Cocaine and Alcohol: A Case Presentation and a Proposed Developmental Model for Parent-Friendly Feedback
This study documents the expected deleterious effects of combined crack-cocaine and alcohol exposure in utero, presents a clinical case, and proposes a developmental model for providing neuropsychological feedback. Currently in the extant literature there are few investigations that have reported the sequelae of crack-cocaine and alcohol together, which is labeled the “Cocktail profile” in the current study. We present a case study that examines the neuropsychological effects of illicit substance use in combination with absence of seizures. A statistically unique patient, “Jane” is a young African American female who had numerous risk factors, but has displayed tremendous resiliency. Her outcome corroborates the theoretical perspective that the overall intellectual functioning of individuals exposed to crack-cocaine prenatally is potentially mediated by post-birth environment. Test results indicate that her overall intellectual ability, language, and memory functioning are greater than expected given her prenatal and developmental history. However, her visual–spatial, executive functioning, and behavioral and emotional functioning are consistent with the “Cocktail profile.” In addition to the presentation of this unique profile, we provide a developmental model for ideographic feedback (Dennis, 2001). A superimposed table elucidates Jane's neuropsychological performance relative to the expected profile encompassing the teratogenic effects of prenatal exposure to crack-cocaine and alcohol. The proposed feedback approach provides an individualized and simplistic method to facilitate the parents' understanding of their child's current functioning in comparison to a clinical disorder. Ultimately, it is hoped that this proposed technique could foster optimism and hope for families struggling with children who suffer from neuropsychological dysfunction.
Executive Functioning in Children Versus Adolescents with Major Depressive Disorder
Objective: Children with Major Depressive Disorder (MDD) have shown a deficit in executive functioning when compared with normal controls. The purpose of this study was to determine if this deficit diminishes with age. Methods: Scores from the Digit Span subtests of the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV), Stroop Color-Word test, Wisconsin Card Sorting Test preservative responses, and the omission and commission variables of Conner's Continuous Performance Test (CPT) were examined among 77 MDD and 96 normal participants. Age groups were created from 6–11 (N = 94, M = 8.06, SD = 1.62) and 12–17 (N = 79, M = 13.71, SD = 1.24). The MDD group consisted of 60% males, 71% right-handed, and 60% Caucasian participants. The normal group consisted of 67% males, 87% right-handed, and 61% Caucasian participants. Results: A 2 × 2 factor analysis of variance (ANOVA) design was utilized to determine diagnostic group differences as well as the interaction between diagnosis and age. The results revealed no significance in the interaction between age and diagnosis across all variables. Significant differences were found between diagnostic groups in the 6–11 age group in CPT omission errors (F(1, 30) = 30.23, p = .00) and commission errors (F(1, 30) = 14.77, p = .00). In the 12–17 age group, significant differences were found in CPT omission errors (F(1, 30) = 10.96, p = .01] and Digit Span (F(1, 32) = 12.16, p = .00). Conclusions: These results suggest that some executive functioning deficits are present in children with MDD when compared with controls, although age is not a contributing factor. These results contribute to limited research on understanding neuropsychological characteristics of MDD children, which can be applied to development of effective treatment.
NEUROLOGICAL AND NEUROPSYCHIATRIC DISORDERS: TRAUMATIC BRAIN INJURY
Relation of Cognitive Impulsivity to Executive Functioning Following Moderate-To-Severe Traumatic Brain Injury
Objective: Prior studies have related impulsive behavior to executive dysfunction, but the subjective experience of impulsivity is less understood. This study examined the relationship between cognitive components of impulsivity and executive skills after traumatic brain injury (TBI). Method: Eighty-nine veterans with moderate-to-severe TBI, who received acute inpatient rehabilitation, were re-assessed at 6-month follow-up. Measures: Barratt Impulsivity Scale (BIS-II), a self-report of impulsivity in six domains (attention, motor, self-control, perseverance, cognitive complexity, cognitive instability); Wisconsin Card Sort (WCST), phonemic and semantic verbal fluency, and Stroop inhibition. Results: Five BIS-II subscales correlated significantly with two of the executive tasks (r = .23–.26, p < .05). Poorer cognitive complexity and perseverance on BIS-II correlated with WCST perseverative errors and fewer categories completed. Poorer BIS-II cognitive stability and complexity correlated with lower phonemic fluency, whereas poorer BIS-II self-control correlated with semantic and paraphasic errors during verbal fluency. Stroop inhibition and BIS-II impulsive attention showed no significant correlations in these analyses. Conclusion: During recovery from TBI, multiple aspects of self-reported impulsivity are related to objective measures of executive functioning. Subjective experiences of impulsivity are associated with measures of perseveration, linguistic errors, and reduced cognitive flexibility. These analyses verify that patients who report greater cognitive complexity and perseverance are better able to organize flexible responses and solve ambiguous problems. Likewise, individuals who experience better impulse control show better suppression of incorrect responses. Additional studies are needed to identify neuropsychological correlates of self-reported attention impulsivity. These findings may inform efforts to build insight into impulse regulation during rehabilitation.
The Comorbidity of Blast Traumatic Brain Injury and Posttraumatic Stress Disorder: A Continuing Obstacle to Treatment
Objective: The purpose of this study is to review the relevant literature on blast TBI (bTBI) and PTSD. It has been found that 95% of blast-injured patients admitted to Walter Reed Army Medical Center had some level of traumatic brain injury (TBI; Stuhmiller, 2008). Ling, Bandak, Armonda, Grant, and Ecklund (2009) noted that explosive blasts account for more than 60% of causalities in the wars in Iraq and Afghanistan. In addition, 25% of returning veterans were diagnosed with a minimum of one psychiatric diagnosis and slightly over half of those were diagnosed with PTSD (Thompson & Gottesman, 2008). Further, it has been found that 44% and 23% of reported TBI cases with loss of consciousness (LOC) also met criteria for PTSD and depression, respectively. The numbers for TBI without LOC were 27% and 8%, respectively (Elder & Cristian, 2009). Method: Review of the literature to explore the mechanisms of action and the biological effects of both pathologies. Additional investigation of the relationship between bTBI and PTSD, including overlapping and differential symptomatology. Results: PTSD and TBI have many overlapping symptoms, such as complaints of fatigue, irritability, poor sleep, impaired concentration, attention, and memory problems. However, a TBI has more organic symptoms, such as headaches, dizziness, visual complaints, hearing loss, balance problems, and cognitive impairment (Elder & Cristian, 2009). Conclusion: Given the high comorbidity of bTBI and PTSD, health-care providers are exploring the similarities and differences between these two disorders in order to provide accurate and effective treatment.
The Educational Impact of a Depressed Right Frontal Skull Fracture
Objective: A 12-year-old Caucasian male experienced a depressed right frontal skull fracture at age 10, which required neurosurgery. Reportedly, this child with Attention-deficit/Hyperactivity Disorder (ADHD) hit his head on a metal bar while swinging. Reportedly, he suffered a brief loss of consciousness, could not remember all of the details, and was apparently confused at the scene. A CT brain scan revealed a full-thickness depression of the right frontal skull fracture with the linear portion of the fracture extending through the roof of the orbit. The decision to operate was based on the neurological status of the patient, the exact location of the sinus involved, and the degree of venous flow compromise. Method: A neuropsychoeducational evaluation was conducted to develop a comprehensive intervention plan. Results: Neuropsychological evaluation revealed significant brain behavior and executive functioning deficits. Psychological evaluation revealed behavioral and personality deficits. Academic difficulties were also noted. Conclusions: Shortly after surgery, this child was released to return to school. The neurosurgeon expected that the surgery would leave the child with no residual effects; however, this was not the case. Although a relatively good student pre-trauma, upon return to school, the child began experiencing difficulties with learning, memory, affect and behavior. Five hundred and four accommodations were offered, but IDEA assistance was not. Upon a 1 year neurological follow-up, the child reported having to repeat 5th grade, and continuing to exhibit headaches, nausea, noise sensitivity, irritability, and frustration. Two years later, this child, now age 12 and in 6th grade, continues to struggle academically and emotionally.
Component Analysis of Verbal Fluency in Patients with Traumatic Brain Injury
Objective: The current study examined whether component scores (i.e., switching and clustering) of phonemic and semantic verbal fluency tests yields greater sensitivity to traumatic brain injury (TBI) than global scores (i.e., number of words generated). Method: Archival data were gathered from a random sample of personal injury litigants referred for a neuropsychological examination due to subjective cognitive complaints secondary to TBI. Twenty mild TBI, 8 moderate TBI, and 12 severe TBI patients along with 95 healthy normal community-dwelling adults were included into the study. Statistical analysis between groups revealed no significant difference in age, or years of formal education completed between groups. Results: Comparison of scores from each TBI group to healthy controls revealed larger effect sizes for component scores than for global scores of verbal fluency. This was most evident in terms of component scores of semantic fluency (e.g., controls vs. mild TBI: semantic switching d = 1.07, semantic cluster size d = 1.17, semantic global d = .05). Comparison between TBI severities revealed less robust results but effect sizes generally favoured component scores for both phonemic and semantic fluency scores. Conclusion(s): Results of the current study illustrate the potential diagnostic utility of component scores of verbal fluency to be advantageously sensitive to TBI.
Examining Psychological Distress, Cognitive Ability, and Functional Outcome Following Traumatic Brain Injury
Objective: The consequences of traumatic brain injury (TBI) involve physical disability, emotional disturbances, cognitive impairments, and behavioral problems (Arango-Lasprilla et al., 2007; Dikmen et al., 1995; Rao et al., 2000; Rassovsky et al., 2006). Within the literature documenting outcomes following TBI, few studies have examined the relationships between psychiatric and cognitive factors on functional outcome (Ponsford et al., 2008). Therefore, the current study aimed to understand the association between outcomes following TBI and examined if psychological distress and cognitive ability predict functional outcomes following moderate and severe TBI. Method: Forty-five individuals who had sustained moderate-to-severe TBI were included in the study. Participants completed a telephone interview and self-report measures on current psychological distress, cognitive ability, and functional independence levels. Correlational and regression analyses were performed in PASW Statistics 18. Results: Cognitive ability and psychological distress were both significantly correlated with functional outcome. Partial correlations demonstrated that cognitive ability and functional outcomes were significantly correlated when controlling for psychological distress but that the correlation between psychological distress and functional outcome, when controlling for cognitive ability, was not significant. A post hoc mediation model was tested using regression and demonstrated that cognitive ability mediates the relationship between psychological distress and functional outcomes. Conclusions: The current study elucidated the associations between outcomes following TBI and demonstrated that cognitive ability mediates the relationship between psychological distress and functional outcome. These data may have important clinical implications for intervention techniques due to the results indicating that treatment of psychological distress following TBI could ultimately improve functional outcomes.
Meta-Analysis of the Neuropsychological Aspects of Mild Traumatic Brain Injury: Time Post-Injury and Cognitive Domains
Objective: Three meta-analyses (Binder et al., 1997; Frencham et al., 2005; Pertab et al., 2009) have been conducted on the neuropsychological effects of mild traumatic brain injury (TBI). None of these tracked how specific domains of the neuropsychological functioning recover post-injury. The purpose of this meta-analyses was to re-analyze studies included in prior analyses to evaluate this issue. Data selection: Studies that compared individuals with mild TBI to controls without TBI were included. Twenty-eight studies with 48 total samples were included with 2,834 participants with TBI and 2,057 controls. There were no demographic differences between groups. Studies were divided into three chronicity or time post-injury groups (e.g., ≤14 days, 15–92 days, and ≥3 months). Seven domains of cognitive functioning were assessed including, for example, processing speed and perceptual reasoning. Data synthesis: Effect sizes (a negative number indicates that the mild TBI group performed worse than the control group) across these groups for all neuropsychological domains were as follows: d = −.37 for ≤14 days, d = −.20 for 15–92 days, and d = −.07 for ≥3 months. Most cognitive domains demonstrated similar improvement in functioning, although visual memory and learning domain had the greatest effect size difference (d = −.66) at ≤14 days. This diminished to d = .03 at ≥3 months. Conclusions: Mild TBI results in relatively minor neuropsychological deficits immediately after injury, but essentially no deficits after 3 months. The current data support the position that cognitive recovery after mild TBI is expected.
The Importance of Screening for Post-Concussion Motor Symptoms
Objective: To evaluate whether the presence of post-concussion motor symptoms affect recovery following sports-related concussion. Methods: Two-hundred and one high school and collegiate athletes who sustained a concussion and endorsed motor symptoms, balance problems, or dizziness, were compared to 197 high school and collegiate athletes who sustained a concussion and did not endorse motor symptoms. Athletes were tested on ImPACT at both baseline and post-concussion. Results: Groups showed no significant differences in baseline test scores. Multivariate analysis of variance (MANOVA) revealed multivariate effects of symptom group and time, with group × time interactions noted. Athletes endorsing motor symptoms within 1 week post-concussion scored significantly worse on verbal memory, visual memory, and reaction time, and also endorsed more non-motor symptoms, when compared with athletes not endorsing motor symptoms post-concussion. These effects were not present 7–10 days post-injury. A smaller sub-group of athletes presented with motor symptoms 7–10 days post-concussion, and MANOVA revealed that these athletes return to baseline cognitive performance, but continue to endorse significantly more non-motor symptoms than athletes not presenting with motor symptoms 7–10 days post-concussion. Conclusions: Athletes presenting with balance problems or dizziness post-concussion score significantly worse than athletes not presenting with motor symptoms, when compared with baseline. Athletes continuing to endorse motor symptoms over 1 week post-concussion should be carefully evaluated with balance testing and also be screened for non-motor symptoms.
Achievement Test Profiles in Children with Traumatic Brain Injury
Objective: Traumatic brain injury (TBI) results in heterogeneous patterns of neurocognitive deficits that have been well documented using tests of intelligence, learning and memory, and attention. Fewer studies have examined the effects of TBI on educational achievement to determine whether heterogeneity also exists on measures that assess these domains. The current study examined these issues in children and adolescents who sustained TBI. Method: Participants included 171 youth with TBI between 7 and 20 years of age who were administered the Woodcock–Johnson Test of Achievement Third Edition (WJ-III: Ach) reading, math, writing, and fluency subtests. Hierarchical cluster analysis (Ward's method) was run specifying three, four, and five clusters using WJ-III: Ach subtests as attributes. Stability of the cluster solutions was examined using the K-means iterative partitioning method. Results: Four clusters were extracted that did not differ on age, gender, ethnicity, or Glasgow Coma Scale scores. Kappa between Ward's and K-means methods was highest for the four-cluster solution (k = .83), and Beale's F-statistic indicated that it accounted for more variance than the three-cluster solution. Clusters differed on both level and pattern of performance with one cluster above average, a second average with low fluency scores, a third below average, and a fourth impaired. Discussion: Results provide some of the first findings on heterogeneity in achievement test performance in children and adolescent with TBI. Four achievement test profiles were identified that were differentiated by both level and pattern of performance. Results may be useful in identifying those children who will have academic difficulties following TBI.
Combat Blast Exposure, Objective Cognitive Functioning, and Subjective Cognitive Complaints Predict Employment Status of Blast-Exposed Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans
Objective: Many OEF/OIF veterans diagnosed with mild traumatic brain injury resulting from blast exposure continue to report that cognitive problems adversely affect their post-deployment occupational functioning. The objective was to evaluate whether blast exposure, subjective cognitive complaints, and objective cognitive performance are associated with employment status in OEF/OIF veterans. Method: Thirty participants were drawn from an ongoing study of neuropsychological functioning in blast-exposed OEF/OIF veterans. Backward stepwise logistic regression was used to construct a logistic regression model with employment status as the dependent variable. The potential independent variables included number of self-reported blast exposures, subscale scores on the Ruff Neurobehavioral Inventory (RNBI), and measures of memory, attention, spatial, and executive functioning from the Neuropsychological Assessment Battery (NAB). Results: Independent variables of the resulting logistic regression model included self-reported blast exposure, RNBI executive functioning, RNBI employment functioning, and NAB number and letter efficiency. The model classified veterans' employment versus unemployment status with 96% overall accuracy. Conclusions: Interim study findings suggest that number of self-reported blast exposures, subjective cognitive complaints, and objective cognitive performance are significantly associated with blast-exposed veterans' employment status.
Differences in Executive Function Profiles in Normal Children and those with Traumatic Brain Injury
Objective: Traumatic brain injury (TBI) results in heterogeneous neurocognitive deficits which vary depending on the nature, mechanism, and severity of injury. Cluster analysis has been used to examine these deficits, although few studies have made direct comparisons between clusters identified in TBI and normal control samples to determine whether clusters identified in TBI differ from what would be expected due to normal variability in test performance among non-brain-injured individuals. The purpose of this study was to identify homogenous subtypes of executive function impairment in pediatric TBI and to compare these clusters to those identified in controls. Method: Participants included children who sustained TBI (n = 143) as well as a normal comparison sample (SS group; n = 143) that were matched on age and sex, and administered the Comprehensive Trail Making Test (CTMT). Hierarchical cluster analysis (Ward's method) was used to analyze CTMT scores for the two groups, with three, four, and five cluster solutions specified. Results: A three-cluster solution fit best for both the TBI and SS groups. The TBI group exhibited lower performance on all clusters compared with controls. However, there was little variability based on the pattern of subtest performance across groups. Conclusions: Results indicate that individuals with TBI are differentiated from normal comparisons on executive functions assessed by the CTMT, although differences are primarily characterized by the level of performance. The CTMT may therefore be most useful in differentiating between individuals with and without TBI based on severity of impairment, rather than pattern of specific executive functioning deficits.
Construct Validity of the Wechsler Intelligence Scale for Children-Fourth Edition in Pediatric Traumatic Brain Injury
Objective: Wechsler Intelligence Scale for Children 4th edition (WISC-IV) is commonly used to evaluate intellectual functioning following traumatic brain injury (TBI). However, little information is available regarding its construct validity when used to assess childhood TBI. The current study examined the construct validity of the WISC-IV Indices in children who had sustained moderate-to-severe TBI. Method: Participants included 66 children with TBI (60% males; mean age: 144.46 months; SD: 35 months) who had subsequently been assessed using the WISC-IV and other tests, including the Woodcock–Johnson Test of Achievement, Third Edition (WJ-III), the Oral and Written Language Scale (OWLS), the Test of Visual Motor Integration, the Test of Memory and Learning (TOMAL), the Wisconsin Card Sorting Test (WCST), the Continuous Performance Test (CPT), Grooved Pegboard (GP), and Grip Strength (GS). Construct validity of the WISC-IV Index scores was examined by calculating correlations with these other measures. Results: Significant association was present between the WISC-IV Verbal Comprehension Index and language ability (r = .807); the WISC-IV Perceptual Reasoning Index and visuomotor integration (r = .59); the Processing Speed Index and broad math skills (r = .73); and the Working Memory Index and (r = .71), attention/concentration (r = .68), and executive function (r = .40). Discussion: Results of the current study provide support for the construct validity of the WISC-IV when used to assess children with TBI. Future research might evaluate other clinical populations to determine whether the results obtained here are generalizable.
Post-Concussion Syndrome 3 months after a Mild Traumatic Brain Injury: Two Methods of Assessing Self-Reported Symptoms in the Acute Phase
Objective: To predict post-concussion syndrome (PCS) according to two methods of assessing self-reported symptoms in the acute phase following mild traumatic brain injury (mTBI). Method: Sample consisted of 354 adults who were contacted by telephone during the initial week, fourth week, and third month following their mTBI. They had to first report their symptoms freely (spontaneous method) and then, according to a standardized checklist (suggested method: Rivermead Post-Concussion Symptoms Questionnaire; King et al., 1995). Logistic regression analyses were applied in order to predict PCS at 3 months from symptoms reported in the first and fourth weeks according to both assessment methods, which controlled mTBI diagnostic criteria. Results: Participants who reported at least three symptoms according to the spontaneous and suggested methods at the first week post-mTBI had, respectively, twice as many chances (OR = 2.24; 95% CI = 1.21–4.12) and almost six times as many chances (OR = 5.82; 95% CI = 2.97–11.41) of developing PCS at 3 months than those who presented fewer than three symptoms. For those who reported at least three symptoms in the fourth week post-mTBI, chances of developing PCS at 3 months were 3.48 for the spontaneous method and 15.69 for the suggested method. Conclusion: The risk of developing PCS at 3 months is higher when the participants reported at least three symptoms at first and fourth week post-mTBI, and the suggested method seems more sensitive at detecting PCS.
Base Rates of Post-Concussive Symptoms in a Non-Concussed Multi-Cultural Sample
Objective: The purpose of this study was to investigate the base rates of symptomatology that characterizes Post-Concussion Syndrome (PCS) in healthy individuals parcelled by cultural identity to examine differences. In this study, we sought to determine if cultural differences exist in terms of base rate endorsement of PCS symptomatology in healthy individuals and whether culture-specific clusters of PCS symptomatology exist in healthy individuals. Methods: A total of 151 participants, consisting of 33 Caucasians, 49 Chinese, Filipinos, and Southeast Asians, 43 Arabs, West Asians, and South Asians, and 8 Africans completed four questionnaires and two subtests of a test of verbal ability. Results: We found that the endorsement of PCS symptoms did not differ by cultural groups in general, but that there were differences between cultures in the base rates of individual symptom endorsement. Conclusions: Our findings suggest that cultural background may play a moderate role in PCS symptomatology and that false-positive conclusions may be reached disproportionally between cultural groups. Knowledge of such symptom endorsement in healthy individuals is essential if we are to further understand PCS. Indeed, the practice of clinical neuropsychology may be exceptionally prone to false-positive conclusions about the presence of PCS where the base rates of symptom endorsement are high in non-brain-injured individuals.
Medical Symptom Validity Test Performance Following Moderate-To-Severe Traumatic Brain Injury
This study assesses Medical Symptom Validity Test (MSVT) performance in participants with moderate-to-severe traumatic brain injury (TBI) and identifies predictors of MSVT performance. Participants hospitalized at a rehabilitation hospital following moderate-to-severe TBI (N = 85) were assessed prior to discharge using a battery of neuropsychological tests. Neuropsychological battery included the following measures: O-Log, Multilingual Aphasia Examination (MAE) Token Test, Wechsler Memory Scale, Fourth Edition (WMS-IV) Visual Reproduction, Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) Letter Numbering Sequencing, California Verbal Learning Test, Second Edition (CVLT-2), Booklet Category Test, Delis-Kaplan Executive Functioning Scales (D-KEFS) Trails, Beck Depression Inventory II, and MSVT. Decision tree analysis using recursive partitioning was used to examine demographic and neuropsychological test predictors of MSVT performance. The study sample had a mean age of 30.8, 12.5 years of education, and post-traumatic amnesia (PTA) of 5.1 weeks. Neuropsychological test performance was uniformly impaired across all measures (Test Battery Mean/T Score = 31.5). Mean MSVT Immediate Recall (IR) was 94.5%. Mean MSVT Delayed Recall (DR) was 92.1%. Mean MSVT Consistency Index (CI) was 90.1%. Neuropsychological test scores did not predict performance on the MSVT. Decision tree analyses revealed participants who had an O-Log score >23 obtained 90% or greater performance on the MSVT IR. Participants who had an O-Log score >24 obtained 90% or greater on the MSVT DR. Based on initial analyses, participants who are fully oriented are able to score >90% correct on the MSVT. Finding intact orientation to be a predictor of MSVT performance should assist clinicians in making determinations of optimal and suboptimal effort in clinical cases where examinees do not evidence disorientation. Effort assessment and application of findings are discussed.
Premorbid IQ Estimates and Current Functioning: Discrepancies in a Collegiate Athlete Sample
Objective: Premorbid IQ estimation is often used as a comparison standard when interpreting neuropsychological (NP) test results. Word-reading tests such as the Wechsler Test of Adult Reading (WTAR) are objective and valid methods for estimating premorbid IQ. The current study aimed to evaluate the WTAR IQ estimate as a predictor of current cognitive functioning in a sample of non-injured college athletes. Methods: A battery of NP tests, including the WTAR, was administered to 509 non-injured college athletes. Test scores were converted to standard score (SS) units, using the athletes at baseline as a reference. Discrepancy scores were calculated by subtracting the SS-converted NP test scores from the WTAR IQ estimate. Results: The WTAR IQ estimate was significantly discrepant from athletes' mean NP test performance by an average of 11 SS points (t = 64.5, p < .001). IQ estimate was related to WTAR performance discrepancies (r = .42, p<.001): for lower IQ athletes (<98), the WTAR underestimated NP test performance by an average of 3.3 SS points; for higher IQ athletes (>105), the WTAR overestimated NP test performance by an average of 5.0 SS points. For all NP tests, the WTAR overestimated NP test performance for higher-IQ athletes and underestimated NP test performance for lower-IQ athletes. Conclusions: As a comparison standard for estimating premorbid functioning, the WTAR introduces a systematic bias—overestimating the performance of higher-IQ individuals and underestimating the performance of lower-IQ individuals. The implications of these findings for post-concussion management will be discussed.
NEUROPSYCHOLOGICAL DOMAINS: ATTENTION
Intraindividual Variability in Response Time: Implications for Sustained Attention
Objective: Intraindividual variability in response time characterizes attentional performance in healthy individuals, yet relationships between performance and performance variability remain poorly understood. The present study sought to examine the relationship between response time (RT) and RT variability in a sample of non-injured college athletes. Methods: The Vigil Continuous Performance Test (CPT) was administered to 443 college athletes participating in a sports-concussion program at baseline. The Vigil has four consecutive blocks of 78 stimuli. Structural equation modeling was used to examine the time-dependent relationships between the average RT and RT standard deviations (SD) for the Vigil's four blocks. Separate models were established for the RT and SD data, and these models were then integrated. Modification indices were consulted, and plausible beta paths were estimated. Results: The final model provided an excellent fit to the data (χ2(14) = 21.92; p = .08). All autoregressive paths for RT and SD were significant. RT and SD were significantly correlated within each block. Modification indices suggested opening paths from RT1 to RT3 (β = .21; t = 8.65), SD1 to RT2 (β = .33; t = 5.53), and SD1 to RT3 (β = .21; t = 2.91). Mean values for RT and SD increased over time. Conclusions: These results suggest that speeded attention degrades over the course of a CPT—evidenced by both slowed RT and increased RT variability. RT variability early in the task predicted slower responding for later blocks. In athletes at baseline, RT variability serves as an early marker of sustained attention problems later in a task.
Attention and Executive Functioning in Post-Traumatic Stress Disorder Clients
Objective: Individuals diagnosed with post-traumatic stress disorder (PTSD) often report difficulties with attention, concentration, memory, and executive functioning (EF; Briere & Spinazzola, 2005; Leskin & White, 2008). Few studies have demonstrated these complaints on neuropsychological measures, thus the current research is designed to address this issue. Method: The current study explores the relationship between PTSD and performance on EF measures utilizing 186 participants diagnosed with PTSD, all of who completed an outpatient neuropsychological evaluation. The PTSD (n = 45) group was compared with a neurological disorder group (ND; n = 80) and anxiety disorder group (ANX; n = 61). Participants were consecutive referrals for a neuropsychological evaluation who met the diagnostic criteria. The ND group consisted of diagnoses such as multiple sclerosis and normal pressure hydrocephalus. Results: A significant difference was found between groups on various measures of attention including the Brief Test of Attention (BTA; F(2, 122) = 4.971, p = .01) and Working Memory Index (WMI) of the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III; F(2, 143) = 7.433, p = .001). However, no differences were found on the Wisconsin Card Sorting Test (WCST) perseverative responses. Post hoc analysis indicated that sustained attention in the PTSD group was similar to the ND group, but significantly poorer than the ANX group. Conclusions: Findings indicate individuals diagnosed with PTSD appeared to have difficulty maintaining attention similar to individuals diagnosed with a neurological disorder. The results suggest that these attentional problems could adversely affect their ability to participate in psychotherapy. Implications of this research include the need to develop treatment strategies that compensate for these attention issues.
Evaluating the Effectiveness of Drivers to Perform a Secondary Task While Driving
Objective: The purpose of this study was to evaluate how a standard measure of inattention was related to drivers' ability to attend to discriminant stimuli while completing a simulated driving task. Method: Participants consisted of 52 adults aged 18–59 (M = 29.85, SD = 10.84) from a normal population. The sample was 55.8% females, 60.0% Caucasian, and 92.3% right-handed, with an average education level of 15.88 (SD = 2.46) years. Variables from the Conners Continuous Performance Test, Second Edition (CPT-II), and STISIM Drive® were used in analyses. Results: Results were considered significant at the p < .05 level. CPT-II hit reaction time was positively correlated with STISIM incorrect responses (r(52) = .45) and total mistakes (r(52) = .33), and negatively correlated with STISIM correct responses (r(52) = −.33). CPT-II detectability demonstrated a significant positive linear relationship with STISIM correct responses (r(52) = .31) and significant negative linear relationships with both STISIM incorrect responses (r(52) = −.36) and total mistakes (r(52) = −.31). CPT-II response style was positively correlated with mean response time (r(52) = .43), incorrect responses (r(52) = .28), missed responses (r(52) = .44), and total mistakes (r(52) = .47), and negatively correlated with correct responses (r(52) = −.47). Conclusion: It appears that individuals who took longer to respond and demonstrated a more cautious response style are more likely to demonstrate difficulty responding to a secondary task while driving. Recommendations are discussed.
Prismatic Adaptation in the Therapy of Spatial and Object Neglect: A Case Study
Objective: Many researchers report positive effects of prismatic adaptation in elimination of hemispatial neglect symptoms in visuo-motor, perceptual, and imagination tasks. The usefulness of this method in rehabilitation of two variants of neglect—space versus object in perceived and imagined space is determinated. Method: A 71-year-old man, 11 years after right hemisphere stroke, participated in the study. Standard paper–pencil tests (drawing, Ota's tests) were used in the diagnosis. Additionally, the computer version of Ota's tests, which can diagnose spatial and object neglect, was applied. The patient was asked to compare angles between clock hands of two clocks presented on either the left or the right side of the computer screen and also had to imagine these clocks. The patient's performance after the administration of prismatic adaptation was compared with the initial performance level. Symptoms of neglect were not observed in the traditional paper–pencil tests but only in the computer-perceptual task (spatial version). The patient showed no signs of spatial neglect in the computer-imagination task and no signs of object neglect in the perceptual and imagination computer tasks. Results: Symptoms of space neglect in the perceived space declined after prismatic adaptation. There were also no signs of spatial neglect 1 hr, 1 week, and 1 month after the rehabilitation session. Conclusion: The prismatic adaptation may be an useful method in rehabilitation of spatial neglect. The computer version of Ota's test seems to be more sensitive in detection of space neglect. More detailed studies on a group of patients with object and space neglect symptoms are necessary.
Adults with Attention-deficit/Hyperactivity Disorder Demonstrate an Isolated Impairment in Rotated Memory for Location on the Brown Location Test
Objective: To explore a clinical observation that adults with ADHD seem to have relative difficulty recalling dot locations when they are rotated from the original presentation on the Brown Location Test (BLT), despite otherwise intact performance on this test. Method: Fourteen individuals (11 males, 3 females) with ADHD were compared with 14 (10 males, 4 females) age, IQ, and gender-matched healthy controls from the BLT standardization sample. Participants were adults (M = 23.4, SD = 6.7 years) with mostly higher-than-average intelligence (M = 109.3, SD = 14.23) and had attended some college (M = 13.96, SD = 2.2 years of education). IQ was estimated with the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) for clinical participants and the Wechsler Abbreviated Scale of Intelligence (WASI) for controls. The Brown Location Test is a dot memory test with learning trials, interference, short, long, rotated, and recognition delays with published psychometric support and clinical validity. Results: On a multivariate analysis of variance (MANOVA), individuals with ADHD had significantly (F(1, 26) = 14.37, η2 = .356) lower scores on the BLT rotated long delay (M = 3.71, SE = .68) than healthy controls (M = 5.96, SE = .68). There were no significant differences on any other BLT subtests. Conclusions: These results suggest that individuals with ADHD score consistently lower on the rotated delay subtest than controls, despite otherwise intact scores visual memory scores. This may be the result of paying less attention to environmental than egocentric cues, weakness in mental rotation, or other difficulties to which this subtest score seems particularly sensitive.
Process Training in the Early Rehabilitation of Attention Deficits in Acquired Brain Injury: A Pilot Study
Background: Process training is a rehabilitation treatment that involves the use of repetitive mental exercises believed to help in the restoration of a cognitive function, presumably through the development of new neural pathways (i.e., neuroplasticity). There is little and inconsistent evidence to support the effectiveness of process training in the delayed treatment of attention deficits resulting from acquired brain damage (i.e., stroke or traumatic brain injury; TBI), and no studies have applied process training early in the rehabilitation process. Method: CogniPlus software was the type of process training used in this pilot study. CogniPlus uses computerized multimedia interactive simulations of real-life situations. Participants: Three inpatients on the Rehabilitation Unit of the Saint John Regional Hospital who had suffered either a stroke or TBI approximately 1 month earlier received 20 sessions of CogniPlus process training 1 hr per day, 5 days a week for 4 weeks (i.e., the “treatment” condition). Three other patients did not receive process training (the “control” condition). All patients in both conditions received standard in-patient rehabilitation therapies for 4 weeks. Results: All patients' scores on the Test of Everyday Attention in both the treatment and control conditions unexpectedly deteriorated over the 1 month period of this study (M scaled difference score (post–pre) = −1.36) with the treatment patients deteriorating 63% less on average than the control patients. Conclusion: Attentional abilities in patients with acquired brain damage may continue to deteriorate during their second month post-injury. However, computerized process training early in the rehabilitation process may reduce this deterioration by as much as 63%.
Neuropsychological Outcomes from Cerebral Malaria in Malawi
Objective: Close to 1 million children die each year in sub-Saharan Africa due to cerebral malaria. Unfortunately, neuroimaging and neuropsychological research is sorely lacking in this field. The purpose of this study was to examine the research in order to determine the neuropsychological effects following long-term survival from cerebral malaria. This poster will critically examine the extant research to determine the sequelae present in these children. Method: A review of the neuropsychological and neuroimaging literature from the years 1990 to 2009 was conducted using research studies that assessed individuals with cerebral malaria resulting in 10 neuropsychological studies and 5 neuroimaging studies. Results: The diagnostic criteria for cerebral malaria were found to be highly inconsistent across studies. The inclusion of retinopathy and coma are emerging as the gold standard for diagnosis of cerebral malaria. In the studies of neuropsychological function, data indicated that cerebral malaria is associated with cognitive deficits in children and behavioral symptoms present upon recovery strongly resemble Attention-deficit/Hyperactivity Disorder (ADHD). The studies reported approximately one-quarter of children diagnosed with cerebral malaria suffer from long-term cognitive, attentional, and working memory deficits as demonstrated at follow-up visits 6 months to 9 years later. The neuroimaging studies consistently identified brain swelling, cortical infarcts, and white matter lesions, particularly in the splenium of the corpus callosum during and following recovery from cerebral malaria. Conclusion: Neuropsychological and neuroimaging data suggest that long-term cognitive deficits are common in a significant portion of patients with many of these presenting with ADHD and executive function deficits. Treatment issues in sub-Saharan Africa will be discussed.
Evaluating the Relationship between a Neurological Measure of Inattention and Driving Performance
Objective: The purpose of this study was to evaluate how a standard measure of inattention was related to driving errors on a simulated driving task. It was predicted that inattention would be positively associated with collisions, tickets, and road deviations. Method: Participants consisted of 52 adults aged 18–59 (M = 29.85, SD = 10.84) from a normal population. The sample was 55.8% females, 60.0% Caucasian, and 92.3% right-handed, with an average education level of 15.88 (SD = 2.46) years. Variables from the Conners Continuous Performance Test, Second Edition (CPT-II), and STISIM Drive® were used in analyses. Results: Results were considered significant at the p < .05 level. STISIM Total Tickets/Violations on the STISM driving program demonstrated a positive linear relationship with CPT-II Hit Reaction Time Standard Error (r = .46) and Variability (r = .43). STISIM Total Adverse Events also was positively correlated with CPT-II Hit Reaction Time Standard Error (r = .42) and Variability (r = .33), and STISIM Total Lane Excursions was positively correlated with CPT-II Omissions (r = .34) and Variability (r = .28). No significant relationships were found regarding STISIM Total Collisions and CPT-II measures. Conclusion: The tendency to obtain tickets, incur adverse events, and deviate from road lanes on a driving simulator task appears to be related to CPT-II measures of inattention and consistency. Measures of inattention were not predictive of accident risk using the CPT-II. The CPT-II is indicated as being useful in the assessment of driving abilities.
NEUROPSYCHOLOGICAL DOMAINS: MEMORY AND AMNESIA
Working Memory: A Comparison Study between the Third and Fourth Editions of the Wechsler Tests of Intelligence and Memory
Objective: It was hypothesized that the working memory measures of the fourth edition Wechsler Memory Scale (WMS) and Wechsler Adult Intelligence Scale (WAIS) would be less related in the third edition because the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) index involves auditory demands, whereas the WAIS-IV index is designed as a visual measure. Method: Participants consisted of 20 adults with average age 34.20 (SD = 13.87) from a clinically referred population. The sample was 65.0% females, 60.0% Caucasian, and had an average education level of 13.38 (SD = 2.06). Standard scores from the Working Memory Indexes on the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III), WAIS-IV, WMS-III, and WMS-IV were utilized. Results: The Working Memory Index on the WAIS-III demonstrated a strong positive linear relationship with the Working Memory Index on the WAIS-IV (r(20) = .88). The Working Memory Index Score on the WMS-III demonstrated a moderate positive correlation with the Visual Working Memory Index on the WMS-IV (r(20) = .59). A moderate positive linear relationship was noted between the WAIS-III and WMS-III Working Memory Indices (r(20) = .56), whereas a strong positive correlation was found between the WAIS-IV Working Memory Index and WMS-IV Visual Working Memory Index (r(20) = .74). Conclusion: The WAIS-IV Working Memory Index is more highly correlated to the WAIS-IV Visual Working Memory Index than in the third edition of both tests. This was unexpected because the WMS-IV Visual Working Memory Index was designed to be more a visual measure of attentional control and manipulation. The current tests may offer a purer measure of working memory, more independent of modality.
Predicting General Memory Performance using Various Assessments of Depression
Objective: The purpose of this study was to determine the strongest predictor of general memory using different assessments of clinical depression. Method: The study utilized samples of varying sizes (N ranged from 99 to 612). Predictor variables included the individual's ethnicity, age, level of education, and level of depression via one of the following measurements: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria; Minnesota Multiphasic Personality Inventory (MMPI) Scales (2, DEP, D1, D2, D3, D4, D5); MCMI-III scales (Depressive Personality, Dysthymic Disorder, and Major Depression); and a positive Rorschach Depression Index (DEPI). The outcome variable was general memory as measured by the Wechsler Memory Scale, Third Edition (WMS-III). Results: A series of multiple regression analyses were used to determine the measure of depression accounting for the greatest proportion of variance in memory functioning. With the exception of the Rorschach DEPI, MCMI-III Depressive Personality, and MMPI-2 Content Depression models, all were significant at the .05 level. The MCMI-III measures of depression appeared to be the strongest predictors, accounting for the largest, Major Depression (rs2 = .051), and second largest, Dysthymic Disorder (rs2 = .050) proportion of general memory variance in their respective models. On the other hand, DSM-IV diagnosis (rs2 = .0006) and the Rorschach DEPI (rs2 = .004) were the weakest and second weakest predictors, respectively. Discussion: Results indicated that the MCMI-III Clinical Syndrome Scales would be best employed to determine the potential effects of depression on memory impairment in comparison to similar constructs (e.g., DSM-IV criteria, MMPI-2, or the Rorschach).
Refining the Clinical Interpretation of Memory Assessment on the Wechsler Memory Scale-Fourth Edition: Base Rates of Low Age-Adjusted Memory Scores
Similar to multivariate statistical analyses, increasing the number of test scores being analyzed in clinical practice will increase Type I errors (false-positives). As a result, there is an increased chance of false-positive diagnoses or clinical inferences of memory impairment when a battery of tests is interpreted. The purpose of this study is to present the prevalence of low scores on the Wechsler Memory Scale-Fourth Edition (WMS-IV; Wechsler, 2009) for healthy adults. Participants included 900 healthy adults (16–69 years of age) who were part of the WMS-IV standardization sample. The WMS-IV contains four tests of learning and memory (Logical Memory, Verbal Paired Associates, Designs, and Visual Reproduction) that provide eight age-adjusted scaled scores. Base rate analyses involved consideration of these subtest scores simultaneously, stratified by Test of Premorbid Functioning (TOPF)-demographic predicted intelligence and years of education. Considering below the 10th percentile as a cutoff (SS ≤ 6), one or more low WMS-IV scores occurs in 90.9% with unusually low, 63.2% with low average, 44.1% with average, 24.8% with high average, and 18.2% with superior/very superior predicted intelligence. When stratified by years of education, one or more WMS-IV scores <10th percentile is found in 70.7% with ≤8, 70.5% with 9–11, 52.9% with 12, 39.1% with 13–15, and 25.9% with 16+ years. Appreciation of the prevalence of low scores is necessary for reducing false-positive rates. It is important for clinicians to know that some low scores are common on the WMS-IV, particularly in those adults with lesser intelligence or education.
Immediate and Delayed Verbal Recall in Post-Traumatic Stress Disorder Clients
Objective: Neuropsychology research has demonstrated that traumatized individuals have problems with memory functioning (Van der Kolk, 2006). Specifically, studies have demonstrated an inverse relationship between severity of Post-traumatic Stress Disorder (PTSD) symptoms and memory functioning (El-Hage, Gaillard, Isingrini, & Belzung, 2006; Jelinek et al., 2006; Vasterling, Brailey, Constans, & Sutker, 1998). Although several studies have shown negative correlations between specific subtests of the Wechsler Memory Scale-Third Edition (WMS-III) and PTSD (e.g., Logical Memory; Bremner et al., 1993; Burriss et al., 2008), few studies have explored both immediate and delayed verbal recall in PTSD clients. Methods: The current study further explored the relationship between individuals diagnosed with PTSD and auditory immediate memory utilizing 186 participants who were consecutive referrals for outpatient neuropsychological evaluations. One-way analysis of variance (ANOVA) was used to compare groups diagnosed with either PTSD (n = 45), a neurological disorder such as multiple sclerosis or hydrocephalus (ND; n = 80), or an anxiety disorder not otherwise specified (ANX; n = 61). Results: Statistically significant differences were found between groups on measures of immediate (F(2, 135) = 3.117; p < .05) and delayed (F(2, 136) = 3.124; p < .05) verbal memory, with medium effect sizes. Post hoc analyses indicated that PTSD clients performed more similarly to those with ND than with ANX. Conclusion: The results suggested that PTSD clients have difficulties with encoding and retention of verbal information similar to those with neurological disorders and more severe than individuals with anxiety disorders. The results indicate evidence that psychotherapy for PTSD needs to address compensatory strategies for these difficulties to improve effectiveness.
Correlations between Measures of Intelligence and Attention in Adults
Objective: The purpose of this study was to ascertain the relationship between measures of intelligence and attention in adults with no known psychological or neurological deficits. Method: Participants included 83 adults with no history of psychological or neurological diagnosis, including 32 males and 51 females. The sample was primarily Caucasians. The average age was 28.10 (SD = 7.18); the average education was 15.95 (SD = 2.25). This study used Pearson correlations between vocabulary, picture completion, block design, digit symbol, and symbol search from the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) and omission errors, commission errors, variability, hit rate, and perseveration scores from the Continuous Performance Test (CPT). Results: The CPT commission score was significantly correlated with the symbol search subtest (r(82) = −.350, p < .01) and the FSIQ (r(82) = −.309, p < .05). The omission score was significantly correlated with the picture completion subtest (r(81) = −.241, p < .05) and the PIQ (r(82) = −.219, p < .05). Variability was significantly correlated to the digit symbol subtest (r(81) = −.268, p < .05). Hit Rate and Perseveration scores were not significantly correlated with any indices or individual subtests on the WAIS-III. Conclusions: Omission errors are more strongly correlated with tasks requiring the identification of a missing part within a timeframe, whereas commission errors are more correlated with tasks requiring the participant to decide if one of two target shapes is in a group of four shapes. These results indicate that neuropsychologists should use caution when interpreting low processing speed, PIQ, and FSIQ scores in adults with attention difficulties as these indices all appear to be impacted by attention.
Myoclonus and Retrieval Deficits Following Anoxic Event
Objective: The objective of this study is to explore the processing disturbances underlying the anterograde amnesia following an anoxic event. Anoxia tends to result in anterograde amnesia as the hippocampus and basal ganglia are particularly vulnerable to the effects of anoxia. Frontal regions can also suffer with a more extensive loss of oxygen. The following study presents the cognitive profile of one who suffered an anoxic event via choking, including demonstrating the presence of retrieval deficits and confabulations despite a relatively intact ability to consolidate new memories. Other noteworthy factors include the presence of verbal apraxia and myclonus. Method: A 59-year-old female who choked at a restaurant resulting in respiratory failure with anoxia. She had been high functioning prior to the event. Evaluation procedures included administration, scoring, and interpretation of comprehensive quantitative and qualitative measures. Results: Neuropsychological testing revealed retrieval deficits with a high number of intrusive responses along with tendencies to confabulate. Furthermore, the individual experienced myolconic movements and had verbal apraxia. Memory consolidation appeared relatively intact when considering her performance on delayed memory measures relative to immediate memory measures. Conclusion: Anoxia may result in anterograde amnesia through processing and executive disturbances outside the expected disturbances in memory consolidation.
A Comparison Study on the Wechsler Memory Scale-Third Edition and Wechsler Memory Scale-Fourth Edition Verbal Paired Associates Subtests
Objective: The purpose of this study was to evaluate how the WMS-III and WMS-IV VPA subtests equate. The item number, content, and semantic association distinguish the WMS-IV from its predecessor. Method: Participants consisted of 20 adults aged 19–68 years (M = 34.20, SD = 13.87) from a clinically referred population. The sample was 65.0% females, 60.0% Caucasian, and had an average education level of M = 13.38 years (SD = 2.06). Scaled scores from the VPA I and II subtests on the WMS-III and WMS-IV were utilized. Results: Results indicated that categorized scores did not differ significantly from their hypothesized values for WMS-III VPA I (χ2(3, N = 20) = 1.84) and VPA II (χ2(3, N = 20) = 3.53), and WMS-IV VPA I (χ2(4, N = 20) = 8.50), and VPA II (χ2(3, N = 20) = 4.80, p > .05). A strong positive linear relationship was found between the WMS-III and WMS-IV VPA I (r(20) = .70) and VPA II (r(20) = .72). Paired sample t-tests indicated no significant differences between the WMS-III and WMS-IV on VPA I (t(19) = −.91) and VPA II (t(19) = −1.73, p > .10). Conclusion: Although the updates made to the VPA subtests on the WMS-IV may appear to alter the memory task, making it more of an associative process, it appears that individuals can be expected to perform similarly on both the WMS-III and WMS-IV VPA subtests among a clinical population.
Intellectual Functioning and Auditory Memory among Homeless Adults at an Outpatient Clinic
Objective: The aim of this study was to determine whether auditory memory and intelligence in a sample of homeless adults significantly differed from those of a normative sample. Method: Participants were 45 homeless, predominantly right-handed (88.9%) adults, most of whom were 45–54 years old (48.9%). This sample was recruited at an outpatient clinic in Miami, FL. The majority were men (77.8%) who identified as Black, African American, or Afrocaribbean (57.8%). Fewer participants were White (20%), Hispanic or Latino (11.1%), or Other (11.1%). Approximately 40% did not complete high school. Auditory memory was measured by three indices of the Wechsler Memory Scale-Third Edition (WMS-III). A prorated Full Scale IQ (FSIQ) was derived from the six core Verbal Comprehension and Perceptual Organization subtests on the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III). Results: Results of a series of one-sample t-tests indicated that this sample differed significantly from the WMS-III normative sample on Auditory Immediate Memory (t(41) = −6.538, p < .001), Auditory Delayed Memory (t(42) = −4.496, p < .001), and Auditory Recognition Delayed (t(41) = −6.246, p < .001), with all indices approximately 1 SD below reported norms. The prorated FSIQ of the studied sample was also found to be significantly lower than the mean FSIQ in the normative sample (t(42) = 6.033, p < .001). Conclusions: As hypothesized, auditory memory and intellectual functioning were significantly impaired in the sample. Demographics as well as physical and psychological conditions will be analyzed to determine potential correlates for such impairment.
Gender Differences in Working Memory Tasks which Include Verbal or Visual Material
Objective: The purpose of the study was to examine gender differences in working memory involving verbal and visual material using the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) digit span subtest and the Wechsler Memory Scale-Third Edition (WMS-III) spatial span subtest, respectively. Method: Participants consisted of 576 adults aged 16–81 (M = 33.12, SD = 13.77) from a normal population. The sample was 50.0% males, 67.3% Caucasian, and 86.6% right-handed, with an average education level of 13.50 (SD = 2.73) years. Results: Results were considered significant at the p < .05 level. One sample t-tests indicated gender effects on WAIS-III digit span subtest (t(575) = 73.56) and WMS-III symbol span subtest (t(575) = 64.35). On average, males (M = 9.58, SD = 2.96) outperformed females (M = 8.98, SD = 3.07) on the WAIS-III digit span subtest. Also, males (M = 9.26, SD = 3.43) outperformed females (M = 8.20, SD = 3.52) on the WMS-III symbol span subtest. Conclusion: The outcome suggests that males perform better than females on working memory tasks that involve material that is either verbal or visual. These results are consistent with past research that has shown that males perform better on both visual and verbal tasks of memory. However, recent research has yielded inconsistent results; females have been demonstrated to perform better on visual working memory tasks and equally with males on verbal working memory tasks. Further research is recommended.
Melancholic Depression and Reduced Verbal Learning Ability on the California Verbal Learning Test
Objective: Melancholic depression (MCD) is a subtype of major depressive disorder (MDD) characterized by pervasive anhedonia. The effect of MDD subtypes on learning is not well understood, but depression subtypes may account for discrepant neuropsychological findings in the depression literature. This study examined relationships between melancholic and verbal learning on the California Verbal Learning Test (CVLT). Methods: Performance of MCD (N = 18) and non-MCD (no MDD subtype; N = 16) participants on the CVLT was examined. Depression subtype was assessed using the SCID. Participants were recruited at Stanford University Medical Center. Analysis of variance (ANOVA)s were conducted with depression subtype as the between-subjects factor and CVLT scores as the dependent variables. Results: MCD patients showed reduced recall on total word learning, short- and long-cued recall, and short- and long-free recall (all p < .05). MCD showed deficits in the number of words learned per trial (learning slope F(1, 30) = 4.74, p < .04). There was a trend for poorer recognition (p = .08), but no difference in retention or clustering strategies between the groups. Conclusions: MCD participants remembered fewer words overall and had reduced new learning across trials. However, learning strategies, retention, and number of words recall at first presentation did not differ between groups. These results indicate that MCD may be associated with a reduced sustained motivation/effort during the CVLT. If accurate, this may be important in a therapy context, with effort and motivation need to be continually monitored. Furthermore, these findings suggest that depression subtype may play a key role in understanding the sometimes inconsistent neuropsychological deficits in depression.
PROFESSIONAL ISSUES: EFFORT AND MOTIVATION
Item Difficulty-Based Effort Measures on the North American Adult Reading Test
Objective: This study examined embedded effort measures based on the North American Adult Reading Test (NAART). Method: Data were collected as part of a post-test only experimental study conducted at a Midwestern University during 2007. Ninety-nine undergraduates without reported neurological injury were randomized to control (n = 31), naïve simulator (n = 34), and coached simulator (n = 34) groups. The sample was 86% females, 86% Caucasian, and 92% right-handed. Average age was 21 years, and average education was 13. Instructions varied by group. Outcome measures included the NAART and Word Memory Test (WMT). Accuracy of embedded effort measures based on low difficulty items (NAART-E1 and NAART-E2) and low–high difficulty difference (NAART-D) were examined in comparison to the WMT. Results: Groups were not different in terms of NAART total errors (p = .093) nor in performance on more difficult NAART items (p = .453). Performance on easier items, however, was significantly different (p = .016), and simulators who failed the WMT made more NAART errors than control participants (p = .011). The WMT correctly classified 100% of control participants and 71% of simulators. NAART-E1 correctly classified 94% of control participants and 21%–29% of simulators. NAART-E2 correctly classified 94% of control participants and 27%–32% of simulators. NAART-D correctly classified 97% of control participants and 9%–12% of simulators. Conclusions: Embedded indices using low difficulty NAART items showed promise as effort measures. NAART-D was less sensitive. Cross-validation of these measures in a clinical sample may be beneficial. It may also be useful to examine these measures across a wider range of educational level.
Successful Malingering: What, Where, And Why
Malingering is the “intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives …” (DSM-IV TR, APA, 2000). This poster will review the neuropsychological profiles of successful brain injury simulators (SBIS) on three popular symptom validity tests (SVTs): The Test of Memory Malingering (TOMM), Word Memory Test (WMT), and Computerized Assessment of Response Bias (CARB). Study 1 examined the ability of simulated malingerers to effectively escape detection against the most frequently used SVT, the Test of Memory Malingering (TOMM). Study 2 examined the ability of simluated malingerers to effectively escape detection against all three frequently used SVTs, the TOMM, WMT, and CARB. Successful brain injury simulators were coached (n = 22; 76%) or uncoached participants who performed at or above specified TOMM cutoff levels for adequate effort (Trial 2 ≥ 45). Using Tombaugh's criteria, 32% of malingerers were misclassified as controls. SBISs scored significantly better than unsuccessful simulators on all standard neuropsychological measures, although notably they suppressed their scores relative to controls on the WCST. In Study 2, SBIS was observed on all three SVTs. Successful simulation occurred whether these measures were used alone or in combination with one another. Successful brain injury simulation has serious clinical implications for the validity and future role of neuropsychological assessment. The results from the current studies emphasize the challenging nature of malingering detection and emphasize the use of multiple malingering detection measures.
The Incremental Utility of a Novel Test of Memory Malingering Consistency Index in Assessing Effort among Litigants
Objective: A subset of examinees who pass the Test of Memory Malingering (TOMM) fail the Word Memory Test (WMT). This study examined response consistency patterns on the TOMM as a novel consistency index (CI). Method: An archival of analysis was conducted on 56 forensic files. Responses were coded to determine whether examinees responded incorrectly consistent, inconsistently, or correctly consistent for each of the 50 items across Trial 1, Trial 2, and the Retention Trial. These patterns were examined to assess any differences in the consistency of responses between examinees who passed both the TOMM and the WMT compared with examinees who failed the WMT but passed the TOMM. The frequency of either incorrectly or correctly consistent responses and inconsistent responses (one or two inconsistent responses) for each examinee within the two groups was examined. A cutoff score of 10 inconsistent responses was selected as the CI for insufficient effort. No examinees who passed both the TOMM and the WMT had >10 inconsistent responses; 9 of the 16 (56%) examinees who passed the TOMM but failed the WMT had >10 inconsistent responses. This index was then used to compare examinees' performance on the Global Memory Index of the Memory Assessment Scale (GMI). Results: Examinees whose CI was <10 performed significantly better on the GMI compared with those with CI >10. Conclusions: The TOMM CI provided a substantial degree of incremental utility to the three traditional TOMM Index scores in identifying insufficient effort as well as poorer GMI scores in a group of brain-injured litigants.
Stroop Color-Word Test as a Symptom Validity Test for Processing Speed: Sensitivity and Specificity
Objective: A number of embedded symptom validity tests are derived from existing neuropsychological tests. Previous studies investigating the use of the Stroop Color-Word Test as a measure of response bias have either used simulators (and thus the results may not generalize to “real world” contexts) or failed to identify cutoffs associated with adequate specificity (>90%). Method: We examined sensitivity and specificity values for each condition of the Comalli Stroop Test in an archival sample comprised 80 non-credible (i.e., motive to feign, failure on >2 unrelated measures of cognitive response bias, and clinician deemed non-credible), and 176 credible (i.e., no motive to feign, <2 failures on unrelated effort indicators, FSIQ >70, no dementia, and no documented verbal learning disability) participants. Results: When selecting cutoffs with >90% specificity, the sensitivity rate for a cutoff of 63 s for Stroop A (word reading) was 64%, for a cut-off of 87 s for Stroop B (color naming) was 61%, and for a cutoff of 166 s for Stroop C (color interference) was 42%. Conclusion: Results suggest that the Comalli Stroop, particularly word reading and color naming, shows good sensitivity as a measure of response bias.
The Significance of the Test of Memory Malingering Retention Trial among Litigants: Is it Really Optional?
Objective: The Test of Memory Malingering (TOMM) is a frequently administered freestanding symptom validity measure. Given a failure on Trial 2 (a score less than 45 correct responses), the examiner has the option of administering a retention trial. According to the manual, “malingerers” typically perform lower on the retention trial than on Trial 2, but this is rare (p18). Greve and Bianchini (2006) reported that 3% of their litigating sample would have been incorrectly classified without administration of the retention trial. To the best of our knowledge, this finding has not been replicated in a similar sample. Method: An archival analysis was conducted on 164 examinees referred for neuropsychological testing due to litigating reasons. We used scores on the three TOMM trials to identify individuals who failed the retention trial but passed either Trial 1 or Trial 2. Results: In our sample, 51 out of 164 examinees (approximately 31%) failed the retention trial. Of these 51 examinees, only 2 passed either Trial 1 or Trial 2 (approximately 4%). These two examinees passed Trial 2. Conclusion: According to the TOMM manual, administration of the retention trial is optional given a pass on Trial 2. Consistent with Greve and Bianchini (2006), our results indicate that while infrequent, examinees passing Trial 2 may fail the retention trial. Not administering this trial may therefore result in inaccurate evaluation of effort due to the presence of false-negatives. Clinicians should exercise caution in choosing to discontinue the test after administration of Trial 2, especially in forensic evaluations.
Sensitivity, Specificity, Positive Predictive Power, and Negative Predictive Power of 15 Embedded Symptom Validity Measures among Litigants: Caution, Dangerous Curve Ahead!
Objective: Effort assessment is critical for accurate evaluation of neuropsychological test performance. Given recent concerns of test security surrounding well-established freestanding symptom validity tests (SVTs), there is currently much interest in the clinical utility of “embedded” symptom validity indices to supplement or perhaps even replace standard instruments of effort assessment. Method: An archival analysis was carried out on 55 examinees referred for neuropsychological testing for litigating reasons. Using four well-known and frequently administered freestanding symptom validity measures as criteria (the Word Memory Test, the Test of Memory Malingering, the Victoria Symptom Validity Test, and the Rey-15 Item Test), we calculated sensitivity and specificity as well as positive and negative predictive power for 15 embedded measures. Results: Sensitivity, specificity, positive predictive power, and negative predictive power varied considerably depending on which of the freestanding SVTs was selected as a criterion. Four embedded measures (Digit Span RDS, Category Test Total Errors on Subtest 7, Errors on Tactile Finger Recognition, and Errors on Finger Tip Number Writing) had the highest sensitivity and specificity. These four embedded measures also showed similar ranges of positive and negative predictive power. Conclusions: Some embedded measures do appear to consistently predict insufficient effort better than others. The sensitivity of the embedded measures examined in this study tended to be low. Clinicians are cautioned regarding the use of embedded symptom validity tests to assess effort either alone or in combination.
You Can't Hide Your Lyin' Eyes: Eye-Tracking Measures and Feigning
Objective: The goal of the study was to determine if eye movements might aid in the causal determination of cognitive impairment versus feigning while taking the Word Memory Test (WMT; Green, 2003). Method: Participants were 30 undergraduates who received course credit for volunteering. We used a within-subjects design (i.e., counter-balanced feigned vs. genuine conditions). Participants wore an EyeLink II head piece to record eye movements. The WMT was administered via computer as described in the user manual. In the feigned condition, participants were given a scenario in which they were asked to pretend that they were in a law suit after a car accident. They were to “trick” the examiner into believing they were memory-impaired. Results: The number of saccades and fixations were less for the genuine compared with the feigned condition (p = .0002 and .0003, respectively). Time duration per word set was significantly less (p < .0001) for the genuine condition. Fixation duration was significantly longer in the feigned condition (p = .0024). With eye measurements alone, participants' performance was correctly classified at 76% (sense. = .80, spec. = .81, PPV = .69, NPV = .83). Conclusion: Eye movements during performance on the WMT significantly predicted feigned versus genuine performance. Future eye tracking research involving participants in real-world conditions with documented disorders, such as TBI or PTSD, may help to ascertain if patients' are performing to the best of their ability.
The Word Memory Test is Resilient to Functionally Disabling Amnesia in Acquired Brain Injury
Objective: Concerns persist that neuropsychological symptom validity tests such as the Word Memory Test (WMT) may mistake genuine memory impairment for insufficient effort. We investigated the WMT's resiliency to profound amnesia. Method: The WMT was administered to a consecutive cohort at a rehabilitation center (n = 55), using a discontinue rule derived from Bauer et al. (2007). Of those with no independent evidence of insufficient effort (n = 47), three patients (aged 25–44) presented with (a) objectively documented brain injury (hypoglycemic coma, anoxia, severe traumatic brain injury), (b) profound anterograde amnesia established through rehabilitation team/family observations, (c) inability to work or live independently primarily due to amnesia, and (d) no external incentive to malinger. The remaining sample (n = 44) was used as a clinical control group (68% traumatic brain injury, 18% stroke, 14% other). Results: The amnestic patients performed worse than the clinical control group on the WMT Immediate Recognition trial (z-scores < −3.5) and at/near floor levels on other standardized memory tests, confirming their amnesia severity. Although one amnestic patient scored below the recommended cutoff for insufficient effort on the WMT, all three scored more than 30 points higher (M = 54 ± 1.1) on the easy versus hard subtests, consistent with the WMT “dementia profile.” Thus, profound amnesia lowered WMT performance, but was not associated with a profile, suggesting insufficient effort. Conclusion: Even patients with profound and functionally disabling amnesia can produce valid WMT profiles. This small case series uniquely adds to the evidence base for the WMT's resiliency to genuine memory impairment.
The Contributory Role of Pre-Injury Income on Cognitive and Psychological Feigning Following Traumatic BrainInjury
Objective: We set out to determine if pre-injury average hourly wage in patients with traumatic brain injury (TBI) would predict feigning in litigating individuals. Method: Archival data were obtained from a random sample of personal injury litigating examinees referred for a neuropsychological examination. We examined test scores of feigning (n = 62) and non-feigning (n = 37) litigants matched in terms of TBI severity. Both groups were administered the Rey 15-Item Test (Rey-15), Test of Memory Malingering (TOMM), and Personality Assessment Inventory (PAI). Results: Pre-injury average hourly wage of both feigning and non-feigning litigants was found to differ between groups and correlate with scores on the TOMM Trial 1, TOMM Trial 2, Rey-15, and the negative impression management scale of the PAI. Furthermore, feigning and non-feigning litigants were found to differ significantly with respect to years of education. Conclusions: Our findings should alert the practicing neuropsychologist that the probability of malingering may be greater in the instance of a low pre-injury salary in litigating patients. Additional research regarding pre-injury income and symptom validity and personality test scores should be undertaken to better understand the relationship.
PROFESSIONAL ISSUES: FORENSIC PRACTICE
Suboptimal Motivation and Psychopathology Profiles in Neuropsychological Evaluations
Objective: The detection, or suspicion, of suboptimal motivation in children could be based on an erratic and unexplained performance during testing, performance on motivation assessments, behavioral observations, knowledge of past history, etc. Constantinou (2010) found that conduct disorder, oppositional defiant disorder, and children diagnosed with Attention-deficit/Hyperactivity Disorder (ADHD) were more likely to be suspected of lowered motivation and score low on motivation assessments. Method: The current study expanded to include larger samples and more diverse diagnoses. Children were matched and divided into diagnostic categories, with 40 children (aged between 6 and 8) in each diagnostic category (conduct disorder, oppositional defiant disorder, learning disorders, ADHD, pervasive developmental disorders, anxiety disorders, and mood disorders). Results: Data from regression analyses and discriminant analysis revealed that only children diagnosed with conduct disorder, oppositional defiant disorder, and mixed type or primarily hyperactive ADHD were more likely to present with suboptimal motivation. A combination of these diagnoses increased this likelihood of suboptimal motivation twofold. Conclusion: Certain childhood psychopathology increases the likelihood of suboptimal motivation. Such findings could help clinicians become more precise in the detection of childhood suboptimal motivation during neuropsychological assessments.
Poster Session B
DEVELOPMENT AND PEDIATRIC: LEARNING DISABILITY
An Investigation of Memory Functioning as a Source of Comorbidity between Attention-deficit/Hyperactivity Disorder and Developmental Dyslexia
Objective: Limited research has examined long-term memory functioning in ADHD subtypes when compared with developmental dyslexia and controls. Thus, the aim of our study was to assess memory functioning in children with ADHD-PI (n = 28), ADHD-C (n = 21), dyslexia (n = 36), and comorbid dyslexia/ADHD (n = 18) in relation to controls (n = 47). Method: Participants included 150 children as noted above, aged 8–12 years. They performed several measures as part of a university-based, NIH/NICHD-funded project (R03 HD048752), including the Children's Memory Scale (Dot Locations, Stories, Word Lists, Numbers, Sequences, and Picture Locations). The groups were equated on Test of Nonverbal Intelligence-Third Edition (TONI-3) IQ, age, race/ethnicity, and gender. Results: A multivariate analysis of variance (MANOVA) for the working memory measures revealed children with dyslexia performed worse than controls on Sequences (F(4, 136) = 11.51, p < .001), Numbers Forward (F(4, 136) = 3.20, p < .05), and Picture Locations (F(4, 136) = 2.68, p < .05). A MANOVA for immediate memory measures revealed differences on Word Lists (F(4, 144) = 7.18, p < .001) and Dot Locations (F(4, 144) = 2.61, p < .05) but not Stories (F(4, 144) = 1.24, ns). Specifically, controls performed better than ADHD-C, dyslexia, and dyslexia/ADHD on Word Lists. Both ADHD groups tended to perform worse than controls on Dot Locations (p < .10). Moreover, after combining the two ADHD groups, this difference was significant (p = .01). Similar results were found on the delayed recall trials for these measures. Further analysis using repeated-measures MANOVA revealed that delayed recall was not substantially worse than immediate recall in ADHD or dyslexia, indicating that reduced memory performance was due to poor encoding of the material. Conclusions: Deficits in selective reminding were found across clinical groups, suggesting a potential source of comorbidity between dyslexia and ADHD.
The Double Deficit Hypothesis in Reading Disabled College Students
The double deficit hypothesis (Wolf & Bowers, 1999) proposes that four subgroups may emerge in a reading disabled (RD) group based on linguistic profiles: phonological awareness (PA) deficit only, visual naming speed (VNS) deficit only, double deficit (DD), or no deficit (ND). These subgroups show different patterns of performance on reading achievement measures. The current study investigates the performance of these RD subgroups on other academic achievement (AA) and neuropsychological (NP) measures. Two hundred and twenty-six college students, who met regression-based discrepancy and/or low achievement criteria for RD, were selected from a larger sample of students evaluated for academic difficulties. Measures of PA, VNS, math and spelling achievement, and neuropsychological function were collected as part of a larger assessment battery. Subgroups based on performance on PA and VNS tasks were identified and compared on AA and NP tasks using multivariate analysis of covariance (MANCOVA). Significant univariate differences were observed on all AA measures (p < .05), however post hoc pairwise comparisons were not significant for a math fluency measure. Significant univariate differences were also observed on verbal (p < .001), visuospatial (p < .001), and processing speed and motor measures (p < .001). Results suggest that PA and VNS deficits are associated with different AA and NP profiles. Patterns of linguistic ability affect the profiles of AA and NP performance that characterize adults with RD. These findings have implications for evaluations and academic accommodations in a university setting.
Neuropsychological Characteristics of Asperger's Disorder
Objective: According to Stewart (2002), Asperger's disorder (AD) is characterized “by normal or accelerated language development in infancy and childhood and a desire to form relationships,” yet AD individuals often fail in their attempts to socialize. AD children usually have areas of special interest that often develop into obsessions; they also show a great degree of social ineptitude (Stewart, 2002). Case histories will show how AD neuropsychological characteristics change throughout development and how appropriate interventions can significantly improve adaptive abilities. Method: Comprehensive neuro/psychoeducational evaluations of three children, two adolescents, and two adults consisted of an assessment of intellectual, educational, attentional, executive and behavioral, affective, and personality functioning. Results: Results from these comprehensive neuro/psychoeducational evaluations revealed attentional, learning, and adaptive problems in all AD examinees. Conclusions: These case histories demonstrate the importance of early evaluation and intervention. As time passes, without an appropriate understanding of children's weaknesses, learning and adaptive abilities can become increasingly problematic and can result in the emergence of significant emotional, social, and behavioral problems.
DEVELOPMENTAL AND PEDIATRIC: ATTENTION-DEFICIT/HYPERACTIVITY DISORDER
Executive and Non-Executive Factors and their Correlates with Intelligence in Children with Attention-deficit Hyperactivity Disorder
Objective: Research shows that individuals with Attention-deficit/Hyperactivity Disorder (ADHD) have impairment in general intelligence and executive functioning. This study examined the associations between the two. In particular, executive factors (EFs) assessed were inhibition, working memory, and sustained attention, whereas non-executive factors (non-EFs) assessed were short-term memory and processing speed. Methods: Participants were 294 children, aged 4–17 (M = 9.08, SD = 2.83) with 72% males, 58% Caucasian, and 89% right-handed. For executive functions, Category, Conner's Continuous Performance Test (CPT), Trails B, Stroop and Wisconsin Card Sort Task were used. For non-executive functions, Wechsler Intellligence Scale for Children-Fourth Edition (WISC-IV) subtests used were Digit Span, Coding, and Symbol Search. WISC-IV Composite scores for Perceptual Reasoning Index (PRI), Verbal Comprehension Index (VCI), and Full Scale Intelligence (FSIQ) were calculated. Results: Pearson correlations were calculated for EF and non-EF factors with the three indices. Only Category Number of Errors showed a weak negative relationship with PRI (r = −.436, p < .033). Conclusions: Children with ADHD did not show strong associations between general intelligence and EF or non-EF factors. Neither verbal intelligence nor perceptual intelligence was significantly associated with any EF or non-EF factors. In general, neither EF nor non-EF factors strongly correlate with intelligence. These results suggest that these cognitive functions may not play a role in determining intellectual abilities in children with ADHD. Therefore, these factors cannot be expected to mediate crystallized or fluid intelligence, which is in direct contradiction to recent research.
Diagnostic Accuracy of the Personality Inventory for Children-2 in Children with Attention-Deficit/Hyperactivity Disorder
Objective: The aim of this study was to investigate the clinical utility of the Personality Inventory for Children-2 (PIC-2) for the classification of Attention-deficit/Hyperactivity Disorder (ADHD). Specifically, the authors were concerned with the sensitivity of PIC-2 to the various subtypes of ADHD (inattentive, hyperactive, or combined). Methods: The sample consisted of 80 (24 females) children diagnosed with ADHD (mean age = 8.9). Half of the sample (40) had comorbid mood disorder or LD. Diagnosis of ADHD (inattentive = 27, hyperactive = 8, combined = 45) was made with DSM-IV/ICD-9 criteria by two board-certified pediatric neuropsychologists. Participants were administered a battery of neuropsychological tests and broad personality measures appropriate for their age. Results: As expected, the ADHD participants had an elevated PIC-2 (ADH) scale (mean = 65.8, SD = 10.93). No significant differences were found between those with (mean = 67.8, SD = 10.09) and those without (mean = 63.78, SD = 11.49) comorbid mental health issues. However, the PIC-2 correctly classified only 50% of the participants as having ADHD based on the recommended cutoff score (65T) as compared to ADHD rating scales, which correctly classified 90% of participants. Based on the subtype, the PIC-2 was insensitve to inattentive (26% sensitivity; mean = 58.93, SD = 7.526%) and hyperactive (25% sensitivity; mean = 64.13, SD = 10.8) subtypes. The PIC-2 correctly classified 69% of the combined type (mean = 70.16, SD = 10.7). Conclusions: The PIC-2 is relatively insensitive to ADHD in children based on established cutoff scores. Modest sensitivity was seen in the ADHD-combined subtype.
How Accurate are Parent and Teacher Attention-deficit/Hyperactivity Disorder Rating Scales when Compared to Neuropsychological Measures of Executive Function and Attention?
Objective: Previous research shows contradictory evidence of impairment in Executive Functioning (EF) in attention-deficit hyperactivity disorder (ADHD) and of a correlation between parent and teacher ADHD rating scales and neuropsychological measures of attention and EF. This study examined this issue. Method: Sixty-one children presenting for a neuropsychological evaluation participated in the study with a parent and teacher completing the forms. The sample consisted of 61% males and 39% females aged 7–16 (M = 10.69, SD = 2.47). The Wisconsin Card Sorting Task and the Conners' Continuous Performance Test (CPT) were used as neuropsychological measures of EF and attention. The Conners' Parent and Teacher ADHD Rating Scales were used to assess the parent and teacher ratings of ADHD symptoms. Results: A multiple regression revealed that only CPT Omission scores were able to predict how children would be evaluated by their parent and/or teacher on the ADHD rating scales (Teacher Hyperactive-Impulsive, R = .363, F(3, 57) = 2.891, p = .008, Teacher Inattentive, R = .341, F(3, 57) = 2.504, p = .015, and Parent Hyperactive-Impulsive, R = .355, F(3, 57) = 2.734, p = .008) except for the Parent Inattentive (R = .142, F(3, 57) = .390, p = .317). Conclusion(s): The findings suggest that neuropsychological measures of EF are not sensitive to the ADHD symptoms reported by parents and teachers. The Omission scores assess sustained attention over time and may be a better way to examine the symptoms that are focused on by parents.
DEVELOPMENTAL AND PEDIATRIC: OTHER
Neurocognitive Late Effects Associated with the Treatment of Pediatric Right Posterior Thalamic Tumor: A Case Report with Early Childhood Onset
Objective: Consideration of several factors regarding treatment of pediatric thalamic tumors is crucial, and includes: (1) age, (2) presence of neurofibromatosis type 1, (3) tumor size/location, and (4) the toxicity of chemotherapy and radiation, as treatment may result in significant tumor reduction and disease control (Packer, 2000). In pediatric thalamic tumors, chemotherapy has been shown to be more effective in younger patients, whereas delayed radiation may prevent growth deficiencies. However, the literature on neuropsychological effects is sparse. Method: Neuropsychological testing was conducted on a 7-year-old Hispanic female with a high-grade glioma of the right posterior thalamus. The individual was diagnosed at age 2 and given a poor prognosis. She has since undergone two resections of a right thalamic and brainstem tumor and chemotherapy, initially presenting with no social, emotional, or behavioral difficulties. Results: The individual's Full Scale IQ fell into the low average range with significantly lower non-verbal than verbal skills, with weaknesses in reading and mathematics. Neuropsychological testing revealed difficulties in visuospatial skills, motor, and short-term visual memory, consistent with deficits found with right thalamic lesions (De Witte et al., 2008). Strengths included attention, executive functioning, expressive and receptive language, verbal memory, long-term visual recall, and behavioral regulation. Conclusion: Given the dearth of available research on pediatric thalamic tumors, discussion focuses on the importance of careful treatment selection and potential treatment risks and benefits in young children with thalamic tumors. The role of the neuropsychologist in longitudinal monitoring of neurocognitive late effects is also discussed.
The Impact of Posttraumatic Stress Disorder (PTSD) on Visual and Verbal Memory in Children
Objective: Research shows that when using neutral stimuli, adult individuals with posttraumatic stress disorder (PTSD) have greater impairments in verbal memory than visual memory. The present study examined whether these impairments follow a similar pattern in children diagnosed with PTSD. Method: The sample consisted of 26 children diagnosed with PTSD. Sixty-five percent of the sample were males (n = 17). Participant's ages ranged from 5 to 15 (M = 8.9, SD = 2.93) and their education levels ranged from 1st to 9th grade (M = 3.28, SD = 2.67). The Verbal Comprehension and Perceptual Reasoning Index scores of the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) were used as a control in the sample. The Wide Range Assessment of Memory and Learning-Second Edition (WRAML-II) Verbal and Visual Memory Indices were used as measures of verbal and visual memory. Results: Two paired-sample t-tests were conducted using SPSS 17. Results from the first revealed no significant difference between Verbal Comprehension Index and Perceptual Reasoning Index scores in children with PTSD (t(25) = −.78, p = .45). The second t-test indicated that there was no significant difference between Verbal Memory and Visual Memory Index scores (t(25) = −1.57, p = .13). Conclusion: There was no difference found in children with PTSD when verbal memory was compared with visual memory. These results contradict previous findings in adults with PTSD that verbal memory is significantly more impaired than visual memory. The results of this study could indicate that PTSD and its cognitive effects manifest differently in children compared with their adult counterparts. Future research should use a larger sample to examine memory deficits and other cognitive sequelae of PTSD in children.
The Developmental Relationship Between Children's Emotion Perception and Intellectual Skills
Objective: As children grow and mature, so do their cognitive, social, and emotional capabilities. Marked improvements in emotion recognition have been found in children between the ages of 5 and 10. The Comprehensive Affect Testing System (CATS) is an assessment tool that was designed to improve neuropsychological understanding and awareness of emotion. It has been used effectively to assess emotion processing in various adult psychiatric and neuropsychological populations as well as in healthy adults, but has not been used extensively with children. The CATS and its 13 unique subtests assess emotion perception across basic emotional communication channels: facial (expression), prosodic (tone of voice), and lexical (meaning of language). Method: The Vocabulary and Matrix Reasoning subtests from the Wechsler Abbreviated Scales of Intelligence (WASI) were used to estimate general intellectual functioning. An abbreviated version of the Comprehensive Affect Testing System (CATS-A) was used to assess emotion perception. Results: Significant correlations existed (p = .05) for Full Scale IQ and several Prosody Subscales and the Prosody Composite Scale. When examining the differential influence of the Verbal and Performance IQ subtests on CATS performance, no significant findings existed for Vocabulary T-scores and CATS performance. Numerous significant correlations, however, were found between Matrix Reasoning T-scores and many CATS subtests and composite scales across communication channels at the p = .05 level. Conclusion: Intelligence is related to emotion recognition. Non-verbal cognitive abilities appear to be most related to emotion perception. This relationship changes over the course of development.
Behavioral Profiles of Children with Epilepsy
Objective: There is considerable research regarding the link between epilepsy and children's mental health problems and difficulties in daily functioning. The purpose of this study is to determine whether differing types of epilepsy contribute to specific mental health problems or patterns of functioning, as measured by the Behavioral Assessment System for Children (BASC). Methods: Participants were 163 children and adolescents aged 4–18 seen in an outpatient (tertiary care) setting in Georgia with a diagnosis of epilepsy. Children had a mean age of 10.6 (SD = 2.87). The sample included predominantly males (61.3%) and was predominantly white (73.6%). Based on the sample availability, main seizure types examined are complex-partial (n = 101) and complex-partial-secondary (n = 33). Descriptive statistics, one-way analysis of variance (ANOVA) tests, and multivariate analysis of variance (MANOVA) tests were conducted to examine differences among children with seizures and same aged peers. Between-group analyses was conducted categorized by seizure type. Differences compared between parent and teacher ratings and specific behavioral indices were identified as being statistically different between group types. Results: Descriptive statistics did not reveal any clinically significant internalizing or externalizing problems. MANOVA analyses showed specific behavioral indices evidenced notable differences between seizure types and between raters. Parent-rated aggression differed significantly between group types. Teacher-rated social and study skills also showed moderate differences. Based on these findings, previous study results suggest that children with epilepsy showing a high rate of behavioral and academic concerns were partially confirmed. Results provide information that may be beneficial to clinicians and school psychologists who provide behavioral support to children who have seizures.
Sex Differences in Neuropsychological Functioning Following Treatment for Pediatric Brain Tumor
Objective: The primary objective of this review is to compare the data examining sex as a risk factor for post-treatment neurocognitive deficits in survivors of childhood brain tumors to what is known regarding sex differences in neuropsychological functioning. The benefits of using this knowledge to create tailored cognitive remediation interventions are also examined. Data selection: A literature review was conducted using five of the most authoritative information search engines (e.g., PsycINFO). Studies of interest identified sex differences in neuropsychological functioning in general and as a result of treatment for childhood cancer more specifically. Search terms included pediatric, gender, male, female, sex, differences, brain tumor, CNS tumor, neuropsychological functioning, and late effects. Outcome data were reviewed. Data synthesis: From the studies reviewed, the neuropsychological domains most affected by brain tumor treatment are attention, executive functioning, processing speed, working memory, visual processing, visual-motor functioning, perceptual reasoning, and the ability to learn. Although data are less prevalent than in the field of acute lymphoblastic leukemia (ALL), findings appear similar in the pediatric brain tumor population—females are more at risk than males for poorer cognitive outcomes. Although there are no unequivocal conclusions regarding sex differences in neuropsychological functioning, males and females often exhibit hemispheric specialization in certain tasks. Conclusions: Based on published research, females appear to be more at risk than males for increased neuropsychological deficits following treatment for a brain tumor. By identifying the differences in male and female neuropsychological functioning, interventions might be more targeted to specific needs of each population.
Behavioral Inhibition in Disruptive Behavior Disorders
Objective: The current study examined three previously identified processes of behavioral inhibition in children with disruptive behavior disorders: inhibition of prepotent responses, stopping of ongoing response given feedback on errors, and interference control. Method: Participants were 138 children diagnosed with a disruptive behavior disorder (46% Conduct Disorder, 54% Oppositional Defiant Disorder) by doctoral level students and 31 children as a normal control group. The disruptive behavior disorders group was 79% males and included participants aged 6–17 (M = 10.75, SD = 3.35); the normal control group was participants aged 6–15 (M = 10.0, SD = 2.74), 55% of which were males. To control for intellectual differences between groups, the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) Vocabulary subtest was included in the analysis as a covariate. Inhibition of prepotent responses was measured through Continuous Performance Test (CPT) commission errors; stopping an ongoing response with perseverative errors on the Wisconsin Card Sorting Test (WCST); and interference control with the Stroop. Three analysis of covariance (ANCOVA)s with alpha set at .05 were performed. Results: Results revealed significant differences between the two groups after controlling for intellectual functioning on CPT-II (F(1, 69) = 14.78, p < .01), WCST (F(1, 97) = 17.01, p < .01), and Stroop (F(1, 108) = 4.93, p = .028). The normal control performed better on all measures (CPT-II: M = 48.49; WCST: M = 12.41; Stroop: M = 24.13) compared with those with disruptive behavior disorders (CPT-II: M = 71.6; WCST: M = 28.22; Stroop: M = 19.9). Conclusions: The results of this research offer further evidence for a deficit in behavioral inhibition in disruptive behavior disorders. It suggests that deficiencies in inhibiting prepotent responses, stopping ongoing responses, and interference control extend beyond just ADHD and are also associated with other disruptive behavior disorders.
Is the Stroop a More Appropriate Measure of Executive Functioning for Children with Perceptual Reasoning Deficits?
Objective: Measures of executive functioning such as the Wisconsin Card Sorting Test (WCST) and the Trails Making Test require the use of perceptual reasoning skills, which makes isolation of executive functioning deficits difficult. This study examines the potential utility of the Stroop test in differentiating executive functioning in children with perceptual reasoning deficits. Methods: Results on the WCST, Trails, and the Stroop test were compared between 42 children aged 7–15 (M = 11.36, SD = 2.21). The sample consisted of 62% males, 48% Caucasian, and 90% right-handed participants. Range of education was 1–10 (M = 5.12, SD = 2.41). For measures of executive functioning, the WCST, Trails B, and Stroop Color Word Score were used. Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) Composite scores for Full Scale Intelligence (FSIQ), Verbal Comprehension Index (VCI), and Perceptual Reasoning Index (PRI) were used. Results: Pearson correlations indicated that the Stroop Color Word test was significantly correlated with the VCI (r = .310, p = .046), but not with the FSIQ or the PRI. In contrast, both the WCST number correct and Trails B were significantly correlated with both the VCI and the PRI at the .05 level. Conclusions: Performance on the Stroop Color Word test is not significantly altered in children with PRI deficits, making it more suitable than the WCST or Trails B as a test of executive functioning for populations suspected to have issues with perceptual reasoning. However, it may not be appropriate for individuals with varied educational backgrounds that prevent optimal language development.
Developmental Trends in Individuals with NF1 and Noona phenotype (NFNS) Compared with Matched NF1 and Controls
Objectives: Recognition of a distinct population of children with NF1 and Noonan phenotype (NFNS) has become more prominent. There have been no studies of neurocognitive functioning in this group compared with NF1. Our primary objective is to compare the developmental trajectories of these clinical groups using a case time-series approach. Methods: Three sets of children were selected from a larger series, matched on age and gender. Two of the sets paired an NFNS, NF1, and control participant, whereas the other set paired an NFNS and control participant, comparing cognitive and behavioral development at two time points (15–21 months, 30–40 months, or 40 months to 5 years). Results: Developmental trends were variable, although generally participants across groups demonstrated gains in cognitive skills with age. However, NFNS participants consistently exhibited greater cognitive, adaptive, and self-regulatory impairments compared with the other participants. Specifically, although control and NF participants performed in the average cognitive range, NFNS participants were low average to impaired. The NFNS participants were also reported to receive more interventions than the NF1 and control participants, with an increase in intervention services over time. Conclusions: These findings suggest that although children with NFNS exhibit a similar trend in development, their functioning is more significantly impaired than children with NF1 or controls, with a higher level of intervention services needed. This suggests more extensive evaluation and treatment approaches in the NFNS population, as they appear to represent a distinct clinical group with unique needs.
A Case Study of a Child with Partial Trisomy 14 Mosaicism and Normal Cognitive Functioning
Objective: Trisomy 14 is a rare genetic condition associated with growth retardation, facial anomalies, congenital heart defects, and, in most cases, mental retardation. This case presents a 13-year-old girl with partial trisomy 14 mosaicism, history of failure to thrive, growth retardation, facial dysmorphism, Pervasive Developmental Disorder, Not Otherwise Specified (PDD, NOS) features, and average intelligence. This is the second documented case of average cognitive development in the context of trisomy 14 and reflects that mental retardation and cognitive delays are not necessary features of partial trisomy 14. Method: Jennifer is a 13-year-old, left-handed girl who was diagnosed with partial trisomy 14 in utero. Jennifer's initial postnatal period was complicated by decreased heart rate and lethargy. Infant development was further complicated by failure to thrive, hypotonia, and feeding problems. Motor development was normal, whereas language development was severely delayed, in part due to oromotor hypotonia. She received early intervention services from 6 months until pre-school. Results: Jennifer's neuropsychological profile revealed average cognitive and academic functioning (FSIQ = 99). Deficits were noted in the areas of learning and memory (2nd–16th percentile), dominant side motor coordination, speed and dexterity (5–8th percentile), mental flexibility (16th percentile), decreased response accuracy on cognitively demanding tasks (1st percentile), theory of mind (11–25th percentile), and reading comprehension (23rd percentile). Multiple symptoms of PDD NOS were evident in early childhood but less so at present. Conclusions: This case reflects that partial trisomy 14 mosaicism does not necessarily result in mental retardation, reflecting the relatively minimal genetic contribution of the tripled partial chromosome on cognitive development.
Interference from Second Language to First Language in Bilinguals
Objective: Previous studies have evaluated verbal learning of the second language in bilinguals. However, interference from the second language to the first language is rarely mentioned in bilingualism literature. The goal of this study was to examine whether verbal learning in the first language (Spanish) is affected by the number of years of exposure to the second language (English). Method: Participants were 28 bilingual speakers, with a mean age of 29.32 (SD = 1.00). There were 14 male and 14 female participants in the sample. The average education level of the sample was 15.43 (SD = 2.43). Participants were administered the Categorical Fluency and Verbal Learning subtests from the Nova Multilingual Neuropsychological Battery in Spanish. Results: Verbal Learning was significantly correlated to the Time in the United States (r = −5.24) and Education (r = .413) at the .5 level. All of the trials of Verbal Learning had a negative correlation with Time in the United States and a positive correlation with Education. Age was shown to not have a significant relationship with performance on the Verbal Learning Task (r = −.066). Conclusions: Because time of exposure to the second language affected performance on the Verbal Learning subtest, it can be concluded that working memory as expressed by the ability to memorize words in the first language is affected by the amount of years the bilingual participant has been exposed to the second language. This effect was shown to be independent of the participant's age, which had no effect on performance.
The Boston Naming Test “Noose” Item: What Is it Good For?
Objective: Recent discussion has questioned the appropriateness of the Boston Naming Test (BNT) noose item, given its culturally inflammatory symbolism. Therefore, the present study investigated performance and emotional responses to BNT stimuli among Black and White cognitively intact college students and assessed for potential differential item functioning (DIF). Method: Data from 50 undergraduate students, including 19 Blacks and 31 Whites (self-identified), were included. Participants were administered all 60 BNT items, followed by an experimental, computer-based test assessing emotional responses to BNT stimuli. Results: Performance differences were found on two items (wreath, p = .05; sphinx, p = .01), with higher mean scores among Whites for both items. Follow-up logistic regressions performed on individual items, using ethnoracial group, overall BNT score, and the interaction term as predictors, revealed a significant interaction on one item (noose, p = .015). Inspection of corresponding mean scores suggested that overall naming ability reliably predicts performance on this item among Whites but not among Black participants. Emotional response to the noose item did not differ between groups; however, ethnoracial group accounted for 7% of the variance in reaction time for emotional responding, with Blacks responding more quickly than Whites. This difference, however, was not statistically significant (p = .07). Conclusion: Results from this study suggest that performance on certain BNT stimuli may be impacted by ethnoracial factors and that the noose item may test different constructs in Blacks when compared with White young adults. These findings, together with the APA ethical principles and multicultural guidelines, suggest that the noose may be an inappropriate item for continued inclusion in the BNT.
Neuropsychological Testing Spanish Speakers: The Challenge of Accurately Assessing Linguistically and Culturally Diverse Individuals
Objective: To address the current state of neuropsychological assessment of Spanish speakers, a three-phase study was designed to: (a) develop a current and comprehensive list of neuropsychological and psychological tests available in Spanish, (b) determine which Spanish tests are being used by Spanish-speaking neuropsychologists, and (c) determine if the Spanish tests used meet the criteria from the testing Standards for Educational and Psychological Tests. Method: Phase 1: the list of Spanish tests was developed by reviewing these sources: (a) previously published studies on tests in Spanish, (b) Buros Mental Measurements Yearbook (Online database), (c) Hispanic Neuropsychological Society List of Spanish Tests, (d) databases (PsychInfo & WorldCat), and (e) Spanish test publishers (e.g., Manual Moderno & TEA). Phase 2: Online survey was administered using Hispanic Neuropsychological Society members. Survey included questions regarding demographics and Spanish test usage with 56 out of 83 responding. Phase 3: tests reported were matched to the Standards for Educational and Psychological Tests to determine whether these tests met the criteria required for tests in English. Results: Findings showed that there are few Spanish tests (555 from 3,500). Of these, relatively fewer tests are being used (216) for neuropsychological testing. Of the 216, there are approximately 25–40 tests that are used frequently and a much larger number of tests that are used infrequently. Finally, almost none of the tests meet the testing standards criteria. Conclusions: Results indicate that the current status of available and useful neuropsychological testing for Spanish speakers is inadequate. Specific suggestions are provided to attempt to remedy this situation.
Neurocognitive Assessment in American Indian Elders
Objective: Little neuropsychological research exists with respect to American Indians. Previous findings with the CERAD battery suggested similar results among older American Indian and Caucasian groups. The purpose of this investigation was to examine the performance of healthy American Indian and Caucasian elders on a brief battery of neurocognitive measures. Methods: Thirty-eight American Indian participants (AI) and 28 Caucasians (C) were administered the Mini-Mental State Examination (MMSE), Digit Span Forward and Backward (DSF, DSB), and Hopkins Verbal Learning Test-Revised (HVLT-R). All participants were primarily English-speaking. Groups were similar in mean years of education (M(AI) = 13.4, M(C) = 14.0), but the Caucasian sample was significantly older (M(AI) = 62.2, M(C) = 71.1, p < .001). analysis of covariance (ANCOVA)s were performed with age, education, gender, and depression scores as covariates. Covariates significant at p < .15 were included in an adjusted model ANCOVA. Results: Scores on the MMSE did not differ significantly (M(AI) = 28.9, M(C) = 29.3, p = .084). Scores on DSF (M(AI) = 5.5, M(C) = 6.8, p < .001), DSB (M(AI) = 4.5, M(C) = 5.5, p < .001), and HVLT-R total (M(AI) = 25.1, M(C) = 29.6, p < .001) were significantly different between groups, with the Caucasian sample obtaining higher scores after adjusting the analyses for significant covariates. Conclusions: Performance on the MMSE was comparable between groups, whereas American Indians obtained slightly lower scores on Digit Span and HVLT-R. These results differ to some extent from previous findings utilizing the CERAD battery. Although further investigation is necessary in larger samples with additional tests, these findings suggest that some measures, possibly those with heavier language components, may require different norms or score adjustments to allow appropriate interpretation.
Performance on the Demsky Golden Interference Task Using a Hispanic Sample
Objective: The present study was conducted to determine whether bilingual participants perform differently on an interference task when it is administered in English or Spanish. Method: Analyses were performed on data collected from non-patient volunteers, who participated in the Nova Multilingual Neuropsychological Battery Pilot Study (NMNB). The study analyzed data from 41 Spanish–English Bilingual participants (whose first language was Spanish) who were administered the Demsky Golden Interference Task (DGIT) as part of the NMNB. Twenty-one of the participants were administered the English version of the Interference Task and 20 participants were administered the Spanish version. The mean age was 28.24 (SD = 8.36). There were 22 females and the average education was 15.83 (SD = 2.09). The DGIT consists of three trials presented to the client at 30-s intervals. Trial 1 measures reading ability. Trial 2 is administered to individuals who are unable to read the words in Trial 1. Trial 3 measures number reading ability. Trial 4 asks the participant to state the number of digits present in each set rather than the numbers written. Results: Overall performance was significantly slower for those administered the Spanish version of the interference task (F(39) = 4.96, p ≤ .05). No other significant differences were observed. Conclusions: The trial that presented competing stimuli for the participant to attend to (Trial 4) yielded a significant lower score. The significant difference between the group administered the English version of the task and the group administered the Spanish version suggests that those receiving the English version may have a higher aptitude for inhibition.
Factors Influencing Performance on Anomia Task among Monolingual and Bilingual Samples
Objective: The goal of this study was to determine factors influencing performance on an anomia task to determine the extent of an individual's visual confrontation naming abilities in monolingual and bilingual samples. Method: The sample consisted of 124 participants including 78 females, average level of education of 16.20 (SD = 2.02), 63 monolingual English speakers, 61 bilingual speakers, and were primarily Caucasian or Hispanic. Participants were administered the anomia subtest of the NOVA Multilingual Neurological Battery (NMNB). The English version of the NMNB was administered to 96 participants, and the Spanish version of the NMNB was administered to 28 participants. The subtest consisted of 11 visual stimuli; participants were directed to verbally identify each of objects. Results: One-way analysis of variance (ANOVA)s were run to measure differences between performance on the Anomia subtest and each measure. At the .05 level, there was a significant difference between performance for language of administration (F = 4.06) and monolingual versus bilingual (F = 8.75). A correlation was run between Acculturation and performance on anomia showed a significant correlation (r = .24). No significant effect was found for ethnic identity. Conclusion: The participants receiving the English version had higher performance for visual naming abilities. Monolingual English speakers did better than the bilinguals. Language proficiency could be a factor as participants may have chosen a version in a language that they are not as proficient in. The significant correlation with acculturation suggested that those with higher acculturation had a higher aptitude for visual naming abilities. Another explanation could be that higher acculturation is associated with higher language proficiency.
Performance of English Monolinguals and Spanish/English Bilinguals on Verbal Tests
Objective: The present study compared the performance of monolingual English speakers and Spanish/English bilinguals on verbal tests. Method: The sample, non-patient volunteers, who participated in the Nova Multilingual Neuropsychological Battery Pilot Study (NMLB), included 63 monolingual English and 33 bilinguals (Spanish and English). The mean age was 27 (SD = 7.6) and mean education was 16.4 (SD = 1.8). Tests were administered in English including the following: Verbal Commands, which asks the participant to demonstrate how they would perform a number of common tasks such as how they would sweep; Categorical Fluency, in which the person must name as many things that fall into that category; Verbal Learning and Verbal Delayed, the ability to learn a list of words when presented several times; Word Recognition, recognition task from verbal learning; Anomia, naming objects; Phonetic Discrimination, assesses ability to differentiate and articulate different words; Spelling, writing words and sentences read aloud; Reading Comprehension, completing sentences with an appropriate word; and Vocabulary, defining words. Results: Analysis revealed significant differences in Verbal Commands (t(93) = −2.146) and Oral Word Recognition (t(93) = −2.03). Bilinguals obtained higher scores than monolinguals on Verbal Commands. Bilinguals recognized more words than monolinguals. No other significant differences were found. Conclusion(s): The results showed that only 2 out of the 11 verbal tasks resulted in a significant difference between bilingual and monolingual participants. Bilingual participants performed better on tasks that measured verbal recognition and were more adept at following verbal instructions to execute motor movements. The test appears to work equally well in bilinguals and monolinguals.
Effects of English as a Second Language (ESL) on Verbal Memory Scores
Objective: Previous research examining the impact of English as a second language (ESL) on neuropsychological test scores did not find effects on verbal memory (Boone, Victor, Wen, Razani, & Pontón, 2007). The purpose of the current study was to further examine this finding. Method: Participants were 32 native English-speaking and 13 ESL clinical patients from a large county hospital who were deemed credible, had no dementia diagnosis, and had an FSIQ >70. Current English use was greater than 50% for 12 of the 13 ESL patients (range 20%–100%). Between-groups differences on the Wechsler Memory Scale-III (WMS-III) Logical Memory I and II and on all Rey Auditory Verbal Learning Test (RAVLT) trials were analyzed with analysis of covariance (ANCOVA)s controlling for years of education. Results: The ESL group had significantly lower scores on RAVLT Trial 1 (ηp2 = .14, F(1, 42) = 6.80, p < .02), Total of Trials 1–5 (ηp2 = .10, F(1, 42) = 4.79, p < .04), and Trial 8 Delayed Recall (ηp2 = .10, F(1, 42) = 4.56, p < .04). Conclusions: ESL status impacted initial and total learning, and delayed recall for rote material. The effect was attenuated by Trial 5, by which time no significant difference on number of words learned was found.
Does Ethnicity Impact the Relationship between Depression and Intelligence among the Homeless?
Objective: This research aimed to investigate the moderating effect of ethnicity on the association between depression and intelligence in a sample of homeless adults. Method: Participants were 45 homeless or formerly homeless, predominantly right-handed (88.9%) adults, most of whom were 45–54 years old (48.9%). This sample was recruited at an outpatient clinic in Miami, FL. The majority of participants were men (77.8%) and approximately 40% did not complete high school. The preponderance of participants identified as Black, African American, or Afrocaribbean (57.8%). Fewer participants were White (20%), Hispanic or Latino (11.1%), or Other (11.1%). These participants were grouped into one category to be compared with the majority. Depression was measured by the Center for Epidemiologic Studies Depression Scale (CES-D). Prorated Full Scale IQ was derived from the six core Verbal Comprehension and Perceptual Organization subtests on the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III). Results: A significant interaction was not observed (F(1, 39) = 3.437, p = 071), indicating that the effect of depression on intelligence does not vary as a function of ethnicity in this sample. The main effect of ethnicity, however, was significant (p = .005), explaining 15.8% of the total variance of intelligence. Conclusions: Results did not support the hypothesis that ethnicity acts as a moderator in the relationship between depression and FSIQ. The interaction was in the predicted direction, however, suggesting that small sample size may be limiting the results. Potential differences in subtest scores that may be influenced by ethnicity and clinical implications will be discussed.
NEUROLOGICAL AND NEUROPSYCHIATRIC DISORDERS: PSYCHIATRIC ILLNESS
A Mediation Model of Post-Traumatic Stress Disorder, Intellectual Functioning, and Depression in a Sample of Homeless Adults
Objective: This study attempted to determine whether depression mediated the relationship between symptoms of post-traumatic stress disorder (PTSD) and intelligence in a homeless sample. Method: Participants were 45 homeless or formerly homeless, predominantly right-handed (88.9%) adults, most of whom were 45–54 years old (48.9%). This sample was recruited at an outpatient clinic in Miami, FL. The majority of participants were males (77.8%), and most identified as Black, African American, or Afrocaribbean (57.8%). Fewer participants were White (20%), Hispanic or Latino (11.1%), or Other (11.1%). Approximately 40% did not complete high school. Baron and Kenny's (1986) three-step method for determining the presence of mediation was utilized. Depression and symptoms of PTSD were measured by the Center for Epidemiologic Studies Depression Scale (CES-D) and the PTSD Checklist-Civilian Version (PCL-C), respectively. A prorated Full Scale IQ was derived from the six core Verbal Comprehension and Perceptual Organization subtests on the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III). Results: Intellectual functioning when regressed on depression yielded significant results (F(1, 40) = 4.634, p = .037). Collinearity between the predictor and proposed mediator were deemed tenable; therefore, the hypothesized mediator (CES-D) was regressed on PCL-C, with significance (F(1, 40) = 22.869, p < .001). Finally, intellectual functioning was regressed on both depression and PTSD, again with significant results (F(2, 39) = 4.34, p = .02), indicating partial mediation. Conclusions: The presence of a statistically significant mediator indicates that the inverse relationship between PTSD and intellectual functioning appears to be made stronger by the presence of depression.
Neuropsychological Correlates of Schizoaffective Disorder and Psychotic Major Depression: A Comparison Study Using a Three-Factor Model
Objective: Cognitive function is impaired in patients with schizoaffective disorder (SAD) and psychotic major depression (PMD). Few studies have examined these two patient groups simultaneously. Here we compared cognitive function in PMD and SAD patients. Follow-up analyses examined the specific role of positive symptoms, negative symptoms, and affective symptoms on cognition. Method: Forty PMD and 18 SAD patients participated. Participants were rated on the Brief Psychiatric Rating Scale (BPRS) and completed a comprehensive neuropsychological assessment including attention, working memory, executive functioning, and verbal memory. Results: Analysis of covariance (ANCOVA) analyses were run with each main neuropsychological test with group as the independent factor and age as the covariate. In all domains, PMD and SAD patients did not differ on their cognitive performance (p > .27). Follow-up regression analyses with the PMD and SAD patients combined utilized positive, negative, and affective symptoms as independent factors to predict cognitive performance. This three-factor model contributed a significant amount of variance in verbal memory, attention, and executive functioning (p < .05). In all cases, negative symptoms played a significant role once the other two factors were covaried. Conclusion: These findings may have important therapeutic implications as residual negative symptoms often remain even after generally successful treatment of these disorders. Given that PMD patients tend to experience more acute symptomatology and SAD patients have more chronic problems, additional studies with larger samples are needed to better understand how these factors may distinctly affect cognitive functioning in these two groups.
Assessing Cognitive Impairment and Functional Ability in Schizophrenia
Objective: Cognitive impairment is a leading cause of disability in people with schizophrenia. Many individuals with this disorder have major impairments in adaptive life skills and the performance of social roles, which lead to a limited capacity to function independently in the community. We hypothesized that patients with greater thought disorder and less complexity, in addition to neuropsychological deficits, would exhibit greater functional impairments. Methods: Participants were 28-year-old schizophrenic outpatients (mean age 50.57 + 5.26 years) reasonably controlled on medication. All participants completed the UCSD Performance-Based Skills Assessment (UPSA), Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and the Rorschach Performance Assessment System (RPAS). The UPSA was used to assess functional ability and the RBANS was used to assess neuropsychological impairment. The Ego-Impairment Index-II (EII-2) and Overall Complexity (Complex) variable of the RPAS were used to assess thought disorder and psychological complexity, respectively. Results: The magnitude of the effect size between the RBANS and the UPSA was large (r = .69, p < .001, R2 = .48). Using a multiple regression model, the EII-2 (t = −1.10, p = .21) and Complex (t = 1.90, p = .07) variables accounted for an additional 7.3% (R2 = .55) of the variance beyond that accounted for by RBANS scores. Conclusion: These preliminary results suggest that the constructs of thought disorder and psychological complexity play a role in the functional limitations seen in schizophrenics above and beyond neuropsychological impairment. Further research should examine how these variables are related to real-world behavior in this population.
Neuropsychological Deficits in Elderly Schizophrenia and Schizoaffective Disorders
Objective: The purpose of this research was to measure cognitive processing deficits in elderly participants with psychotic disorders compared with normal participants using Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) and Trail Making B. Method: Participants were outpatients diagnosed with schizophrenia or schizoaffective disorder (N = 38) compared with participants with no history of neuropsychological or psychiatric disorders (N = 4). The participants were 75.0% Caucasian and 57.3% females with a mean age of 64. Participants' Full Scale IQ (FSIQ) on the WAIS-III was utilized as a measure of general intelligence and Trail Making B T-score was utilized as a measure of executive functioning. Results: All analyses were conducted at the .01 level of significance. There was a significant difference on FSIQ between schizophrenics/schizoaffective (M = 80.79) and normal participants (M = 104.09, F(1, 70) = 29.865, p < .001). For this reason, FSIQ was utilized as a covariate. A one-way between-subjects analysis of covariance (ANCOVA) demonstrated that schizophrenic and schizoaffective participants (M = 32.39), as a group, performed significantly more poorly on Trail Making B than normal participants (M = 47.36, F(1,70) = 10.20, p = .002). Conclusion: This study supports previous findings that have demonstrated both intellectual and executive functioning deficits in psychotic populations. Participants with a psychiatric diagnosis performed significantly worse on measures of intelligence. After the effects of intelligence were controlled for, this population obtained significantly lower scores on a measure of executive functioning. This deficit in the ability to make judgments, solve problems, and inhibit thought and behavior has vast implications for quality-of-life and psychiatric and psychological treatment.
Cognitive Deficits in Adolescents with Major Depressive Disorder
Objective: The purpose of this study was to examine if adolescents with major depressive disorder (MDD) manifest similar cognitive deficits as do adults. Method: Scores from coding and block design from the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) and Trail Making Test were examined. Vocabulary, similarities, Matrix Reasoning, and Digit Span scores were included to rule out executive functioning, working memory, and non-verbal skills as confounds. The sample consisted of 58 adolescents aged (M = 10.4 years, SD = 2.8). Thirty-two patients were diagnosed with MDD (M = 10.8 years, SD = 2.8) and 26 adolescents with no psychological diagnoses (M = 9.9 years, SD = 2.8). The majority of the sample was Caucasian (54%), followed by Hispanic (24%), Other (14%), and Black (8.0%); the sample was also predominantly males (58.6%) and right-handed (91.7%). Results: A one-way analysis of covariance (ANCOVA) was conducted controlling for age. Significant differences were found at the .05 level for coding (F(1, 54) = 14.43, p < .001), Trails A (F(1, 49) = 11.36, p = .001), and Trails B (F(1, 49) = 14.59 p < .001). Participants with MDD performed significantly lower than participants with no psychological diagnoses. Significant differences were also found in Digit Span (F(1, 54) = 9.690, p = .003) and vocabulary (F(1, 54) = 9.01, p = .004). No significance was found for matrix reasoning or similarities. Conclusions: This research indicates that adolescents with MDD suffer from similar cognitive deficits as their adult counterparts. This is consistent with existing evidence regarding cognitive deficits associated with MDD and indicates that these deficits already emerge during adolescence. More research is required to determine the relationship between MDD, working memory, and executive functioning among adolescent populations to determine if these affect or are effects of this deficit.
Visual Perception Deficits in Psychotic Disorders
Objective: Previous research has focused on overall deficits in psychotic disorders as reflected on Full Scale IQ, attention, and problem-solving. The purpose of this study was to measure visual perception deficits in individuals with psychotic disorders. Method: Participants consisted of schizophrenics and schizoaffectives (N = 38) and normals. There were 57.3% females; 89% were right-handed and 75.0% Caucasian, with mean age 64. Measures included participants' PIQ scaled score as well as Block Design, Picture Completion, and Matrix Reasoning scaled scores. Results: Data on visual perception were analyzed using a one-way between-subjects analysis of variance (ANOVA). There was a significant difference at the .05 level (p < .001) between schizophrenics/schizoaffectives (M = 79.368) on visual perceptual tasks in PIQ and normals (M = 100.912, F(1, 70) = 32.012, p < .001). There were also significant differences in each of the subtests as measured by a series of one-way between-subjects ANOVAs; Block Design schizophrenics/schizoaffectives (M = 6.526), normals (M = 9.618, F(1, 70) = 23.841, p < .001); Picture Completion schizophrenics/schizoaffectives (M = 6.538), normals (M = 10.500, F(1, 70) = 25.168, p < .001). Matrix Reasoning schizophrenics/schizoaffectives (M = 7.552), normals (M = 11.088, F(1, 70) = 21.804, p < .001). Conclusion: Participants with psychotic disorders performed significantly more poorly across perceptual measures than those without psychiatric diagnoses. This study supports previous findings that have demonstrated visual perception deficits in psychotic populations. These results should be applied to the development of adequate perceptual assessments for future clinical trials.
Neuropsychological Functioning Across Different States of Bipolar Disorder: Mania or Hypomania and Depression
Objective: The aim of the study was to compare neuropsychological functioning across different states of bipolar disorder: mania/hypomania and depression. Method: Cognitive functions were examined in 30 depressed bipolar patients aged 18–68 (M = 45.6, SD = 12.6; 18 women and 12 men) who fulfilled DSM-IV criteria for depressive episode (Hamilton Depression Rating Scale score ≥ 11) and 30 manic or hypomanic bipolar patients aged 23–68 (M = 48.1, SD = 11.5; 18 women and 12 men) who fulfilled DSM-IV criteria for manic or hypomanic episode (Young Mania Rating Scale ≥ 11). The comparison group consisted of 30 healthy participants aged 23–71 (M = 46.2, SD = 12.2; 20 women and 10 men) without history of psychiatric or neurological disorders. The study was performed at Central Clinical Hospital in Lodz, Poland. A neuropsychological battery assessed executive functions and fluency (Wisconsin Card Sorting Test [WCST], Controlled Oral Word Association Test FAS, Stroop Color-Word Interference Test), working memory and attention (Trail Making Test Part B-TMT, N-back Test), psychomotor speed (TMT A), and reaction time (N-back Test). Results: The bipolar groups showed cognitive dysfunctions in working memory, fluency, attention, psychomotor speed, and reaction time in relation to comparison group. Manic/hypomanic group was also impaired on WCST, a measure of executive functions, which was not observed in depressive patients. Manic/hypomanic patients were significantly more impaired on executive functions than depressed group. Conclusion: A poorer neuropsychological performance was observed in different states of bipolar disorder but during manic/hypomanic state, cognitive deficits were more serious regarding executive functions.
Cognitive Functioning and Longitudinal Functional Outcomes in Patients with First Episode Bipolar I Disorder
Objective: Cognitive deficits are present early in the course of bipolar disorder, but it is unknown whether such deficits predict longitudinal functional outcomes. The goal of this study was to evaluate whether cognitive functioning early in the course of bipolar illness predicts functional outcomes 6 months after cognitive assessment. Method: Fifty-three clinically stable patients with a DSM-IV Bipolar I diagnosis were recruited from a large Medical School Mood Disorders clinic within 3 months of their first manic episode. Participants were administered a neuropsychological battery yielding cognitive scores in verbal/premorbid IQ, spatial reasoning, attention/processing speed, learning/memory, and executive functioning. Six months later, 45 patients were administered the Multidimensional Scale of Independent Functioning (MSIF), a structured interview rating scale assessing functioning across work, educational, and residential environments. Mood ratings were also obtained at baseline and 6 months. Results: Using sequential multiple regression, mood ratings were entered simultaneously and found to marginally predict 6-month MSIF scores (R2 = .15, F(3, 41) = 2.42, p = .08). Only 6-month depression ratings predicted MSIF scores (t = 2.4, p = .02). In the second step of the regression, the five cognitive scores were entered simultaneously, yielding a significant increase in R2 (R2 change = .29, F change(5, 36) = 3.7, p = .008). Learning/memory was the only cognitive domain adding unique variance in the full model (t = −3.3, p = .002). Conclusions: Learning/memory functioning predicted 6-month functional outcomes in recently diagnosed patients with bipolar disorder. Findings provide support for the utility of neuropsychological assessment early in the course of bipolar illness and suggest that cognitive difficulties in recently diagnosed patients may represent clinical targets for treatment and intervention.
On the Moderating Role of Mood Disorder in Patients with Pain Disorder and Its Impact on Neuropsychological Function
Objective: The present study examined the moderating role of psychological impairment in patients with pain disorder and its impact on neuropsychological function. More specifically, we set out to determine whether reliable differences exist in terms of neuropsychological functioning between patients with pain disorder reporting psychological impairment and patients with pain disorder without any psychological concerns. Method: Archival data were obtained from a random sample of litigating, but non-feigning patients who sustained a traumatic injury (e.g., soft tissue, fracture, whiplash, but no traumatic brain injury) as a result of a motor vehicle accident. A total of 63 patients who had undergone a comprehensive neuropsychological examination were included in this study. Participants in this study were given a host of omnibus measures related to neuropsychological and psychological functioning, in hand with symptom validity measures. Based on their test findings and subjective report within the context of a clinical interview, these patients were grouped into two groups: (a) patients suffering from pain with no psychological complaints (n = 21) and (b) patients suffering from pain who also endorsed psychological impairments (n = 42). Results: We found significant differences between the two groups on measures of neuropsychological functioning, reported pain severity, and in terms of various aspects of personality. Conclusion: Understanding the moderating role of mood disorder in patients with pain disorder and its impact on neuropsychological function can help the practicing neuropsychologist in terms of a differential diagnosis and in terms of directing treatment.
Pseudo-Dementia Secondary to Generalized Anxiety Disorder
Objective: The objective of this study was to explore the utility of neuropsychological assessment in determining dementia versus pseudo-dementia. Pseudo-dementia refers to reported symptoms of memory loss caused by psychiatric disturbance rather than a neurodegenerative disorder. Pseudo-dementia is often characterized by vague memory complaints, bradyphrenia, and bradykinesia of a less insidious onset than is often seen in true dementias. Treatment typically involves psychotherapy, medication, or a combination. Method: A 58-year-old, right-handed, Caucasian female was assessed in a hospital setting following neurologist diagnosis of a dementia. Patient reported changes in cognitive abilities 1–2 years ago with difficulty sustaining attentional focus, completing simple mathematics, switching topic, staying mentally organized, recalling where she placed personal objects, and recalling new information. Frank repeating was reported by family members as were word-finding difficulties. Personality changes were noted, with social withdrawal, new onset of ruminative thoughts, and high levels of anxiety. Archival neuropsychological data, de-identified history, and neurologist report conducted pre- and post-treatment for anxiety will be organized and presented in a single study case summary. Evaluation procedures included administration, scoring, and interpretation of comprehensive quantitative and qualitative measures. Results: Pre-treatment assessment revealed several areas of mild relative impairment in executive functioning (complex attention, processing speed, and verbal fluency) and variable verbal memory with significant depression and anxiety. Post-treatment assessment revealed generally intact cognitive abilities. Conclusion: Neuropsychological assessment is an extremely effective tool in differentiating between a true neurodegenerative condition and a pseudo-dementia.
Case Studies: Pre- to Post-Neuropsychological Assessment in Patients Reporting Catastrophic Post-ECT Memory Loss
Objective: It has been reported that given advances in safety and efficacy of electroconvulsive therapy (ECT), cognitive issues have emerged as the main clinical concern. We have implemented a brief (<45 min) battery to evaluate neurocognitive functions in patients prior to undergoing ECT based on the Repeatable Battery for the Assessment of Neuropsychological Status and other selected measures of working memory, initiation, and mental flexibility. A previous group study indicated that ECT resulted in significant improvement in depressive symptoms, with most measures of cognitive functioning showing net gains following ECT. It is particularly important to investigate specifically the individual cases of patients complaining of catastrophic post-ECT memory deficits. Method: We present two such clinical cases of patients who were assessed prior to the initiation of ECT and again 3.5 and 5 months later, respectively (later assessments were conducted as well). Following ECT, both participants complained of generalized cognitive decline, with one participant reporting complete amnesia for a very significant event (autobiographical memory deficit). Results: In both cases, comparison of pre- and post-ECT results provided no evidence for systematic deterioration of mental status, with improvements in most cognitive measures. Conclusions: Findings were discussed in terms of feasibility/patient tolerance as well as clinical utility.
NEUROLOGICAL AND NEUROPSYCHIATRIC DISORDERS: TREATMENT AND REHABILITATION
Sensory Modulation, A Neuropsychologically-based Intervention
Objective: To review the neuropsychological mechanisms and evidence for efficacy of sensory–motor groups as an intervention for patients with SMI experiencing sensory dysregulation. Exploration of this topic is timely in that sensory processing disorders are likely to be included as a new diagnostic category in DSM-V. Data selection: A review of the occupational therapy and neuropsychological literature focusing on sensory integration with results as measured by fMRI, EEG, and the Adult/Adolescent Sensory Profile (A/ASP), as well as review of the relevant neuropsychological and neurological mechanisms of sensory integration. Data synthesis: Sensory–motor groups, based on A. Jane Ayres's theory of Sensory Integration (Ayres, 1972), increase the likeliness of recovery by effectively addressing dysregulation (i.e., decreased attention, aggression, impulsiveness, etc.) often found in the SMI population (Ogden, Pain, & Fisher, 2006). Consistent with Ayres's theory, multiple sources attribute dysregulation to CNS and PNS inefficiency; this inefficiency includes the presence of underreactive or overreactive responses to sensory information (Blakeney, Strickland, & Wilkinson, 1983; Brown, Tollefson, Dunn, Cromwell, & Filion, 2001; MacRae, 2005) which may result in the misinterpretation of sensory information, disorientation, decreased visuo-spatial skills, poor visual perception, altered body scheme, and astereognosis. Sources are mixed but suggest neurological changes as shown on fMRI and EEG following interventions, and anecdotal information from our group shows notable changes in mood, outlook, and ability to attend to stimulation appropriately. Conclusions: Evidence suggests that sensory–motor groups are effective for this population. This corroborates the results observed in an inpatient unit. Recommendations for further research are included.
Cognitive Change Following Bone Marrow Transplant for Multiple Sclerosis
Multiple sclerosis (MS) is an autoimmune disease routinely treated with immunomodulators. A sub-population of patients, however, demonstrate mounting disability despite pharmacotherapy. Bone marrow transplantation (BMT) is an immunoablative technique that reconstitutes the immune system to slow, halt, or reverse MS pathology at a cellular level. Neuropsychological testing was added to the protocol to evaluate the impact of BMT on cognition. Objective: To determine the extent and severity of cognitive dysfunction and to determine if BMT impacts cognition. Method: Seven participants were assessed before and after 2 months BMT with neuropsychological measures from various cognitive domains. Results: Seventy-one percent show impairment on one or more cognitive measures at both time points. Forty-three percent and 57% show impairment on five or more measures at baseline and follow-up, respectively. Cognitive domains prone to impairment include processing speed, immediate visual memory, expression of conceptual reasoning, and semantic fluency. Decline was evident in all participants on at least one cognitive measure at follow-up, with 86% demonstrating decline on at least three measures. Immediate visual recall, attainment and expression of conceptual reasoning, and phonemic and semantic verbal fluency declined as measured by practice-adjusted reliable change indices. Conclusions: Findings are consistent with literature documenting cognitive impairment in a large proportion of individuals with MS. The deterioration of cognition over time was representative of the early recovery phase following BMT. Follow-up of patients by our group shows stable or improved neurological function over time. Further longitudinal follow-up of cognition will evaluate whether eventual neuropsychological change proceeds in parallel with this neurological outcome.
Pediatric Outcomes in Neurorehabilitation
Children often have a better prognosis from mild brain injury, but there is limited research on child outcomes following severe brain injury and there are often a diverse array of cognitive and behavioral symptoms in children. The research hypothesis in this study is that children will have significant neurorehabilitative gains across multiple domains of functioning as measured by the Mayo Portland Adaptability Inventory-4 (MPAI-4). Children (N = 49, 26 boys and 23 girls) involved in neurorehabilitation and completed the MPAI-4 at admission and discharge. Mean age is 14.8 years and mean grade level is 9. Most participants had TBIs (68%) which were severe (63%) and 32% of participants had one of three other CNS disorders (epilepsy, infection, post-tumor resection). The average length of stay was 252 days. After discharge, there was a 90-day follow-up call to parents regarding if their child was improving, stable, or worse since discharge. Children's discharge scores were statistically significantly lower on all MPAI subscales suggesting improved functioning (physical/cognitive ability 49.6–46.8, community participation 48.4–46.5, psychosocial adjustment 49.3–46.1), however the magnitude of difference is smaller than the adult treatment effects and may not represent clinically significant gains. Total MPAI-4 scores were significantly lower for 44 of 49 children at discharge. Children's MPAI-4 score change (treatment effect size) was compared with the adult score change and was significantly smaller (2.9 versus 5.0 Total MPAI score points), despite similar length of stay and time since injury. Data suggest that pediatric ABI outcomes are complex and likely require multiple instruments to adequately measure.
A Test of the Health Belief Model: The Ability of Barriers, Benefits, Susceptibility, and Severity Perceptions to Predict Parental Adherence to Pediatric Assessment Recommendations
Objective: This study explored the utility of the Health Belief Model (HBM) as a predictor of parents' adherence to recommendations made by mental health professionals after a pediatric neuropsychological evaluation. Method: The sample was made up of 40 parents seeking a neuropsychological evaluation for their school-aged children aged 5–18 at a private practice or community setting in Baltimore, MD. There were no additional exclusion criteria for the purpose of this study. Well-established measuring instruments, with confirmed reliability and validity, were used to assess each component of the four constructs of the HBM (i.e., perceived severity, perceived susceptibility, perceived benefits, and perceived barriers) and adherence to neuropsychological assessment recommendations. Results: The major findings were that (a) perceived behavior severity, perceived susceptibility to future problems, perceived benefits of following recommendations, and perceived barriers were not significantly associated with adherence to neuropsychological evaluation recommendations. (b) Adherence rates were not significantly different between home-based recommendations and service-related recommendations. Conclusions: Although the study had a number of limitations, the results suggest that although the constructs of HBM often predict adherence to medical regimens, the HBM does not appear to predict adherence to recommendations made by mental health professionals after a neuropsychological evaluation. Studies examining adherence to recommendations after psychological assessment is scant. Thus, future studies may want to look at additional predictors of adherence to recommendations in the hopes of improving adherence rates.
The Effect of a Goal-Focused Intervention for Everyday Action in Schizophrenia
Objective: Executive functioning is a strong predictor of everyday action abilities in schizophrenia. Previous research has shown that patients with schizophrenia show a unique performance on the Naturalistic Action Test (NAT), a measure of everyday action, which consisted of a high number of off-task errors consistent with executive dysfunction. This study examined that whether or not an intervention aimed at remediating executive deficits would positively impact everyday action performance in individuals with schizophrenia. Method: The sample consisted of 23 participants with a diagnosis of schizophrenia or schizoaffective disorder who were recruited from inpatient psychiatric units. Participants were randomly assigned to two groups, and they performed the NAT at a baseline session and again after either the intervention or a placebo-controlled session. Each participant also received a short battery of neuropsychological tests. Results: Group-by-time analysis of variance (ANOVA)s showed that patients who received the intervention did not show greater overall performance on the NAT (p = .79), did not commit fewer errors (p = .91), and did not accomplish more of the steps (p = .81) than patients who received a placebo-controlled intervention. Effect sizes were also small. Conclusion: The hypothesis that this intervention would help improve patients' performance on the NAT was not supported. Because this intervention worked previously in a brain-injured population with executive dysfunction, these results may indicate that patients with schizophrenia differ fundamentally from other patient populations in their underlying pathology. Because of the severe functional impairments present in schizophrenia, future research should continue to investigate different cognitive intervention strategies and their effectiveness.
Neuropsychological Profiles as Predictors of Treatment Response in Chronic Depression
Mood disorders are associated with cognitive deficits, and reports indicate that repeated (chronic depression) depressive episodes might actually have the most deleterious impact on cognition. Neuropsychological instruments successfully characterize cognitive functions, whereas cognitive therapy and its many variants, including cognitive-behavioral therapy (CBT), have demonstrated effectiveness and efficacy in treating depressive disorder. In a proof-of-concept investigation, 25 participants with recurrent/chronic major depressive disorder were recruited to receive manualized CBT (Mind Over Mood). Baseline evaluations included the NEO PI-R, a test of normal personality traits, and a selected battery of neuropsychological measures designed to be brief, but comprehensive of the cognitive domains (attention/concentration, processing speed, and learning/memory) reportedly affected by depression. A prerequisite for enrollment in the study was current, unsuccessful treatment with an antidepressant, which was defined by an entry score of 17 or higher on the Hamilton Rating Scale for Depression (HRSD). California Verbal Learning Test-II (CVLT-II), Trail Making Test (TMT-B), Stroop Color & Word Test, and the Brief Visuospatial Memory Test-Revised (BVMT-R) were among the neuropsychological tasks administered at baseline and at the conclusion of the 12-week intervention. The neurocognitive and NEO PI-R variables were compared using an area under the curve and random regression analysis that used all of the available data. Neuropsychological measures of fluency and impulse control appeared to predict treatment response, as did a few factors from the NEO PI-R. Our findings suggest that neuropsychological instruments could have a role in the diagnosis and appropriate treatment of chronic depression.
The Effect of a Speed of Processing Intervention on Adults with HIV
Objective: Those aging with HIV are more vulnerable to cognitive and functional deficits. In this study, 52 middle-aged and older adults (Mage = 51.5 years; range 40.7–70.6 years) with HIV were randomly assigned to a visual speed of processing training condition or a no-contact control condition to determine the effectiveness of this intervention. Method: In the visual speed of processing training condition, participants received 10 hr of computerized visuo-cognitive exercises. At baseline and post-test, the following measures were administered: Useful Field of View (UFOV®) Test, Wisconsin Card Sorting Test, Finger Tapping Test, and the Timed Instrumental Activities of Daily Living (TIADL) Test. Results: Controlling for baseline performance, analysis of covariance (ANCOVA)s were used to examine treatment effects on these measures between the two groups at post-test. Treatment effects were detected on UFOV® (F(2, 40) = 5.61, p = .022); the visual speed of processing training group improved on their UFOV® performance. Furthermore, transfer of training was observed on the TIADL Test (F(2, 37) = 4.104, p = .05); the visual speed of processing group improved their speed and accuracy in performing these laboratory instrumental activities of daily living. Next, we examined the relationship between the cognitive measures and performance on the TIADL Test; only baseline (r = .52, p = .001) and post-test (r = .48, p = .001) UFOV® scores were significantly related to baseline and post-test TIADL performance, respectively. Conclusions: This study emphasizes that computerized cognitive remediation therapy may benefit cognitive and everyday functioning in this growing population.
Development of a NeuroCognitive Enrichment Program as an Adjunct to Traditional Behavioral Health Therapies
To meet the growing demand for behavioral health services for service members returning from the wars in Iraq and Afghanistan, we developed a NeuroCognitive Enrichment Program as an adjunct to traditional behavioral health treatment modalities. In this poster presentation, we will discuss advances in the treatment of traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD), with an emphasis on cognitive retraining and neurofeedback methods. In addition, we will discuss the development of our neurocognitive program and present pre- and post-treatment data on a subset of participants diagnosed with PTSD and/or TBI. In particular, we are interested in the effects of the therapies on participants' self-report of quality of life, perceived control, and psychological well-being.
Long-term Neuropsychological Sequelae Following Electrical Injury: Preliminary Results of the Initial Phase of a Longitudinal Research Study
The purpose of this study was to determine the nature and prevalence of neuropsychological and psychiatric sequelae following electrical injury. Electrically injured patients were recruited from the outpatient clinic of a rehabilitation hospital between January 2008 and March 2010. Patients completed psychological questionnaires measuring depression, anxiety and post-traumatic stress disorder (PTSD), and a series of standardized psychometric measures of neuropsychological functioning. Student's t-tests and regression analyses were conducted to examine the effects of injury factors and psychiatric symptoms on neuropsychological functioning. Twenty-four patients (23 males and 1 female) were studied, with a mean (±SD) age of 44.2 ± 10.4 years and mean education of 11.9 ± 2.5 years. They were evaluated on average 38.0 ± 47.9 months post-injury, and high-voltage electrical injury was the most frequent etiology (62.5%). Psychiatric symptoms were found in 18 (73.9%) patients, of which depression and PTSD were the most frequent (73.9%), followed by anxiety (65.1%). The majority (65.2%) of patients experienced a combination of depression, anxiety, and/or PTSD. Younger (24–44 years) patients had significantly more anxiety and PTSD symptoms than older (45–64 years) patients (p < .05). Patients tested more than 1 year post-injury had significantly poorer performance in processing speed and semantic fluency (p < .01). Those with psychiatric symptoms had significantly worse scores in language, attention, processing speed, visual spatial ability, and memory (p < .05), than those without psychiatric symptoms. These findings support the conclusion that psychiatric symptoms and neuropsychological deficits in language, visual spatial ability, visual memory, and processing speed are common following electrical injury. A larger, multi-center, longitudinal study is warranted to further explore these findings.
NEUROPSYCHOLOGICAL DOMAINS: OTHER
What Does Naming Pictures of Objects Measure for Preschool Children?
Objective: The Naming Pictures of Objects subtest on the Dean–Woodcock Sensory Motor Battery (DWSMB) is listed with the sensory tests and can be useful in assessing sensory–motor dysfunction such as visual agnosia, oral-motor dyspraxia, or dysarthria. The simplicity of the stimuli pictures should theoretically increase the dependency of sensory–motor functioning and minimize the impact of language skills. The purpose of this study was to test this hypothesis for preschool children. Method: Participants were 31 preschool children (mean age 4.53 years, SD = .31 years). All participants completed the Phonological Processing and Speeded Naming subtests from the NEPSY and the DWSMB as part of a reading study. Results: There were five significant correlations between the Naming Pictures of Objects subtest and 16 sensory subtests from the DWSMB. The mean of these correlations was .280. There were two positive correlations between the Naming Pictures of Objects subtest and 12 motor subtests from the DWMSB. The mean of these correlations was .246. The correlation between the Naming Pictures of Objects and Speeded Naming and Phonological Processing was −.232 and .461, respectively. Linear regression showed that Speeded Naming predicted a significant proportion of the variance in the Naming Pictures of Objects subtest (R2 = .188, p = .015). Conclusions: The results suggest that although Naming Pictures of Objects seems related to sensory and motor skills, there is a large rapid automized naming component. This was expected given that preschool children will not find the stimuli as linguistically simple as older children and adults. The implications will be discussed for practitioners and researchers.
Semantic Learning Strategy on the California Verbal Learning Test (CVLT)
In the present study, we were looking for the relationship of semantic clustering to a variety of CVLT recall variables, rate of learning, education level, and the attention and verbal ability measures of the Wechsler Adult Intelligence Scale-Revised (WAIS-R). Verbal intelligence and education level were expected to be primarily associated with semantic strategy, and a relatively lesser use of semantic strategy would be individual of attention and concentration ability. We found strong systematic and specific factorial relationships among the CVLT short-term free and cued recall variables, long-term free and cued recall variables, CVLT Slope, CVLT semantic clustering, and the WAIS-R FFD factor scale. All of the variables were dimensionally individual of the WAIS-R verbal comprehension factor score and education level. It was concluded that short-term and long-term recall rate of learning and use of a logical semantic learning strategy were primarily associated with attention and concentration ability rather than verbal comprehension and education level in our diagnostically and demographically diverse, neuropsychiatric sample.
An Investigation of Head Accelerometry, Cognitive Function, and Brain Blood Flow during Intercollegiate Boxing and Its Impact Regarding Head Injury Assessment in Combat
Objective: The goal of this study was to investigate head impacts, neuropsychological performance, and cerebral blood flow in intercollegiate boxers to increase understanding about consequences of head impacts in this population. If significant correlations were found between measures, recommendations for increasing efficiency of head impact assessment in combat environments might be made. Method: Participants were 31 intercollegiate male boxers with a mean age of 20.74 years, height 70.14 in., weight 164.32 lbs., and experience 1.5 years. Assessments occurred before and after two full-effort 2-min sparring rounds. The Impact Headgear system tracked location/number of head impacts, translational acceleration, and rotational forces. The ImPACT test and Automated Neuropsychological Assessment Metrics (ANAM) measured neuropsychological performance and the Brain Acoustic Monitor (BAM) measured cerebral blood flow. Sparring bouts were videotaped to validate head impacts. Results: Impact Headgear recorded an average of 26.81 impacts per boxer, most of which were below the 25% probability for brain injury. The ImPACT test showed a decrease in verbal memory (p < .05), delayed memory (p < .01), and improved reaction time (p < .01). The ANAM showed a decrease in delayed memory (p < .01) and improved reaction time (p < .01). BAM detected no significant changes, and no significant correlations were found between the BAM and the neuropsychological measures. Conclusion: In the current sample, head impacts were below threshold to cause brain disturbance detectable through BAM; however, consistent with research in amateur boxing, mild decline in memory function was detected. Research with a larger sample across greater impacts is recommended to further investigate the efficacy of the BAM.
The Influence of Thyroid on Cognition in a Sample of Hispanic and Non-Hispanic Rural Dwelling Women
Objective: The aim of this study was to examine the relation of thyroid markers (TSH and FT4) and cognition in a sample of Hispanic and non-Hispanic rural dwelling women. Methods: Project FRONTIER is a community-based participatory research project studying rural health. Data were analyzed from 198 enrolled women (Hispanic: n = 75; non-Hispanic: n = 121). Thyroid function was assessed using TSH and FT4 markers. Cognition was assessed using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Data were analyzed using linear regression. Age was entered into the model as a covariate. Results: TSH was related to neuropsychological functioning in Hispanic women, but not in non-Hispanic women. In Hispanic women, TSH levels were negatively related to the RBANS Attention Index and Language Index, indicating that elevated TSH levels were related to poorer Attention and Language scores. The reFT4 levels were not significantly related to neuropsycholgical functioning. In non-Hispanic women, neither TSH nor FT4 levels were related to RBANS scores. Age did not significantly influence the results of this study. Conclusions: The current study demonstrated a significant association between TSH and neuropsychological functioning for Hispanic women only. As few studies have examined the relationship between thyroid functioning and cognition in an ethnically diverse sample, this study provides new insights regarding the relation of thyroid functioning on cognition in rural Hispanic women.
A Factor Analytic Investigation of a Four-Factor Component Model of Right–Left Orientation and Judgment of Line Orientation
The study employed a confirmatory approach to investigate correlations between performances on two measures thought to be associated with spatial orientation. A factor analysis was conducted for A.L. Benton's right–left orientation (RLO) and judgment of line orientation (JLO) among a demographically mixed, heterogeneous neuropsychiatric sample. Items obtained from RLO were utilized to construct four component variables: (1) identifying single left parts of the confronting examiner, (2) identifying single right parts of the confronting examiner, (3) executing double uncrossed commands, and (4) executing double crossed commands. These variables were factor analyzed with total performance on JLO. Factor analysis indicated JLO performance to be vastly independent of the four component variables of RLO, with 94% of the variance explained. Contrary to the supposition of a shared interdependence between visuospatial and proprioceptive skill, findings suggest that these abilities are highly independent of each other, indicating that both RLO and JLO uniquely contribute information with regard to neuropsychological status.
Cognition in Polysubstance Users with Hippocampal-Associated Anomalies: An Urban Case Series
Objective: This case series examines marginalized chronic polysubstance users with multiple physical and mental illnesses. Neuropsychological and neuroimaging findings are used to document the cases. We describe polyetiologic factors that may contribute to the observed impairments. Method: Three cases were selected from a larger study (n ≈ 200) examining residents living in single-room occupancy hotels in a Canadian urban setting. Using MRI scans, individuals were selected for hippocampal anomalies, based on size and location of fluid-filled spaces which are not typically seen in normal hippocampi. Abnormalities outside the hippocampus included white matter hyperintensities, prominent Virchow-Robin spaces, and cortical atrophy. All three cases tested positive for hepatitis C and negative for HIV. Psychiatric diagnoses included cocaine dependence and substance-induced psychosis. Neurocognitive measures evaluated information processing, sustained attention, motor functioning, executive functioning, and memory. Results: Cognitive deficits (including severe memory impairments) were evident in the context of premorbid ability estimates that fell within normal limits, with predicted FSIQ ranging from 90 to 110. Interestingly, impairment profiles differed across the three cases. Despite chronic heavy substance use and identifiable hippocampal anomalies, memory was not universally impaired in this series. Indeed, performance on a memory measure (Hopkins Verbal Learning Test [HVLT]) ranged from normal to 3 SD below the standard mean. Conclusions: This case series illustrates a range of neurocognitive impairments and neuroanatomical aberrations in marginalized urban dwellers engaged in chronic polysubstance use. Our observations reveal the complexity and challenges inherent in the evaluation of this cohort, particularly with reference to the potential etiological factors contributing to variation in the cognitive profiles.
Employment-Focused Neuropsychological Assessment: Implications for Autism Spectrum Disorder (ASD), Job Coaches, and Employers
Objective: Social, communication, motor, and cognitive deficits of autism, a complex neurodevelopmental disability, are typically identified by age 3. In 1980, the American Psychiatric Association added autism to known mental disorders, and federal law mandated programs for school-age children. However, there are limited federal initiatives to support the new face of autism—the young adult. Seventy-six percent of teenagers with Autism Spectrum Disorder (ASD) over 16 have never applied for a job and 79% of adults with ASD live at home. Wages for disabled workers are linked to productivity—not hours worked—and 90% live in poverty. A transition program for school-age students of 14 and older offers an entry into the work world while receiving services through their schools. Method: Participants included six public school ASD students, aged 14–16. Each received a neuropsychological evaluation including the NEPSY-II, Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV)-Integrated, and personality assessment. Neuropsychological profiles identified cognitive, psychomotor, and affective characteristics. Six employment sites were identified for part-time placement, 2 days per week, for the scholastic year. Sites included a golf course, theatre, grocery store, library, and town hall. A counselor was assigned as job coach/social facilitator/translator among the employer, co-workers, and participants. Analysis of the neuropsychological strengths and occupational preferences was matched with position demands, employer support, possible environmental modifications, task analysis, and training procedures. Results: Five of the six participants received favorable evaluations and continued on through the summer. Conclusion: Awareness of individual neuropsychological strengths, co-morbidity, and idiosyncratic behavior resulted in decreased miscommunication and a successful experience with the world of work.
Are There Adverse Effects of Multiple Chronic Medical Conditions on Cognition?
Objective: An emerging literature suggests that there may be an additive negative effect of chronic medical conditions (CMCs) on cognitive functioning. The purpose of this study was to extend this literature, which suggests that multiple CMCs have a negative impact on attention, by using a more comprehensive battery to examine processing speed, attention, and executive functioning. Method: A mixed clinical sample of 111 veterans with valid performances on the Test of Memory Malingering (TOMM) but no conditions with known neuropathology was seen for neuropsychological evaluation. Participants were placed into three groups of approximately equal size based on number of CMCs: ≤2 (n = 31), 3–4 (n = 38), and ≥5 (n = 42). Composite domain T-scores for processing speed, attention, executive functioning, language, visuoperception, and memory were calculated and analyzed using analysis of variance (ANOVA). Results: There were no significant group differences in gender, education, or ethnicity, but the 3–4 CMC group was significantly younger than the other two groups (M = 48.76 vs. M = 55.35 for the ≤2 group and M = 59.93 for the ≥5 group). Using age as a covariate, there were no significant group differences on any of the domain T-scores. Conclusion: Contrary to the current literature, the results of this study did not replicate previous findings of an additive negative effect of CMCs on cognitive functioning. Differing results may be due to sample composition and the definition of what constitutes a chronic medical condition.
A Neuropsychological Perspective on the Comorbidity of Anxiety and Behavior Disorders
Objective: The U.S. Department of Education estimates that nearly 439,000 students in the United States are served in special education under the category of emotional disturbance. Within this classification, however, there is rarely a documented distinction between internalizing and externalizing disorders, likely because internalizing disorders only affect the individual and are therefore not addressed in the school system. As a result, when children and adolescents are experiencing both externalizing (disruptive behaviors) and internalizing (anxiety) symptoms, the system fails to recognize and treat the internalizing symptoms. This poster will explore the relationship between disruptive behaviors (i.e., oppositional defiance and conduct problems) and anxiety in children and adolescents, and will propose a case for comorbidity that is useful in treatment for disruptive behavior disorders. Data selection: Reviews of literature and empirical studies were synthesized as data sources if they specifically addressed neurological, environmental, or developmental differences in the development of anxiety and disruptive behaviors in child or adolescent samples. Empirical studies were constrained to the last decade in order to make use of the most advanced findings. Data synthesis: This review identified shared neurological underpinnings of anxiety and disruptive behaviors, as well as empirically supported interventions that have been successfully applied to both disorders. Conclusions: A strong case for the comorbidity of anxiety disorders and disruptive behavior is presented in this review, and makes the argument for empirical research to support the conclusions.
Analyses of Verbal Intellectual Ability within the Wechsler Adult Intelligence Scale-Revised, Boston Naming Test, and the California Verbal Learning Test (CVLT) among United States Veterans
Objective: Verbal intellectual ability, as well as years of formal education, has been empirically predictive of how well an individual utilizes either a serial or semantic learning strategy. The dimensional relationships between demographic variables (age and years of education), factors of the Wechsler Adult Intelligence Scale-Revised (WAIS-R) (VCI and FFD), Boston Naming Test total score, and utilizing serial or semantic clustering on the California Verbal Learning Test (CVLT) were examined. Method: An unselected serial sample of 347 U.S. veterans were clinically referred for neuropsychological assessment within the Palo Alto VA Healthcare System. No exclusion criteria were used. These veteran patients exhibited mixed medical and neuropsychiatric diagnoses and were administered the WAIS-R, Boston Naming Test, and the CVLT. Factor scales were derived from the test variables. First, VCI (as a measure of verbal intellectual ability) was grouped with years of education and FFD (as a measure of attention span) was grouped with age; Boston Naming Test total score, CVLT serial clustering, and semantic clustering were then each individually factored in. Robust factorial relationships were found between Boston Naming Test and the VCI/education factor, and between the FFD/age factor with CVLT clustering (serial or semantic). Results: Analyses resulted in the finding that the ability to use either semantic or serial clustering, on the CVLT, is independent of verbal intellectual ability and education. Dimensionally, verbal intellectual ability is better predicted by attention span (FFD) within this sample (r2 = 63.43). Conclusion: These results suggest implications for interpretation of the CVLT learning strategies in combination with intellectual and demographic variables.
Does Neuropsychological Impairment Overrule Sex Differences in Processing Speed Within a Pediatric Sample?
Objective: Recent research involving the Woodcock–Johnson Test of Cognitive Abilities has suggested that significant processing speed differences exist between sexes in a normal sample (Camarata & Woodcock, 2006). The present study explores the differences in processing speed between sexes in a sample of neuropsychologically impaired children and adolescents. Method: Independent sample t-tests were utilized to compare processing speed differences between sexes in children with neuropsychological disorders. Group 1 (n = 79) included children ages 5:0 to 6:11, group 2 (n = 489) included children ages 7:0 to 9:11, and group 3 (n = 535) included children ages 10:0 to 13:11. All children were administered the Dean–Woodcock Sensory Motor Battery and the Woodcock–Johnson Test of Cognitive Abilities-Third Edition. Results: There were no significant differences in processing speed between sexes in either group 1 (t(77) = .203, p = .84) or group 2 (t(487) = .409, p = .68). However, there was a significant difference in processing speed scores between sexes for group 3 (t(533) = −2.02, p = .44). Within this group, girls (M = 502.51, SE = 1.69) demonstrated better processing speed than boys (M = 497.84, SE = 1.58). However, the effect size for this difference was small (r = .09). Conclusions: According to our findings, children with neuropsychological disorders may not demonstrate the same processing speed differences observed between boys and girls without such impairment. Although processing speed differences were found in the 10–13 age group, the small effect size suggests that there is likely little clinical utility to the finding.
Neuropsychological Profile Comparisons of Anosognosic and Alexithymic Individuals
Objective: Anosognosia is currently defined as a “commonly occurring unawareness of cognitive, linguistic, sensory, and motor deficits after focal injuries (e.g., Wernicke's aphasia) or conditions affecting the CNS more diffusely (e.g., traumatic brain injury and dementia)” (Loring, 1999, p. 14). Conversely, alexithymia, a condition characterized by “difficulty in recognizing and describing one's emotions” (Loring, 1999, p. 10), causes “disruption of both affective and cognitive processes.” Individuals diagnosed with alexithymia are often “incapable of expressing emotions in the sense that, while the emotion may be experienced … it cannot be associated with a mental representation and so formally expressed” (Beaumont, Kenealy, & Rogers, 1999, p. 43). This poster highlights the neuropsychological profiles of two clinical cases. Method: Two neuropsychological evaluations were conducted. The first is a 68-year-old Caucasian female, who suffered a mild Traumatic Brain Injury (mTBI) following a motor vehicle accident (MVA). This woman believed that she was “just fine” and that “nothing was wrong.” The second is a 55-year-old male, diagnosed with alexithymia, had no history of neuropsychological involvement, but did exhibit suicidal ideation and action (i.e., he bought a gun) and was psychiatrically hospitalized for 6 weeks. Results: Normal and impaired neuropsychological data for each case example will be presented. Conclusion: The first individual's anosognosia compromised effectiveness of outpatient rehabilitation (e.g., missing appointments, refusing to take medicine). The second individual's alexithymia compromised the effectiveness of inpatient treatment (e.g., inability to cope with others' intense emotions, lack of affective awareness that interfered with integrated problem solving).
Self-Reported Information Processing Speed Deficits in Multiple Sclerosis: Association with Neuropsychological Functioning, Emotional Status, and Personality
Objective: Information processing speed (IPS) deficits are common in multiple sclerosis (MS). However, no studies have investigated whether MS patients accurately perceive these deficits. This study investigated the associations between a Processing Speed Questionnaire (PSQ) and measures of neuropsychological functioning in a sample of MS patients. Method: Patients were recruited through a large specialty clinic of a university medical center. Controls were recruited from the community by word-of-mouth, flyers, and email list servers. The PSQ was administered as part of a comprehensive neuropsychological battery assessing cognition, emotional functioning, and personality. Results: MS patients (N = 83) reported significantly more IPS deficits than controls (N = 22, t(21.68) = 6.340, p < .001). Among MS patients, self-reports of slowed IPS were significantly associated with increased age (r = .28, p = .010). When controlling for age, slowed IPS was significantly associated with low conscientiousness (r = −.33, p = .003), and low extroversion (r = −.50, p < .001), but increased depression (r = .34, p = .002), neuroticism (r = .35, p = .001), and anxiety (r = .43, p < .001). In contrast, PSQ scores were not significantly correlated with objective tests of IPS. Conclusions: Consistent with our previous research in self-reported memory, self-reported IPS deficits were not significantly associated with performance on objective tests. However, patients' PSQ scores did correlate with anxiety, depression, and various personality traits. Further knowledge of these associations may help clinicians better understand patient reports of slowed IPS and may contribute to improved assessment and feedback practices in clinical neuropsychology.
Processing Speed in Collegiate Athletes as Measured by the Wechsler Adult Intelligence Scale-Fourth Edition
Objective: The purpose of this research was to examine whether the Processing Speed Index (PSI) subtests of the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) would detect differences in collegiate athletes and non-athletes. Further, the study explored whether there was a relationship between PSI and coaches' ratings of “decision-making speed” among their athletes. Methods: Participants included fifty-five 18–24-year-old college students from a private university. A collegiate athlete subgroup included 20 players from the men's baseball team and 17 from the men's soccer team. A contrast group included 18 students from a humanities course. The WAIS-IV PSI subtests were administered to all participants. Coaches were asked to complete two Likert scale ratings of their athletes' speed of problem-solving while engaged in their sports activity. Results: One-way analysis of variance (ANOVA) indicated no significant differences between the collegiate athletes and non-athletes using Coding and Symbol Search scaled scores. A bivariate correlation between the coaches' ratings of athletes' perceived abilities also showed no relationship with performance on PSI subtests. Discussion: PSI is a construct recently introduced on Wechsler intelligence scales. Little is said in the test's manual about what achieving high or low scores mean in everyday life. Despite intuitive expectations, this investigation showed that PSI is not related to speed in making decisions while engaged in collegiate sports. This finding raises questions about just what PSI measures. Additional research is underway to examine the relationship PSI has with other paced, everyday decision-making tasks.
Neural Correlates of Divergent Thinking
Objective: The objective of this study was to examine the neural correlates of creativity through the Torrance Test of Creative Thinking (TTCT). It was hypothesized that TCTT would negatively correlate with the corpus callosum and positively correlate with specific gray matter regions, including parietal lobe, anterior cingulate gyrus, and the inferior frontal gyrus. Methods: Eighteen male healthy control participants (age range: 25–52, mean age = 40.78, SD = 7.74; 15 right-handers; college-educated) were sampled from the community via advertisement. High-resolution MRI scans were acquired on a 1.5 T MRI scanner. Participants completed the non-verbal portion of the TTCT as part of a larger cognitive battery. Voxel-based morphology was used to analyze regional volumes. Regression analyses of TTCT to volume were restrained within the anatomic regions identified. Results: Regression identified one significant focus of association with TTCT. This was located within the right parietal lobe (MNI coordinates: 44, −24, 63; 276 voxels). The relationship indicated that increased volume was associated with increased scores on the TCTT. No other significant foci were found. Conclusion: This report adds to the growing body of literature indicating associations of creative or divergent thinking with specific brain regions. Here, a region of the parietal lobe was found to be positively correlated with a measure of divergent or creative thinking. Based on theories of parietal lobe function and the requirements of the TCTT, the area observed may be related to the translation of an internal verbal description to external graphic spatial representation.
Criterion Validity of the Test of Memory and Learning (TOMAL) in Pediatric TBI
Objective: Children with traumatic brain injury (TBI) often undergo neuropsychological evaluation to identify neurocognitive deficits and sparing, as well as to assist in rehabilitation and educational planning. However, for many commonly available tests, only limited information is available regarding sensitivity to TBI. To address this issue, the current study examined the criterion validity of the Test of Memory and Learning (TOMAL) in youth that sustained TBI. Method: Participants included 300 children; 150 had sustained moderate-to-severe TBI. They were 11.7 years of age (SD = 3.7) and 57.3% were males. The remaining 150 were gender- and age-matched controls who were 11.5 years of age (SD = 3.1) and 52.7% were males. Multivariate analysis of variance (MANOVA) was used to examine the differences between the groups in the TOMAL subtests and index scores. ROC analysis was used to examine sensitivity and specificity of classification of TBI and control participants based on TOMAL subtests and indexes. Results: The TBI group scored approximately 1.3 SDs below the control group on most TOMAL scores. The ROC analysis indicated that Object Recall (OR) had the highest area under the ROC curve at .82, followed by Memory for Stories Delayed, Visual Selective Reminding, Letters Forward, Digits Forward, and Facial Memory subtests. Of the indexes, the Composite Memory Index (CMI) proved to be most sensitive, yielding an optimal cutoff score of 83. Discussion: Findings suggest that TOMAL subtest and index scores show differing levels of sensitivity and specificity to TBI. Furthermore, the OR subtest and CMI are the most sensitive to deficits following TBI.
The Relationship Between Self-Reported Cognitive Difficulties and Medication Adherence in Multiple Sclerosis
Objective: Patients who report missing medications frequently identify problems with memory as a primary cause. To date, no study has specifically examined the relationship between self-reported cognitive difficulties and adherence to medication regimens in multiple sclerosis (MS). The purpose of this study was to examine the association between self-reported cognitive difficulties and adherence to medications in MS. Methods: Seventy-two patients with MS were recruited from a local MS specialty clinic and given a complete psychodiagnostic interview. The interview included self-report questionnaires about perceived cognitive difficulties and auxiliary medication adherence (e.g., psychotropics and spasticity medications). Adherence to disease-modifying therapies (DMT) was also monitored prospectively for 2 months using Medication Event Monitoring System (MEMS) caps. Results: Patients who retrospectively reported missing auxiliary medications at the outset of the study missed significantly more DMT prospectively (Z = −3.98, p < .001). In addition, patients who missed auxiliary medications reported significantly more processing speed (t(71) = −2.18, p = .035) and memory difficulties (t(71) = −2.97, p = .004) than patients who demonstrated good auxiliary medication adherence. Difficulties with memory and processing speed were also associated with poorer prospective adherence to DMT (r = .31, p = .007 and r = .26, p = .029, respectively). Conclusion: Self-reported memory and processing speed difficulties are related to poor auxiliary medication adherence. Poor adherence to auxiliary medications is also related to worse prospective DMT adherence. Clinicians should note that adherence should be carefully monitored among patients who report cognitive difficulties.
Working Memory and Academic Achievement in Chinese Children with Obstructive Sleep Apnea
Objective: This study hypothesizes children with obstructive sleep apnea (OSA) would have neuropsychological deficits in working memory (WM) and lower levels of academic achievement, compared with healthy controls. It is hypothesized that academic achievement would correlate with working memory performance in OSA children. Method: This is a prospective study for baseline assessment of WM functions and academic achievement in children. Chinese children with OSA (n = 12), and healthy gender- and age-matched controls (n = 12) were recruited from the Sleep Disorders Clinic, Prince of Wales Hospital, Hong Kong. All children were assessed with verbal/spatial N-back tasks, digit- and spatial-span tasks tapping on Baddeley's WM model components, and standardized academic assessment tools on Chinese reading-comprehension and arithmetic skills. All underwent overnight polysomnographic sleep study (PSG). Between-group comparisons were used to reveal deficits in WM and academic attainment in the OSA group and relationships between WM and academic attainment in the OSA group were explored with correlational analyses. Results: Children with OSA had significantly more problems than healthy controls on verbal 0-back task (t(22) = 2.656, p = .017, d = 1.084). They scored significantly lower on academic achievement test that measures arithmetic skills (t(22) = 2.150, p = .043, d = .876). Strong correlation was found between verbal working memory functions and arithmetic test performance among OSA children (r = .704, p = .011). Conclusion(s): Impairments in verbal working memory and arithmetic skills were found in children with OSA and the two were highly correlated. Further investigations into specific predictors of working memory and its related deficits and potential intervention strategies are crucial to reduce long-term adverse effects of OSA in children's cognitive development and learning.
Examining Sex Differences on Concussion Outcomes in High-School and Collegiate Athletes
Objective: To investigate sex differences in neurocognitive function and post-concussion symptom scores among concussed high-school and collegiate athletes. Method: A prospective repeated-measures design was used to compare baseline and post-concussion neurocognitive performance and concussion symptoms. Independent variables were sex (male, female) and time (baseline and 2 days, 7 days, 14 days post-injury). The dependent variables were the Immediate Post-concussion Assessment and Cognitive Test (ImPACT) cognitive composite scores (i.e., verbal memory, visual memory, motor processing speed, reaction time) and total concussion symptoms. Ninety-four concussed athletes with a baseline ImPACT test completed a follow-up ImPACT test at 2-, 7- and 14-day post-concussion. Repeated-measures analysis of variance (ANOVA)s were conducted on each cognitive composite score. Results: Results revealed a significant sex difference in visual memory composite scores (F(3, 32) = 3.53, p = .03). Female athletes demonstrated cognitive impairments 14 days post-concussion compared with male athletes who demonstrated a return to baseline at 14 days post-injury. The results also indicated significant sex differences on total concussion symptoms at 7 days post-concussion (F(3, 32) = 5.75, p = .003), as female athletes reported a higher total number of concussion symptoms than males. There were no other significant sex differences on the other neurocognitive composite scores. Conclusion: Female athletes at both high-school and collegiate levels may exhibit a more prolonged cognitive recovery and appear to exhibit longlasting concussion symptoms than males.
PROFESSIONAL ISSUES: TEST DEVELOPMENT AND METHODS
Do the Rey-Osterrieth and Modified Taylor Complex Figures Show Similar Levels of Perceptual Clustering and Fragmentation?
Objective: The Rey-Osterrieth (ROCF) and modified Taylor (MTCF) complex figures generally produce comparable accuracy scores on learning, memory, and construction but no studies appear to have compared these figures using process scores. The purpose of this study was to examine whether the figures show similar levels of perceptual clustering and fragmentation. Method: The sample consisted of 74 adults (30 men, 44 women), aged 21–88 with 10–21 years of education, recruited from the general community. A repeated-measures design was used wherein all participants received both figures 1 week apart in counterbalanced order. An incidental memory procedure (copy, immediate recall [IR], delayed recall [DR]) was employed. Figures were scored for accuracy (see Lezak et al., 2004) and process (Binder & Wonser, 1989). Results: Using paired sample t-tests, there were no significant differences between the figures on perceptual clustering or fragmentation at copy, or fragmentation at IR or DR. The MTCF produced moderately higher scores than the ROCF on some, but not all, perceptual clustering scores at IR and DR. Correlations between accuracy and process scores (perceptual clustering: r = .11 to .60; fragmentation: r = −.06 to −.37) were similar for both figures. Conclusions: The ROCF and MTCF showed similar levels of fragmentation on all trials, but there were differences in some perceptual clustering scores at memory that favoured the MTCF. Given that the two figures share the same basic features (rectangle/square, horizontal and vertical midlines, two diagonal lines) that form the basis of this process scoring system, this is a curious finding that will be explored further.
Neuropsychological Test Usage in the United States
Objective: To investigate and update existing literature on neuropsychological test usage in the United States. To compare this information to previously presented (pilot study presented at National Academy of Neuropsychology (NAN) Annual Meeting 2009) and published (Camara, Nathan, & Puente, 2000) on neuropsychological test usage. Method: A comprehensive list of neuropsychological tests was compiled using information from test publishers, published literature, and a previous study analyzing neuropsychological test usage from the Pacific Northwest Neuropsychological Society and North Carolina Neuropsychological Society. Survey monkey was used to send this list of neuropsychological tests, as well as demographic questions, to members of the NAN. Three reminders resulted in 545 responses. Results: The findings indicate that many of the same tests were endorsed by both the regional groups as well as those a decade ago. However, the order of prevalence of usage did change relative to 10 years ago. Tests involving intellectual and executive functions were more common in the current list. The top 10 tests were as follows: Trail Making Test, Boston Naming Test, Rey Complex Figure Test, Wisconsin Card Sorting Test, Minnesota Multiphasic Personality Inventory, California Verbal Learning Test, Controlled Oral Word Association Test (FAS), Word Fluency, Wechsler Adult Intelligence Scale, Beck Depression Inventory, and Grooved Pegboard Test. No patterns were evident with regard to relationship of test usage to demographics. Conclusion: Findings suggest that no great change has occurred over the last decade with regard to neuropsychological test usage although a greater emphasis appears to be placed on tests of executive, memory, and intellectual functions. Batteries were not very prevalent in the current survey. Although no clear demographic differences emerge, additional work needs to be pursued relative to related issues, including time to administer, score, and interpret such tests.
Exploratory Factor Analysis of the Cattell-Horn-Carroll and Tactile-Kinesthetic Factors
Objective: The study analyzed the factorial structure of sensory–motor and cognitive abilities using exploratory factor analysis with promax rotation. The goal was to verify whether sensory–motor abilities contribute to the existing factor solution of the Cattell-Horn-Carrell (CHC) approach. Method: Participant sample (n = 4,952) consisted of 4,457 neurologically impaired individuals and 495 normals. Diagnoses were made by a licensed neuropsychologist after a review of results from medical examinations and neuropsychological assessment conducted prior to the study. The Dean–Woodcock Neuropsychological Battery (DWNB) offers tactile and kinesthetic tests adopted from well-known neurological examination tasks. Cognitive functions were tested using Woodcock–Johnson III Test of Cognitive Abilities (WJ-III-COG). Each participant was administered the DWNB and WJ-III-COG according to the procedures described in the manuals. An exploratory factor analysis (EFA) was conducted using principal axis factoring in SPSS and used multiple extraction methods. Results: The results suggested a four-factor solution, with the CHC factors loading on a separate factor than tactile-kinesthetic abilities. Conclusions: The first factor was related to variables that included simple sensory and simple motor tasks. The second factor was related to cognitive abilities. The third factor mostly contained complex motor, and the fourth factor was a mixture of simple sensory and construction tasks. Although factors were correlated, the current factor solution indicated that tactile-kinesthetic factors may exist separately from cognitive factors in the existing CHC model.
Comparison of Trail Making Test A and B Standard Scores based on Heaton and Tombaugh Systems
Objective: For the widely used neuropsychological measures Trail Making Test A (TMTA) and B (TMTB), Heaton et al. (1991) created robust norms correcting for age, gender, ethnicity, and education, whereas Tombaugh (2004) norms correct for age and education (starting age 55+ years). Clinically often-observed discrepancy between standard scores based on Heaton and Tombaugh systems may affect uniformity of test score interpretation and also call for improved psychometric sophistication of norms for certain demographic groups. This study investigated frequency of discrepancy between Heaton and Tombaugh standard scores and evaluated group effects on the discrepancy based on demographic factors. Methods: TMTA and TMTB scores of 271 primary brain tumor patients (mean age = 46.06 ± 15.27, education = 15.00 ± 2.74, female = 45%, GBM = 36.9%, left hemisphere tumor location = 66%) were obtained from baseline evaluation. Raw scores were converted to Heaton and Tombaugh norms. Correlations, chi-square analyses, and one-way analysis of variance (ANOVA)s were performed. Results: As expected, standard scores with Heaton and Tombaugh norms correlated significantly (rTMTA = .62, p < .01, rTMTB = .79, p < .01), but exhibited statistically significant within-group differences (χ2TMTA = 202.65, p < .01, χ2TMTB = 267.49, p < .01). Compared with Heaton system, patients who obtained lower standard scores on Tombaugh system had received less education (mean years = 13.65 ± 2.35) than those obtaining equivalent (mean years = 15.23 ± 2.68) and higher (mean years = 17.00 ± 1.00) standard scores on Tombaugh system (FEducation = 7.61, p < .01). Other demographic characteristics of age, gender, ethnicity, handedness, tumor location, and laterality did not differentiate the patients showing discrepancy on two systems. Conclusion: Interesting differences emerged between TMTA and TMTB standard scores based on Heaton and Tombaugh systems. Future studies are indicated to assess these discrepancies.
Driving Simulator Assessment: Reliability, Factor Structure, and Validity in Veterans with Traumatic Brain Injury and Healthy Controls
Objective: Simulators are widely used, but recognized standards of assessment are needed. We analyzed the psychometric properties of multiple driving simulator measures. Method: Twenty-one veterans with moderate-to-severe traumatic brain injury (TBI) and 20 healthy controls drove four standard simulator scenarios of increasing complexity, while automated measures and observer ratings were made. History of car accidents in the past 5 years was obtained by structured interview. Analyses: internal-consistency reliability, factor analysis, correlation. Results: Moderate-to-high reliability (.7 to .9) was found for automated measures of steering accuracy, steering variability, speed compliance, speed variability, reaction time, divided attention, and driving legality. Two factors accounted for over 70% of the variability: basic vehicle control (steering, speed) and cognitive skills (attention, reaction time, legality). TBI was associated with significantly lower scores on the cognitive skills factor, but not with basic vehicle control. History of car accidents correlated significantly with poorer performance on automated measures of steering accuracy and driving legality. Accident history had weaker correlations with observer-rated performance. Conclusion: This study describes seven reliable simulator indices, with initial indications of ecological validity. These measures added significantly to observational driver ratings. We found that TBI may have greater impact on patients' higher-order cognitive driving skills, such as processing speed, divided attention, and ability to follow rules, than on their basic ability to control a vehicle's speed and direction. Future studies should provide norms for these simulator indices, analyze their ability to predict driving skills in the community, and evaluate the efficacy of simulator training for neuropsychological rehabilitation.
Evaluation of a Computer Graphics Tablet-based Administration of the Rey-Osterrieth Complex Figure Test
Objective: Computer-based administration of visual design copy measures with a computer graphics tablet presents significant data collection advantages in both clinical and research settings. We measured time-to-completion and participant reactions to using a tablet-based data entry method when completing a widely used design copy measure, the Rey-Osterrieth Complex Figure Test (ROCFT). Method: The ROCFT was administered to a convenience sample of 62 university students using a computer graphics tablet input method. In addition to completing the ROCFT, participants completed an alternate form of the test using pencil and paper, as well as an ad hoc measure of participant attitudes regarding the computer entry method and hardware. Time-to-completion data and qualitative participant reactions were also collected. Statistical analyses included comparison of time-to-completion across computer-based and paper-and-pencil administration methods and descriptive statistics for quantitative participant ratings of the computer-based administration method. Results: Time-to-completion was greater for tablet computer-based administration at a statistically significant level (p < .0001). Mean participant ratings on a 5-point Likert-type scale (1 = disagree; 5 = agree) were as follows for tablet computer-based administration variables: uncomfortable w/equipment = 3.39; would perform better w/paper-and-pencil = 4.63; computer method more interesting = 4.03; distracted by equipment = 2.43; would be uncomfortable using computer method in high stakes situations = 4.03; preferred computer method to pencil-and-paper = 2.43; and previous experience with similar computer equipment = 1.26. Conclusion(s): Results of the study strongly suggest that computer graphics tablet-based administration increases time-to-completion versus traditional pencil-and-paper administration methods. Additionally, participant ratings regarding use of the computer-based administration method indicate that participants experience significant misgivings about using this administration method, particularly in real-world situations.
Construct Validity of Reynolds Intellectual Assessment Scales (RIAS) in Brain-Injured Children
Objective: The Reynolds Intellectual Assessment Scales (RIAS) is a new measure of intelligence whose psychometric properties in clinical populations have not been extensively studied. The current study examines the construct validity of the RIAS in children and adolescents with various forms of brain injury. Methods: Participants included 100 children and adolescents with various forms of brain damage, primarily traumatic brain injury. The sample was on average 13.5 years old (SD = 3.6), and 57% were males. Participants were administered the RIAS as part of a comprehensive neuropsychological evaluation, as well as the Continuous Performance Test (CPT), Processing Speed Index (PSI) subtests of the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV), Oral and Written Language Scales (OWLS), Beery-Buktenica Developmental Test of Visual-Motor Integration, 5th ed. (VMI), and Purdue Pegboard (PP). Correlations between the RIAS and the other measures were used to examine the construct validity of the RIAS. Results: As anticipated, compared with the RIAS Verbal Index (VIX), the Nonverbal Index (NIX) exhibited stronger correlations with the VMI (r = .39 vs. .60), PSI (r = .32 vs. .58), and PP (r = .18 vs. .30). Variable correlations were present across the CPT scores. Contrary to expectations, the VIX and NIX exhibited comparable correlations with the OWLS (r = .76 vs. .72). Conclusions: These results provide preliminary evidence supporting the RIAS construct validity in children and adolescents with various forms of brain dysfunction, although high correlations between the NIX and OWLS deserve further investigation. Additional research is necessary to confirm these findings, including examination in more homogeneous samples to determine whether the relationships identified here generalize to other clinical populations.
Saliency and Carry-Over Effects of the Items of the Test of Memory and Malingering
Objective: To investigate whether the target items in the recognition phase of the Test of Memory and Malingering (TOMM) booklets would be more or less salient than the distracter items. The secondary purpose was to determine if participants would be subject to carry-over effects on subsequent booklets through mere exposure to the targets from the initial presentation where saliency was tested. Method: Thirty-eight undergraduate students from a small U.S. state university were presented only the recognition phase from the three booklets of the TOMM. The participants were asked which image did they prefer for each recognition trial. Each of the TOMM booklets was presented in each of the serial positions to test saliency in the first serial position and carry-over effects in the subsequent serial positions. Results: An exact binomial sign test indicated that 17 of the target items of the TOMM were either selected for or against at a level significantly greater than would be expected by chance. A one-way repeated-measures analysis of variance (ANOVA) was run to determine if there were differences between the number of target hits for any book in each serial position. A significant carry-over effect was not found, Wilks' Lambda = .800, F(4, 66) = 1.952, p = .112. Conclusions: Despite the fact that some of the target or distracter items may have been more salient, all of the trial booklets in all serial positions were at a chance level and they did not differ significantly, which suggests that any normally administered TOMM or other symptom validity test should approximate chance performance.
Initial Psychometric Properties of the Fazio Laterality Inventory
Objective: To provide a modernized handedness measure with clear instructions to produce an accurate measure of lateral preference. Methods: Participants: Participants were 280 people with an average age of 34.6 years (SD = 13.9). The participants predominantly considered themselves right-handed (86%), were Caucasian (87.6%), and female (73.1%). Participants were a convenience sample from a graduate institution; they were also asked to invite others to participate. Only participants who indicated not having a condition affecting their hand use were included in statistical analyses (n = 275). Measures: Participants were administered the handedness instrument under investigation, the Fazio Laterality Inventory (FLI). The FLI was available online and in a paper version. The FLI is based on earlier handedness research. Participants rated the use of their right hand as a percentage on 12 everyday tasks. Psychometric properties were examined using SPSS. Results: The FLI showed a high level of internal reliability (Cronbach's alpha = .921). Sample size proved adequate to run a PCA (KMO = .905). Two components were extracted (initial eigenvalues were 6.67 and 1.19) with a correlation of .533, so a direct oblimin rotation was used. The components are believed to represent handedness and uncertainty regarding hand usage. Conclusion: The FLI uses modern everyday tasks to assess laterality. The instructions seemed to be well understood by all participants. It shows promising initial psychometric properties which will likely be improved with item revision to remove those which load predominantly on uncertainty. Future studies will validate the initial component loadings as well as establish criterion and discriminant validity.
Poster Session C
AGING AND DEMENTIA: ALZHEIMERS DISEASE
Accuracy of Attentional Measures in Discriminating Alzheimer's Disease from Normal Aging
Although Alzheimer's disease (AD) has been traditionally characterized as a memory disorder, an increasing body of research has demonstrated that attention is also impaired in early-stage AD. Given recent suggestions that the benefits of pharmacological interventions for AD are maximized if treatment is initiated in the beginning stage of the disease, early diagnosis is essential. The present study investigated the clinical utility of four experimental attention tasks in discriminating early-stage AD patients from healthy older adults. Participants were 19 individuals diagnosed with early-stage AD and a comparison group of 30 healthy older adults. All participants completed the four experimental tasks, which were designed to assess various subtypes of attention (selective attention, focused attention, and two tasks of divided attention). Receiver operating characteristic (ROC) plots were constructed and examined to determine the sensitivity and specificity of each task at a range of cutoff points. There was variability in the discriminative ability of the four tasks, with areas under the curves ranging from a low of .696 for the selective attention task to a high of .933 for one of the divided attention tasks. When the four tasks were considered in combination via discriminant function analysis, one discriminant function was calculated and was significantly associated with group membership (χ2(4) = 45.58, p < .001). The combination of the four tasks correctly classified 89.9% of participants. These findings suggest that the use of attentional measures can contribute to the early detection and accurate diagnosis of Alzheimer's disease.
Serum Brain-Derived Neurotrophic Factor (BDNF) Levels are Associated with Memory Performance in Alzheimer's Disease: An Investigation by the Texas Alzheimer's Research Consortium (TARC)
Objective: The exploration for biomarkers that have diagnostic, predictive, and/or therapeutic utility for Alzheimer's disease (AD) is of vital importance given the rapidly aging population. Several recent studies have documented altered levels of brain-derived neurotrophic factor (BDNF) in mild cognitive impairment (MCI) and AD. However, few human studies have examined the link between peripheral BDNF levels and detailed neuropsychological functioning among normal elders or patients diagnosed with AD. The current study sought to examine the link between serum BDNF levels and neuropsychological functioning in a sample of controls and patients with AD from the Texas Alzheimer's Research Consortium (TARC). Method: There were 399 participants (probable AD: n = 198; controls: n = 201) in the TARC Longitudinal Research Cohort available for analysis. BDNF levels were assayed via multiplex immunoassay. Regression analyses were utilized to examine the relationship between BDNF levels and neuropsychological functioning. Results: BDNF levels did not significantly predict any neuropsychological scores among the control group. In the AD group, BDNF levels were significantly negatively associated with scores on immediate (β = −.07 (.02), t = −3.55, p = .001) and delayed (β = −.05 (.02), t = −2.79, p = .01) verbal memory (Wechsler Logical Memory immediate and delayed indices) and immediate (β = −.12 (.05), t = −2.70, p = .01) visual reproduction (Wechsler Visual Reproduction immediate index). No other neuropsychological variables were significantly related with BDNF levels. Conclusions: BDNF was associated with poorer attention and visual learning in AD patients.
Depression Symptoms and Neuropsychological Performance in a Sample of Alzheimer's and Normal Elderly
Objective: There is little information on how specific depression symptoms may differentially impact neuropsychological functioning in cognitively intact elders and elders with Alzheimer's Disease (AD). The current study investigated the relation of depressive symptom clusters to performance on neurocognitive testing. Method: Three hundred and thirty-one normal controls (NC) and 284 AD were administered the Geriatric Depression Scale (GDS) and a standardized neuropsychological battery as part of a large cohort study. Total score and depression subscale scores of dysphoria, meaninglessness, apathy, and cognitive impairment were calculated. Data were analyzed for AD and normal controls by gender using linear regression with neuropsychological test scores as outcome variables and subscale scores as predictor variables. Results: Total GDS and subscale scores were differentially related to neuropsychological test scores by gender and diagnosis. None of the subscales were related to test scores for NC males. NC females' performance was negatively related to cognitive impairment subscale for Trails B, Logical Memory I & II (LMI & LMII), and Visual Reproductions II: apathy to Trails B and meaninglessness to Controlled Oral Word Association Test (COWAT). For AD performance was negatively related to dysphoria for females on BNT, Trails B, LMI & LMII and for males to Digit Span. Apathy was positively related to LMII for both genders. For male AD, meaninglessness was negatively related to LMII. Conclusion: The impact of depression and symptoms of depression varies for both gender and cognitive impairment. These results suggest the importance of taking depression and depression symptoms along with gender into consideration when evaluating specific cognitive functions in both AD and cognitively intact elders.
Processing and Motor Speed in Alzheimer's Disease and Vascular Dementia
Objective: A recent study found that motor speed and processing may be a better marker of Alzheimer's disease (AD) than of vascular dementia (VaD). The current study aimed to investigate possible differences in processing and motor speed in individuals with AD and VaD. Method: There were 64 participants with a mean age of 78.20 (SD = 8.66) and mean education of 13.81 (SD = 2.93). There were 34 females and 30 males. All participants were Caucasian. Both the AD group and the VaD group consisted of 32 individuals each. Neuropsychological examinations and CT or MRI were used to differentiate between AD and VaD. The participants were given the Trail Making Test (Trails A + B) and the Rey-Osterreith Complex Figure Test. Results: All analyses were conducted at the .05 level of significance. An analysis of variance (ANOVA) (F = 5.733, p = .02, λ = .085) revealed that performance by individuals with AD (M = 79.91, SD = 12.73) was significantly worse than individuals with VaD (M = 87.91, SD = 13.97) on Trails B. Conclusion: Trails B is considered the best general indicator of cerebral dysfunction and requires more complex processing than Trails A. The findings suggest that complex processing may be more difficult for individuals with AD than for individuals with VaD supporting the findings of the recent study, but in contradiction to previous literature. It is important to consider that Trails B appears to be more sensitive to the progressive cognitive decline of AD than the Rey-Osterreith Complex Figure Test and Trails A during assessment.
The Relationship of Education Level and Intelligence in Individuals Diagnosed with Alzheimer's Disease or Vascular Dementia
Objective: The present study examined the relationship between education and performance on the Wechsler Adult Intelligence Scale-Revised (WAIS-R) in individuals diagnosed with dementia, hypothesizing differences in the magnitude of the relationship between education and intellectual performance in VAD and AD. Method: Participants were 258 individuals with either Alzheimer's dementia (AD) or vascular dementia (VaD). The AD group (n = 163) ranged in age from 61 to 93 (M = 80.74, SD = 6.01), was 65.6% females, and had an education of 12.1 years (SD = 3.12). The VaD group (n = 95) ranged in age from 47 to 92 (M = 77.6, SD = 7.62), was 44% females, and had education of 13.21 years (SD = 2.70). Pearson correlations were utilized to determine the relationship between education and performance on six WAIS-R subtests. Results: Correlations were significant on all six subtests (Information, Digit Span, Vocabulary, Similarities, Block Design, and Digit Symbol) for the AD group, but only on three of the subtests (Information, Vocabulary, and Digit Symbol) for the VaD group. Correlations between education and subtest performance were highest on Information and Vocabulary for AD (r = .37 and .49, respectively) and for VaD (r = .45 and .32, respectively). Multiple regression indicated that the interaction between education and dementia type was non-significant. Discussion: Education was correlated with performance on many of the WAIS-R subtests. Although the magnitude of these correlations differed between AD and VaD on certain subtests, the relationship between education and subtest performance was not shown to vary significantly as a function of dementia type.
As Easy As 1–2? Sequencing or Perseveration on Wechsler Adult Intelligence Scale-Fourth Edition Digit Span in Dementia?
Objective: To examine the rate of failure on the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) Digit Span Sequencing subtest in those diagnosed with dementia or normal aging. Method: Two hundred and thirty-six individuals consecutively referred to a University Medical Center-based memory disorder clinic were screened with a neuropsychological battery which included the WAIS-IV Digit Span subtest. Fifty-six individuals were diagnosed with mild or moderate Alzheimer's disease, 18 with vascular dementia, 58 with mild cognitive disorder (MCI), 35 with primary depression, 36 with mixed or other dementias, and 33 with normal aging. Failure on the first sequencing item by perseveration (continuing to reverse the digits) and subsequent performance was recorded. Results: Fifty-three percent of individuals failed the first sequencing item and 42% of those continued to perseverate until quickly meeting discontinue criteria. Failure was highly correlated with other measures of frontal functioning such as the Stroop Color-Word score and Trails B, along with other measures of information processing. Failure rates on the first sequencing item were higher for those diagnosed with any form of dementia (60% failed) than normals (18% failed). Ninety-three percent of participants who met discontinuation criteria after the second trial were subsequently able to perform at least a three-digit sequence if given reminders of the subtest instructions. Conclusion(s): Failure by perseveration was noted in those with dementia and MCI on the sequencing subtest of WAIS-IV Digit Span. Failure correlated with measures of frontal functioning. Although perseverative errors occurred in normals, the failure rate was significantly higher in those diagnosed with a dementia or MCI.
Does Memory Predict Decline in Activities of Daily Living in Older Adults with Alzheimer's Disease?
Objective: This study examined whether auditory and visual memory could significantly predict deficits in financial management, medication management, driving, dressing, grooming, and feeding abilities. Methods: Participants were 54 older adults, ranging in age between 65 and 93 (M = 78, SD = 5.20); all identified as Caucasian, 57% were females, and 82% were right-handed. The auditory memory measures were the Wechsler Memory Scale-Third Edition (WMS-III)'s Auditory Memory, Auditory Delayed Memory, Logical Memory I and II, and Word List I and II. The visual memory measures were WMS-III's Visual Memory, Visual Delayed Memory, Faces I and II, and Family Pictures I and II as well as the Rey Complex Figure Test (RCFT). Results: Pearson correlations assessed the abilities of auditory and visual memory measures to predict decline in self-care activities. Of the auditory measures, Logical Memory I significantly correlated with declines in financial (r = −.36, p < .01) and medication (r = −.23, p < .05) management. Word List I significantly correlated with declines in financial (r = −.43, p < .05) and medication (r = −.40, p < .05) management. Of the visual–spatial measures, the RCFT correlated with financial management (r = −.39, p < .01), medication management (r = −.42, p < .01), driving (r = −.39, p < .01), and dressing (r = −.25, p < .05) abilities. Faces I correlated with medication management (r = −.27, p < .05), and the Visual Delayed Index correlated with driving (r = .33, p < .05) and dressing (r = .32, p < .05) abilities. Discussion: Auditory memory measures predicted declines in financial and medication management, whereas visual–spatial memory measures predicted declines in financial, medication, driving, and dressing abilities. Memory measures may help neuropsychologists make recommendations regarding daily care for individuals with Alzheimer's.
AGING AND DEMENTIA: HEALTHY AGING AND COGNITION
Neuropsychological Predictors of Self-Rated Physical and Mental Health among Community-Dwelling Older Adults
Objective: Self-rated health (SRH) is frequently used to index quality of life among older individuals and is an important predictor of functional outcomes. Although there is increasing appreciation of SRH as a multidimensional construct, little research to date has examined the role of neuropsychological predictors of health perceptions. As cognitive changes are associated with both increasing age and declining health, we addressed whether neuropsychological predictors differed between self-rated physical (SRPH) and mental health (SRMH) in a sample of older adults. Method: Ninety-seven community-dwelling older adults (51–91 years; M = 65.9) completed a neuropsychological test battery including the California Verbal Learning Test-Second Edition (CVLT-2), Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) Coding, ETS Vocabulary, and Delis-Kaplan Executive Function System (D-KEFS) subtests. SRMH and SRPH were measured using the SF-36v2. A composite representing executive function and speed (EF/Speed) was formed from those variables displaying significant correlations with SRH (p ≤ .05). Hierarchical regression was used to evaluate predictors of SRPH and SRMH. Results: As expected, increasing age predicted worse ratings of SRPH (β = −.25, p < .031; R2 = .05), whereas neuropsychological performance was non-contributory. In contrast, increasing age predicted better ratings of SRMH (β = .32, p < .012) as did better EF/Speed performance (β = 1.04, p < .006; overall R2 = .10). Conclusions: Predictors of self-rated physical and mental health differ with advancing age. Specifically, perceptions of physical health decline, whereas perceptions of mental health increase, consistent with literature suggesting that emotional satisfaction may improve with age. Further, executive function and processing speed may be important positive predictors of higher mental health ratings among older individuals.
Cognitive Performance in Individuals with Self-Identified Cognitive Complaints
Objective: To examine cognitive performance in individuals with and without self-reported memory and/or problem-solving difficulties in a large, diverse population-based sample. Those with self-identified cognitive complaints (CC) were predicted to have lower cognitive functioning as measured by the Montreal Cognitive Assessment (MoCA) than those without complaints (WC). Method: The MoCA was administered to 2,673 individuals as part of the population-based Dallas Heart Study (Mage = 50.4 [11.2]; range = 18–85), who answered three yes/no questions regarding cognitive complaints. The CC group endorsed ≥1 questions, and total scores of the CC (N = 539) and WC (N = 2,134) groups were compared, demographic variables examined, and frequently missed MoCA items were reviewed. Results: CC participants had significantly lower MoCA scores (M = 22.10 [4.5]) than WC participants (M = 23.48 [3.9]; F(1) = 14.6, p < .001), even when controlling for age, education, and race. In participants ≥65 years old (N = 301), WC and CC MoCA performances did not significantly differ (F(1) = .091, p = .76) after controlling for education. Participants who endorsed problem-solving difficulty had the lowest MoCA scores (M(SD) = 20.32 [4.8]). The most frequently missed MoCA items in the CC group were cube drawing, delayed recall, and sentence repetition. Less educated (p < .001) individuals were more likely to endorse cognitive problems, as were females (p < .001). Conclusion: Participants responding to three simple cognitive complaint questions had significantly lower MoCA scores, even when controlling for demographic variables in the sample as a whole. Reports of cognitive complaints, particularly problem-solving difficulty, could indicate either long-standing problems or objective cognitive dysfunction that warrants clinical follow-up in some cases.
Age Differences in Neuropsychological Predictors of Everyday Problem-Solving
Objective: Everyday problem-solving (EPS) tasks are important markers of real-world functioning in older adults. Models propose that EPS is comprised of fluid and crystallized components that are differentially impacted across age. To date, little is known regarding the extent to which these neuropsychological components account for EPS. We investigated whether fluid and crystallized abilities predicted EPS performance differently in young and older adults. Method: Seventy-four older (M = 66.24 years) and 64 young adults (M = 19.5 years) were tested on a battery of traditional neuropsychological and everyday cognitive measures (i.e., Californial Verbal Learning Test-Second Edition (CVLT-II), select Delis-Kaplan Executive Function System (D-KEFS) subtests, Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) Digit Symbol-Coding, ETS Vocabulary, EPS). EPS was indexed by the number of safe/effective solutions generated for everyday scenarios (ri = .85). Separate hierarchical regression models were conducted in young and older age groups to determine which cognitive variables accounted for EPS ability. Results: In young adults, better mental flexibility was the only significant predictor of better EPS performance (β = .434, p < .013), accounting for 9.1% of unique variance. In older adults, age, education, female sex, and semantic knowledge accounted for 50.9% of EPS variance. Better semantic knowledge was the only significant cognitive predictor of better EPS (β = .358, p < .002), accounting for 13.8% of variance beyond demographic variables. Conclusion: Important neuropsychological predictors of EPS performance differ across age. When solving everyday problems, younger adults may rely on fluid cognitive abilities that tend to peak in early adulthood. Consistent with aging theories, older adults rely on crystallized cognitive abilities that are more robust to the aging process.
Reliable Change Index Scores for Animal Fluency
Objective: Reliable change index (RCI) scores were determined for participants in four age groups (50–59, 60–69, 70–79, 80–89) who had follow-up testing within 9–15 months of the baseline. RCI scores indicate how much a person's animal fluency score must decrease to be significant at the 95% confidence level. Method: Participants were older adults without dementia. There were 177 participants in their 50s, 408 in their 60s, 370 in their 70s, and 115 in their 80s. The mean age for the entire sample was 68.42 years and mean education was 14.6 years. For the animal fluency task, each participant was asked to generate as many animal names as possible in 1 min. The mean animal fluency score for the entire sample was 18.3 and for each of the age decades (50s, 60s, 70s, 80s) was 20.49, 18.97, 17.26, and 15.87. Results: The RCI for the total group was 7.85, indicating that an older adult's animal fluency score must decrease by 8 or more points to be significant, that is, to be 95% confident that the decrease was not due to chance. RCI scores for the four age groups (50s, 60s, 70s, 80s) were 9.20, 8.37, 7.15, and 5.15, respectively. A minimum 10-point decline on animal fluency is needed to reach statistical significance for persons 50–59, 9-point decline for those 60–69, 8 for those 70–79, and 6 for those 80–89. Conclusions: An annual decline of at least 8 points on animal fluency is generally needed for there to be a statistically reliable decline for an individual older adult.
AGING AND DEMENTIA: OTHER
Evaluating the Utility of the AD8: A Correlational Analysis through Cognitive and Mood Assessment Measures
The AD8 is often used in multidisciplinary settings as a brief, sensitive measure that can aid in the diagnosis of dementia. It also aids in the detection of cognitive change through the assessment of functional activities. This study aimed to validate the AD8's utility as a screening assessment for patients with cognitive complaints. Patients were administered the Mini-mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), AD8, Geriatric Depression Scale (GDS), Geriatric Anxiety Inventory (GAI), Trails A & B, Symbol Digit Modalities Test (Oral and Written), Cognitive Screening Tool, and NEO-Five Factor Inventory (NEO-FFI). Not all patients attended with a caregiver and thus, 371 patients were administered the AD8, and of those, 275 caregivers also completed the measure. Pearson product moment correlations were utilized. Significant and positive correlations were observed between patient AD8 scores and GDS (.49), GAI (.41), and Neuroticism (.37) scores. No significant correlations were observed between these mood measures and caregiver AD8 scores. Significant inverse correlations were observed between caregiver AD8 scores and MMSE (.33) and MoCA (.35). Inverse correlations, of lower magnitude, were observed for caregiver AD8 scores and cognitive measures. Patient symptom complaint (cognitive or psychological) appears to be suggestive of overall distress. This suggests the utility of the patient AD8 as a psychological marker rather than an indication of true cognitive status. Conversely, complaints by the caregiver track cognitive status reasonably well and are not associated with patient's reported depression and anxiety. Depression and dementia can often present similarly in an elderly population and thus, the caregiver AD8 may assist in teasing out actual cognitive decline in depressed patients.
Lack of Equivalence between the Mini-Mental State Examination (MMSE) and the Clinical Dementia Rating (CDR) in Very Mild-to-Moderate Stage Dementia
Objective: Despite the ubiquity of the Mini-Mental State Examination (MMSE) and the Clinical Dementia Rating (CDR) in the assessment of older adults and the use of both tests to stage dementia severity, the score equivalence between the two tests is unknown. We sought to create derived CDR scores based on the MMSE and to determine the accuracy of such derivations. Methods: Data from 566 adult participants (mean age = 76.6, SD = 8.4) in a longitudinal research registry at an NIH-funded Alzheimer's Disease Center were used to create derived CDR scores based on the MMSE with and without a measure of independent functioning, the Lawton-Brody questionnaire. Derived scores were calculated using the results of an ordinal logistic regression model and accuracy was estimated using five-fold cross-validation. Results: A significant proportion of the variance in CDR scores was explained by MMSE score (R2 = .74); adding Lawton-Brody scores to the ordinal model improved model fit (R2 = .82). However, the accuracy of the derived scores was acceptable (i.e., >80%) only at extreme CDR scores (i.e., CDR scores of 0 and 3). This accuracy was improved only marginally when Lawton-Brody scores were added as a predictor. Conclusions: Although CDR scores can be derived from MMSE scores, these derived scores are not accurate for true CDR scores of .5, 1, and 2. Assuming the CDR is a more reliable and valid tool for the staging of dementia severity, the MMSE is likely misused when used to stage pre-clinical to moderate dementia.
White Matter Integrity and Working Memory in Mild Cognitive Impairment
Objective: To determine if performance on a verbal working memory test (n-back) is related to anterior white matter integrity in patients with mild cognitive impairment (MCI). Method: Patients with MCI (n = 18) and cognitively normal controls (n = 16) underwent a battery of cognitive tests including a verbal n-back task (0, 1, 2, and 3-back), and a research MRI scan including diffusion-tensor imaging (DTI, b = 0, 1000 s/mm2, 12 directions, 0.85 mm cubed voxels). Regions of interest (ROIs) were placed in right and left anterior and posterior normal appearing white matter (NAWM) on axial slices of fractional anisotropy (FA) and trace DTI parameter maps. ROIs were placed at the level of the trigone, the body of the lateral ventricles, and the centrum semiovale (three consecutive slices at each level). In addition, ROIs were placed in the genu and splenium of the corpus callosum on the trigone slices. Results: The groups were not significantly different on age, education, or sex. MCI patients performed significantly worse than controls on the 1-, 2-, and 3-back but not 0-back conditions of the n-back task. FA was significantly lower in anterior NAWM compared with posterior NAWM in both groups. There was a trend (p = .055) toward higher posterior trace in the MCI group in the lateral ventricle slices only. Anterior trace in these slices was positively correlated with 3-back performance in the MCI group. Conclusions: MCI may be associated with changes in posterior white matter integrity. Anterior white matter integrity in MCI is associated with working memory performance.
Estimated Cumulative Residential Arsenic Groundwater Exposure and Cognitive Functioning: A Project FRONTIER Study
Objective: Groundwater arsenic exposure has been linked to a range of neurodevelopmental and neuropathological processes; however, no research has been conducted looking at long-term low-level arsenic exposure and cognitive functioning. The current study sought to examine the link between estimated cumulative residential groundwater arsenic exposure and neuropsychological functioning through an ongoing epidemiological study of rural health, Project FRONTIER. Method: Data were available on 242 participants with a mean age and education of 63.7 (SD = 12.9) and 10.4 (SD = 4.1), respectively. An estimated cumulative arsenic exposure index (CAI) was generated using geospatial information systems (GIS), current residential location and time at that location, and well-water arsenic levels from the Texas Water Development Board. Results: After accounting for appropriate covariates in linear regression models, higher CAI was associated with significantly poorer global cognition (Mini-mental State Examination [MMSE] scores; B = −.003, SD = .002, t = −2.19, p = .03), executive functioning (Executive Interview [EXIT25] scores; B = .007, SD = .002, t = 3.16; p = .002), and verbal fluency (FAS scores; B = −.013, SD = .006, t = −2.15, p = .03). CAI was not significantly associated with scores on tests of memory (visual or verbal), visuospatial skills, or attention. Conclusions: The Environmental Protection Agency (EPA) and National Research Council (NRC) have repeatedly pointed toward the need for epidemiological studies examining the non-cancer health outcomes of long-term, low-level arsenic exposure. The current results demonstrate that chronic exposure to levels of arsenic below the current U.S. standard (10 μg/L) is associated with significantly poorer neuropsychological functioning among rural-dwelling adults and elders.
Influence of Age and Education on Tests of Executive Functioning: Comparing Older Adults
Objective: The present study examined the influence of age and education on executive functioning within a sample of older adults. Method: Participants in the present study consisted of non-patient volunteers aged 55–93 years (M = 67.392, SD = 9.478), who participated in the Nova Southeastern University study, Normal Neuropsychological Variation in a Normal Population. The average level of education was 13.705 with an SD of 2.857. Performance on the following tests, which are established measures of executive functioning, was evaluated: Controlled Oral Word Association Test (COWAT), Boston Naming Test (BNT), The Stroop Color-Word Test, Trails B, and Digit Symbol from the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III). Pearson correlations were used to determine whether age and education were related to performance on tests of executive functioning. Results: Analyses were considered significant at the .05 level. A significant relationship emerged between age and performance on the COWAT (r = .155, p = .028), BNT (r = .223, p = .002), Stroop word trial (r = −.163, p = .021), Stroop color/word trial (r = −.211, p = .001), and interference (r = −.141, p = .047). Education was significantly related to performance on Digit Symbol (r = .460, p < .001), Trails B (r = .216, p = .002), Stroop color trial (r = .204, p = .004), Stroop word/color (r = .159, p = .024) and interference (r = .226, p = .001). Discussion: Similar to findings of earlier research, the present study found that age and education profoundly influenced performance on speed-dependent task of executive functioning. Measures of accuracy, such as the errors made on the Trails B test were unaffected by age or education.
NEUROLOGICAL AND NEUROPSYCHIATRIC DISORDERS: CEREBROVASCULAR DISEASE
Patterns of Cognitive Performance in Stroke Patients: Use of the Cognistat in Right Versus Left Cerebrovascular Accidents
Objective: This study examined the effects of a right versus left hemisphere stroke (RHS vs. LHS) on patterns of cognitive performance using the Neurobehavioral Cognitive Status Examination (Cognistat). Data selection: Archival data were utilized. Participants included residents with RHS (n = 24; gender: males = 13; females = 11; age: M = 60.85; education: 11.56 years) or LHS (n = 19; males = 10; females = 9; age: M = 53.94; education: 9.56 years) from an inpatient rehabilitation setting. Data synthesis: The Cognistat was administered as part of routine clinical care. Differences in patterns of performance were expected between the two groups, and these differences were thought to be accounted for by the hemispheric location of the stroke event. Parametric and non-parametric comparisons for each of the Cognistat subtests revealed few significant differences between the groups. Specifically, those in the RHS group performed significantly better than the LHS group on the Orientation and Calculation subtests, whereas those in the LHS group performed significantly better than the RHS group on the Repetition subtest. Sensitivity, specificity, positive predictive power, and negative predictive power of the screens versus metrics for each group were also calculated. Conclusions: Results demonstrated an overall sensitivity of each of the Cognistat subtests to detect neurocognitive impairment; however, results did not confirm any predicted patterns of performance to differentiate between the RHS and LHS groups. This study investigated the Cognistat's utility as a brief initial cognitive screen in stroke patients. Limitations of the study, directions for future research, and clinical implications were addressed.
Recovery from Hypoxic Encephalopathy due to Wolff Parkinson White Syndrome
Objectives: Wolff Parkinson White Syndrome (WPW) is a rare congenital disorder that causes arrhythmia and sudden cardiac arrest (CA). This case demonstrates hypoxic encephalopathy due to CA with good subsequent cognitive recovery. The patient was a 30-year-old woman with a Bachelor's degree that had CA due to WPW with 6–12 min of hypoxia, tonic-clonic seizures, and 3 days of coma. MRI was unremarkable but EEG showed diffuse slowing consistent with metabolic encephalopathy and spiking indicative of right hemisphere seizure activity. Method: Neuropsychological examinations of intellectual, memory, executive, language, and personality functioning were conducted at 1 month and at 8 years after CA. Results: Intelligence (Wechsler Adult Intelligence Scale-Third Edition [WAIS-III] IQ = 89, Wechsler Adult Intelligence Scale-Fourth Edition [WAIS-IV] IQ = 96) and Working Memory (99, 100) were relatively intact over time and consistent with premorbid estimates (Wide Range Achievement Test-Third Edition [WRAT-3] Reading = 105, Wide Range Achievement Test-Fourth Edition [WRAT-4] = 103, WAIS Vocabulary = 9, 10). Memory (Wechsler Memory Scale-Third Edition; WMS-III General Memory = 69, Immediate = 72), Processing Speed (76), executive (Trails B < 55, Wisconsin Card Sorting Test; [WCST] perseverations = 90), and language functioning (FAS = 60) were impaired 1 month after CA. Memory (Wechsler Memory Scale-Fourth Edition [WMS-IV] Delayed Memory = 82, Immediate = 83), Processing Speed (84), executive (Trails = 85, WCST perseverations = 97), and language (FAS = 85) functioning improved significantly at follow-up. Conclusion: Anoxic encephalopathy after CA produces characteristic marked impairment of memory, executive function, and processing speed that can be seen at the post-acute stage of recovery and typically has a poor prognosis. However, good recovery of cognitive functions appears to occur in some cases. Prognosis may be mediated by age, gender, and cerebral reserve. Working memory and intelligence are relatively resistant to hypoxic encephalopathy, and reading vocabulary appears to provide a reasonable estimate of premorbid ability that remains stable during recovery.
Gender Differences in Individuals with Cerebrovascular Disease
Objective: The present study examined gender differences in the comorbidity rates of psychiatric disorders occurring in individuals diagnosed with cerebrovascular disease (CVD). Methodology: The 52 participants were individuals with a primary diagnosis involving cerebrovascular disease. All of the diagnoses were classified according to the International Classification of Diseases, Ninth Revision (ICD-9, 1998). There were a total of 28 male participants (mean age = 51.86, SD = 19.64) and 24 female participants (mean age = 51.81, SD = 18.01). The participants were interviewed and evaluated by neuropsychologists independently. Results: The results of the analysis indicated significant differences between males and females in rates of comorbid psychiatric disorders. Overall, 42.3% of individuals in the present study had a secondary psychiatric diagnosis with 28.6% of males and 58.3% of females having a comorbid psychiatric diagnosis. Specifically, 14.3% of the males and 20.8% of the females had a secondary mood disorder, 10.7% of males and 33.3% of females had a comorbid anxiety disorder, and 3.6% of males and 4.2% of females had a diagnosis of learning disorder NOS. Conclusions: Past research suggests that the occurrence of mental health issues in general population is about 5%–14%. Yet, these statistics seem to increase drastically for individuals with CVD. According to our findings, despite increase in prevalence, the gender prevalence rates seem similar to those found in general population. Indeed, female risk for psychiatric complications seems to almost double of this in males. The implications point toward clinical preventive programs targeting the CVD patients, with consideration of gender risk.
NEUROLOGICAL AND NEUROPSYCHIATRIC DISORDERS: OTHER
Processing Speed and Working Memory in Multiple Sclerosis (MS): Comparison of the Relative and Independent Consequence Models
Objective: The goal of this study was to investigate the application of the relative and independent consequence models (DeLuca et al., 2004) in explaining the relationship between processing speed (PS) and working memory (WM) impairments in MS. Method: Participants included 45 MS outpatients (33 females) and 29 healthy controls (15 females). The groups did not differ for education, but did for age (MS: M = 46.87, SD = 9.13; controls: M = 36.10, SD = 13.81). Participants completed the n-back task as part of a larger neuropsychological battery along with questionnaires measuring fatigue and depression. Reaction time (RT) and percentage of dyad responses were measures of PS and WM, respectively. Total consecutive responses (CR) were calculated to evaluate task approach (i.e., if participants responded to items consecutively or skipped items intermittently). Using path analysis, separate models were created for the 1- and 2-back conditions, with RT and CR included as endogeneous variables and percentage of dyad responses as the outcome variable. Results: For the MS group, path models demonstrated that in the 2-back condition, PS was directly related to WM performance as well as indirectly related to WM performance through total CR (all standardized coefficients p < .05). These results were not replicated in the models examining control participants. Conclusions: Results of the present study provide support for the relative consequence model, as impaired PS was found to predict impaired WM in the MS group, but not the control group. The importance of examining task approach was also demonstrated, as total CR partially mediated the relationship between PS and WM.
Relationship between Depressive Symptoms and Neuropsychological Performance in Acquired Brain Injury
Objective: Teasing apart the cognitive effects of acquired brain injury (ABI) and depression is an important clinical task. There is considerable evidence that depression impacts cognition, but the nature and strength of this relationship in patients with ABI is unclear. The present study aimed to investigate how depressive symptoms relate to neuropsychological performance in this patient group. Method: Forty-six neurorehabilitation outpatients with ABI (40% traumatic brain injury, 42% stroke, 18% other; mean age 41 ± 13) underwent comprehensive neuropsychological assessment as part of standard care. Neuropsychological test scores were aggregated into indices of learning, memory recall, processing speed, working memory, and executive functioning. Depressive symptoms were measured with the Beck Depression Inventory (BDI-II). Results: Depressive symptoms correlated modestly with the learning index (r = −.28, p = .06) and minimally with the other index scores (r = .01 to .16). In a multivariate analysis of variance (MANOVA), depressed patients (BDI-II >13) performed lower than non-depressed patients (BDI-II ≤ 13) on the set of neuropsychological index scores (F = 2.85, p = .03). However, the pattern of univariate contrasts again suggested that this effect was entirely confined to learning (Cohen's d = .71). Depressive symptoms were similarly related to immediate recall scores on the California Verbal Learning Test-II and Wechsler Memory Scale-III Logical Memory, the two measures that comprised the learning index. Conclusion: Depressive symptoms were modestly related to learning inefficiency in our sample. Our findings are limited to ABI patients with mild-to-moderate depressive symptoms and are only partly in keeping with prior research.
5-HTTLPR Genotype and the Effects of Adverse Childhood Experiences on Risk of Antisocial Personality Disorder
Objective: Antisocial personality disorder (ASPD) frequently co-occurs with substance dependence (SD). A polymorphism (5-HTTLPR) in the gene encoding the serotonin transporter (SLC6A4) has been widely studied as a risk factor for a variety of psychopathologic conditions, including aggressive/violent behavior. Childhood abuse is also an important predictor of ASPD. We examined 5-HTTLPR genotype and adverse childhood events (ACEs) as risk factors for ASPD in an SD sample. Method: A total of 1,381 participants, including 602 European Americans (EAs) and 779 African Americans (AAs), were interviewed to obtain lifetime diagnoses of ASPD and SD and information on ACEs. Tri-allelic genotypes for 5-HTTLPR were obtained using standard methods. We used logistic GEE regression to examine ACEs and 5-HTTLPR genotype and their interaction as predictors of ASPD. Results: Among the participants, 203 (14.7%) were diagnosed with ASPD. The frequency of the low-functioning 5-HTTLPR S′ allele did not differ between the ASPD and non-ASPD groups, and there was no overall 5-HTTLPR × ACE interaction. However, among EAs, male sex (OR = 3.36; p < .001) and ACE history (OR = 1.47; p = .002) were significant predictors of ASPD. Among AAs, there was a significant interaction of sex × 5-HTTLPR genotype × ACEs (χ2 = 13.92, p < .001). Among AA men, each additional ACE significantly increased the odds of ASPD irrespective of genotype, whereas among AA women, the effect of ACEs on ASPD was significant only among S′ homozygotes. Conclusions: Childhood maltreatment contributes to the risk of antisocial personality disorder, an effect that in AA women may be moderated by 5-HTTLPR genotype.
Memory Outcomes after Surgery for Intractable Temporal Lobe Epilepsy
Objective: Anterior temporal lobectomy (ATL) is an established treatment for refractory temporal lobe epilepsy (TLE), and memory deficits are one of the primary adverse neuropsychological consequences reported of the procedure. In addition, the question of the relative sensitivity of verbal and visual memory indexes has been debated because of inconsistent findings regarding post-operative memory status. This study reports a sample of patients with TLE all of whom had unilateral hippocampal sclerosis (HS) identified with volumetric MRI prior to ATL. All patients were assessed with verbal and visual memory indexes from the Wechsler Memory Scale-Third Edition (WMS-III). Method: The present study included WMS-III Index data collected in 100 patients (52 left TLE, 48 right TLE) who completed pre- and post-operative memory assessment between 1997 and 2010. Results: There were no statistically significant differences in verbal or visual memory (immediate and delayed recall) indexes between patients with left- versus right-sided HS prior to ATL (all p > .1). After surgery, patients with left ATL showed significantly poorer verbal immediate (t(98) = −2.17, p = .03) and verbal delayed (t(97) = −2.91, p < .01) memory indexes relative to patients after right-sided surgery. The reverse was also found, as patients with right ATL revealed significantly poorer visual immediate (t(97) = 2.46, p < .02) and visual delayed (t(97) = 2.90, p < .01) memory indexes relative to patients after left-sided surgery. Conclusions: In this relatively homogenous sample of patients with HS identified prior to surgery, small but statistically significant changes in verbal and visual memory ability were evident after left or right ATL, respectively.
Exacerbation History is Associated with Medication and Appointment Adherence in Multiple Sclerosis
Objective: Although there is no cure for Relapsing-Remitting Multiple Sclerosis (RRMS), treatment with disease-modifying therapies (DMT) can reduce exacerbations and preserve overall quality of life. Nevertheless, more than 25% of RRMS patients do not adequately adhere to DMTs. Medical patients who fail to actively engage in treatment by attending appointments and adhering to prescribed medication regimens have poorer disease outcomes. This is the first study to examine the association between exacerbation history and medication/appointment adherence in MS. Method: Medical charts for 75 RRMS patients were reviewed to obtain information regarding disease and appointment adherence for approximately a 6-year period prior to participant's enrollment in the study. DMT medication adherence was assessed retrospectively by self-report and also monitored prospectively for 8 weeks using Medication Event Monitoring System (MEMS) caps and a medication diary. Results: Patients with higher annualized relapse rates had fewer missed doses per MEMS (r = −.327, p < .01), diary (r = −.312, p < .01), and self-report (r = −.383, p < .01). Patients with higher annualized relapse rates were less likely to miss (r = −.490, p < .01), cancel (r = −.505, p < .01), and no-show to appointments (r = −.293, p < .05). Conclusion: Higher annualized relapse rates were associated with better medication and appointment adherence. In contrast, patients who experienced a relatively stable disease course frequently failed to adhere to both DMT and scheduled clinic appointments. Given recent evidence highlighting the importance of early, preventative treatment, clinicians should consider discussing the implications of remaining adherent during relatively asymptomatic periods of MS.
Neuroimaging as a Diagnostic Tool for Children and Adolescents
Objective: The past 8 years have seen a significant increase in interest concerning the use of imaging techniques for neuropsychological purposes. Researchers working with children and adolescents, in particular, have found this a salient issue because of the belief that there is a neurological element to most prevalent childhood Axis I disorders. The idea that an objective assessment could be made with reliability across population samples is indeed an intriguing notion. This poster will present a review of the current literature addressing the diagnosing of Axis I behavior disorders in children and adolescents through the use of imaging techniques. Data selection: Empirical studies utilizing SPECT, CT, QEEG, MRI, and fMRI techniques with children and adolescents suffering from prevalent Axis I disorders (e.g., Attention-deficit/Hyperactivity Disorder; ADHD, bipolar disorder) were examined. Those which directly addressed the use of imaging as a diagnostic tool, or suggested diagnostic usefulness, were included in the review. Data synthesis: Empirical studies attempting to diagnose disorders based on imaging have had some success in identifying those with the disorder, but also return a high rate of false-positives. Some studies failed to find any reliable neurological differences. Many studies have been conducted which attempt to isolate the neurological differences which characterize these disorders and assist in building the foundation of knowledge that is essential for diagnosis. Conclusions: Imaging studies have contributed to the understanding of childhood behavior problems, but have not been able to offer reliable and consistent differential diagnoses for neurological disorders at this time.
Traditional Versus Computerized Finger Tapping in Patients with Parkinson's Disease
Objective: The purpose of this study was to compare the CNS Vital Signs computerized finger tapping speed with the traditional Finger Tapping Test in patients with Parkinson's disease (PD). It was hypothesized that the participants would be faster on the computer due to having less strict tapping criteria and no administration monitoring, thereby allowing the PD patients to compensate somewhat for their motor disturbances. Methods: Participants were 33 outpatients with probable or definite PD. The sample was 67% males, their average age was 63.9 (SD = 9.8) years, and their average education was 16.1 (SD = 3.7) years. They had been diagnosed with PD 7.5 years prior (SD = 5.7, range = 1–26). Mean Unified Parkinson's Disease Rating Scale motor scores (part III; on-medication) and Modified Hoehn and Yahr Scale scores were 14.1 (SD = 6.9) and 2.1 (SD = .5), respectively. Results: Participants tapped faster on the computer with their right (p < .002, Cohen's d = .66) and left (p < .001, d = 1.03) hands. The differences between computerized and traditional tapping attenuated when comparing normative scores (right hand, p < .30, d = .22; left hand, p < .001, d = .60). The percentages of patients with scores below the 10th percentile were 33.3% and 39.4% for the right- and left-hand traditional tapping, and 24.2% and 27.3% for the computerized tapping. Conclusions: Patients with PD were able to tap faster on the computer than on the traditional finger tapper. The differences attenuated, but did not disappear, when comparing normative scores.
How Confident Can We Be in the Reporting of Evidence-Based Diagnostic Validity Statistics?
Objective: The aim of this study was to review the reporting of evidence-based diagnostic validity statistics in the neuropsychological and psychological literature. In 1999, the American Psychological Association (APA) Task Force on Statistical Inference recommended routine use of confidence intervals (CI) when reporting study results. Despite the shift toward interval-based estimation, it is unclear whether these recommendations are being adopted for the reporting of evidence-based statistics. Data selection: The PsycINFO (CSA) database was searched for studies reporting the combination of terms “sensitivity” and “specificity” in the “Title” or “Abstract” fields between January 1, 2009 and April 24, 2010 inclusive. Thirty peer-reviewed articles and one dissertation were identified. Eighteen articles met broad inclusion criteria for a diagnostic validity study. Articles not in English were excluded, as were those that did not numerically quantify sensitivity and specificity statistics. Data synthesis: Only 2 of the 18 articles (i.e., 11%) reviewed reported sensitivity and specificity values bounded by CIs. Eleven of the articles focused on a neuropsychological population or hypothesis and these 11 included the 2 articles reporting CIs. Consideration of CIs would have altered the interpretation of results in a proportion of the studies, sometimes radically. Conclusions: Most neuropsychological and psychological studies included in this brief review, which explicitly report sensitivity and specificity statistics in the Title or Abstract, have not reported CIs. In some studies, conclusions regarding diagnostic validity would have changed if CIs were considered. This review highlights the need to improve the practice of reporting diagnostic validity statistics to improve the accuracy of inferences in evidence-based practice.
Utilizing the Minnesota Multiphasic Personality Inventory-2 and Millon Clinical Multiaxial Inventory-III to Predict Epileptic and Non-Epileptic Seizure Patients
Objectives: Patients may have either epileptic seizures (ES) with EEG correlates or non-epileptic seizures (NES) which appear clinically similar but lack EEG correlates. The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) is routinely used in seizure patients to identify psychopathology and to aid identification of patients with NES. This study examined the ability of several of the MMPI-2 validity and clinical scales in conjunction with the Millon Clinical Multiaxial Inventory-III (MCMI-III) Dependent scale to differentiate between ES and NES. Data selection: This study includes 64 inpatients on a video-EEG unit of a comprehensive epilepsy center. The MMPI-2 and MCMI-III were administered, and an epileptologist, based on video-EEG data, diagnosed 21 patients with ES and 43 with NES. A logistic regression analysis was performed with type of epilepsy diagnosis as the dependent variable (DV) and MMPI-2 clinical scale 1, MMPI-2 clinical scale 3, MMPI-2 validity scale FBS, and MCMI-III scale 3 as predictor variables. Data synthesis: A total of 64 cases were analyzed and the full model significantly predicted type of epilepsy diagnosis (omnibus chi-square = 11.508, df = 4, p = .021). MMPI-2 scale 3 and the FBS scale were the significant predictors in this model. Conclusions: This study suggests that patients presenting with higher scores on the dependent scale of the MCMI-III in conjunction with higher scores on scales 1 and 3 of the MMPI-2 should be examined for increased scores on the FBS scale. Specifically, patients whose profiles have higher FBS scores are more likely to have ES; conversely, profiles with lower FBS scores appear predictive of NES.
Examining the Influences of Age, Education, and the Wechsler Adult Intelligence Scale-Third Edition FSIQ on the Benton Visual Retention Test Multiple Choice
Objective: Performance on the Benton Visual Retention Test (BVRT) Multiple Choice is related to recognition memory. However, by analyzing the impact of demographic variables, age, education, and intelligence, it was found that these factors influence how well a person performs on the test. Method: This sample comprised of 150 unselected mixed clinical and medical patients that were given the Benton Visual Retention Multiple Choice (MCVRT) and the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) as part of a psychological assessment. Both the test variables and demographic variables were individually factored in and used to create factor scales: age, education, the WAIS III FSIQ, and the BVRT Multiple Choice Items broken into groups of 4 (MCVRT items #1–4, MCVRT items #5–8, MCVRT #9–12, and MCVRT #13–16). Results: Factor analyses indicated that education and FSIQ were not related to age but did relate to the level of performance (defined as the number of items correctly recognized) on the last quarter of the test (MCVRT #13–16) and moderately impacted MCVRT items #9–12. Performance on MCVRT items #1–4 and MCVRT items #5–8 was instead determined primarily by age. These analyses specify that the first half of the BVRT Multiple Choice inversely relates to age, whereas the last half of the BVRT Multiple Choice loads on years of education and FSIQ. Conclusion: Knowing that demographic variables have various influences on different portions of the BVRT Multiple Choice, future interpretation of the BVRT Multiple Choice should acknowledge the impact of these variables as to reflect a component-based globalized measure of intelligence.
Descriptive Neuropsychological Assessment Data for a Sample of Patients with Parkinson's Disease
Objective: The objective was to examine the neuropsychological assessment profile of a group of patients with Parkinson's disease. Method: The study sample consisted of 60 participants (38 men) with a mean age of 64.7 (SD = 9.7) and mean education of 14.3 years (SD = 3.0). The sample was comprised of individuals living in the community with advanced Parkinson's disease involving motor fluctuations (wearing off and dyskinesia). Group means, standard deviations, and ranges were explored. Results: The group mean for the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Total Scale score was 85.8 (SD = 15.7). RBANS index scores were as follows: Immediate Memory = 87.1 (SD = 16.4); Visuospatial/Constructional = 90.0 (SD = 18.6); Language = 91.4 (SD = 10.2); Attention = 86.3 (SD = 18.1); and Delayed Memory = 90.5 (SD = 17.0). Group means presented as T-scores included the Wisconsin Card Sorting Test (T = 44.9; SD = 10.9), Trails A (T = 39.4; SD = 10.7), Trails B (T = 38.4; SD = 10.8), Letter Fluency (T = 44.8; SD = 10.8), and Category Fluency (T = 47.5; SD = 12.7). The mean raw score on the Mini-mental State Examination (MMSE) was 27.6 (SD = 2.6). Conclusion: Although group means were below normal population means, scores on most of the neuropsychological variables were within 1 SD of normal controls. However, considering the relatively high level of education in this sample, these scores are likely indicative of significant cognitive decline from premorbid levels for many individuals in this sample.
Pre-surgical Wechsler Adult Intelligence Scale-Fourth Edition: Functioning among Selected Right and Left Temporal Lobe Epilepsy Patients
Objective: Epilepsy is a common neurological disorder with cognitive and psychiatric comorbidity. About 30% of patients with complex partial seizures had medication refractory epilepsy. Patients with temporal lobe epilepsy (TLE) can exhibit cognitive deficits, and these are predictive of surgical outcome. However, there are little data regarding the performance of patients with known neurological disease on the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV). This study compares the pre-surgical performance of left and right TLE patients on the WAIS-IV. Method: Patients completing a pre-surgical evaluation for medically refractory epilepsy. Participants: Nineteen patients met study inclusion and exclusion criteria. There were 9 left TLE and 10 right TLE patients. Variables/measure(s): all participants completed comprehensive neuropsychological evaluations. Results: The mean age of left TLE sample was 34 (SD = 9.8) and had 12.8 years of education. The mean age of right TLE group was 32 (SD = 10.7) and had 14.1 years of education. The average FSIQ, VCI, and PRI of the left TLE and right TLE groups did not significantly differ from a mean of 100 (left TLE: FSIQ = 91.3, VCI = 92.9, PRI = 92.9, WMI = 93.6, PSI = 93.1; right TLE: FSIQ = 91.0, VCI = 90.5, PRI = 93.7, WMI = 97.4, PSI = 93.7). Analysis of variance (ANOVA) found no significant differences in WAIS-IV index scores between the left and right TLE groups. Conclusion(s): While preliminary, there was no significant difference between patients with left TLE versus those with right TLE. Previous data with prior versions of the Wechsler Adult Intelligence Test has also failed to reliably lateralize patients with known left or right TLE. Implications for surgical treatment and cognitive outcome are discussed.
Longitudinal Analysis of Fatigue and Cognition in Multiple Sclerosis
Objective: Approximately 50% of patients with multiple sclerosis (MS) experience cognitive impairment, which has a negative impact on performance of daily activities. Although patients report that fatigue contributes to cognitive difficulties, previous empirical studies have not found a clear linear association. This study assessed coping style as a moderator of the relationship between fatigue and cognition in a longitudinal MS sample. We hypothesized that patients with high fatigue who use more adaptive coping would have better cognitive functioning than patients who use less adaptive coping. Method: Fifty participants (39 females) with a clinical diagnosis of MS completed fatigue, coping, and cognitive measures and were reassessed 3 years later. Scores on the Fatigue Impact Scale at time 1 and an adaptive coping index (a composite index of the difference between the active and avoidant scales on the COPE) at time 2 were used to predict performance on a battery of cognitive tests known to be sensitive to MS. Results: There were significant main effects of fatigue (R2 = .13, p = .008) and coping style (R2 = .09, p = .018) on cognition. There was also a significant interaction between fatigue and the adaptive coping index (p = .004), which accounted for an additional 11.5% of the variance in cognition. Conclusions: Patients with high fatigue who used more adaptive coping had substantially better cognitive functioning than patients who used less adaptive coping. Patients with low fatigue experienced good cognitive functioning regardless of coping style. These results suggest that learning adaptive coping strategies may lessen the negative impact of fatigue on cognition for patients with MS.
Attributional Style in Multiple Sclerosis
Objective: Past studies have shown that attributional style is related to depression in multiple sclerosis (MS) patients, but it is unclear whether attributions for MS and non-MS-related events operate similarly. This study sought to describe attributional style and its correlates in an MS population. Methods: Fifty-two community-dwelling MS patients were administered the Attributional Styles Questionnaire (ASQ; using only negative events), the Chicago Multiscale Depression Inventory (CMDI), the Multiple Sclerosis Attitudes Index (MSAI), and the Expanded Disability Status Scale (EDSS). Results: Patients with more depressogenic attributional styles overall were significantly (p < .01) more depressed. More specifically, stable (p < .05) and global (p < .01) attributional styles were related to higher depression scores on the CMDI. Additionally, more disabled patients (higher EDSS) attributed more events to MS-related causes (p < .05) and felt more helpless (MSAI) toward their MS (p < .01). The more internal attributions patients made about MS-related causes, the less helpless they felt toward their MS (p < .05). In contrast, the more internal attributions patients made about non-MS-related causes, the more helpless they felt (p < .05). Conclusion: These data show that attributional style is associated with depression in MS. Internal attributions, however, appear to be related to lower helplessness when in reference to disease-related events and higher helplessness in relation to non-MS-related events. Also, more disabled patients were more likely to attribute hypothetical events to their MS and to feel helpless toward their disease.7
Relationship of Subjective Patient Complaints to Neuropsychological Test Performance and Diagnosis
Objective: Patients with suspected memory loss based on subjective complaints constitute the majority of referrals to most neuropsychological practices. Differentiating between objective and subjective impairment, and understanding how complaints are related to diagnosis, can facilitate understanding of underlying pathology and contribute to effective treatment. Method: One hundred and seventeen adults referred for evaluation due to memory complaints who had no clear neurologic cause for their complaints (e.g., absence of structural lesion) served as participants. Comprehensive cognitive assessment was completed which included a structured clinical interview of subjective (6 cognitive, 9 sensorimotor, and 10 vegetative) complaints. Patients were classified into one of the three groups based on their test performance: 33 patients displayed true memory dysfunction, 48 showed normal memory, but impairment in other domain(s), and 36 had no cognitive deficit. Patients were then evaluated using history and current psychological functioning to uncover potential etiologies for presenting concerns. Results: Twenty-six of 33 (79%) patients with bona fide memory dysfunction demonstrated symptoms related to probable neuropathology versus psychopathology, whereas 26 of 48 (54%) patients with other domain impairment showed the reverse (p = .006). Patients with other domain impairment demonstrated the highest percentage of complaints overall, with individuals having concurrent neurologic and psychiatric disease acknowledging the most. Complaints of vegetative symptoms were most effective in differentiating neurologic from psychiatric etiology; psychiatric etiologies having more vegetative complaints. Conclusions: A small percentage (28%) of patients referred for evaluation of subjective memory complaints had actual memory impairment. Psychopathology was associated with an increase in subjective complaints. Subjective complaints can help to inform testing decisions and offer valuable information about potential diagnosis.
Self and Informant Ratings of Cognition in Multiple Sclerosis (MS) and Healthy Controls: Relationship to Objective Measures
Multiple sclerosis (MS) often leads to objective deficits in information processing speed (IPS), memory, and executive functioning. The Multiple Sclerosis Neuropsychological Questionnaire (MSNQ) is a brief questionnaire that allows individuals with MS and informants to subjectively rate extent and impact of MS-related cognitive impairment. Objective: To determine whether a greater degree of correlation with objective cognitive performance is found with informant over self-ratings. Self-ratings were expected to show stronger correlations with depression. Method: Fifty-five individuals with MS and 26 demographically matched healthy controls (HC) underwent neuropsychological evaluation including the MSNQ and the Beck Depression Inventory-Fast Screen (BDI-FS). Results: Self and informant MSNQ ratings significantly differed from each other for both MS and HC groups, although the MS and HC groups did not differ regarding their ratings on either form. Although both self and informant forms in the MS group correlated with some objective measures of cognition, as expected, the relationship was stronger with the informant form. The self-form positively correlated with scores on the BDI-FS in the MS group. Objective measures of IPS were the most sensitive to impairment in MS and HC groups. Conclusions: Subjective ratings of cognition in individuals with MS correlate with depression and less so with cognition, whereas informant ratings demonstrate stronger correlations with cognition and none with depression. Controls demonstrate a similar pattern of correlations for cognitive measures but not for depression. Utility of the MSNQ as a screening tool in a clinical setting is discussed.
Learning Disorders and Temporal Lobe Epilepsy: A Case Study
Objective: This case study describes the relationship between left temporal lobe epilepsy (TLE) and learning disabilities in a 26-year-old male college student. The client developed seizures following an episode of mycoplasma encephalitis at the age of 7. The client underwent a left temporal lobectomy involving resection of the left mesial temporal lobe, amygdala, hippocampus, and part of the brain stem 6 years prior to the current evaluation in an attempt to address the frequency of the seizures. The surgery was extensive, including neocortical resection extending posterior to the vein of Labbe along the inferior temporal gyrus. The lobectomy reportedly successfully eliminated the seizures and the need for anti-seizure medications, but no neurological or neuropsychological follow-up occurred until 2009 when he was referred by his academic program for an evaluation of learning disabilities. Method: The client participated in a comprehensive neuropsychological evaluation at a university-based training clinic. The evaluation consisted of extensive neuropsychological, academic, and personality assessment. Results: Results of the neuropsychological evaluation indicated significant expressive language functioning deficits, with generally better preserved receptive language. Conclusions: Compared with a pre-surgical neuropsychological evaluation, there was evidence for subtle to mild improvement in several aspects of cognitive functioning, likely due to seizure elimination and discontinuation of the anti-seizure medication. Nonetheless, his deficits resulted in significant functional impact on his academic abilities, which required extensive academic accommodations.
Multiple Chemical Sensitivity (MCS) is a Neuropsychological Disease
Multiple chemical sensitivity (MCS) is an orphan disease, shunned by its rightful parents, neuropsychology and medicine. MCS has medical, immunological, toxicological, neuropsychological, and psychological aspects. An extensive literature on the topic has been developed since WWII, including: MCS is an international condition, with prevalence studies of up to 46% in an Italian population sample. A quasi-experimental study showed that after accidental exposure of workers for 2 months to gasoline-contaminated soil in a tunnel, 1/4 of the men developed persistent MCS. Temporomandibular joint implants patients develop MCS after surgery. Statistically significant responses were found in MCS subjects (all measures, p<0.02) in tonic electrodermal response to test substances compared with controls, and compared with the control substance. SPECT found that MCS cases presented poorer neurocognitive function at baseline, and neurocognitive worsening after chemical exposure. Chemical exposure caused neurocognitive impairment and SPECT brain dysfunction particularly affecting odor-processing areas. Neuropsychologists are ideally suited to research, diagnose and treat people with this condition. While some patients or claimants presenting with multiple chemical sensitivity will have hypochondriacal overtones, others are actually suffering from a sensitivity, akin to allergy. The best available diagnostic tool for MCS is a comprehensive neuropsychological evaluation, assessing cognitive and executive function, personality and emotional disorders, as well as effort and malingering, along with a medical and historical record review. Neuropsychologists performing this evaluation should be familiar with the extensive literature documenting the reality of multiple chemical sensitivity as a neurotoxic/neuropsychological disorder.
HIV Infection is Associated with Comparable Deficits in Time- and Event-based Prospective Memory
Objective: According to McDaniel and Einstein's (2000) multi-process theory of prospective memory (ProM; i.e., “remembering to remember”), time-based tasks rely more heavily on strategic processes dependent on prefrontal systems than do event-based tasks. Given the prominent frontostriatal pathophysiology of HIV infection, one would expect that HIV-infected individuals would demonstrate greater deficits in time- versus event-based ProM, but the two prior studies that have examined this question produced variable results, perhaps due to small sample sizes and measurement differences. Method: Participants included 143 individuals with HIV infection and 43 demographically similar seronegative adults (HIV-negative) completed a comprehensive neurocognitive, psychiatric, and medical evaluation. Individuals with severe psychiatric illness, neurological disease, or current substance dependence were excluded. All participants also completed the Memory for Intentions Screening Test (MIST), which yields psychometrically parallel subscales of time- and event-based ProM. Results: A repeated-measures analysis of variance (ANOVA) revealed main effects of HIV serostatus (p = .016) and cue type (p < .001), but no interaction between serostatus and cue (p = .861). Planned pair-wise comparisons showed a significant HIV effect on time-based ProM (p = .016, Cohen's d = .48) and a trend-level effect on event-based ProM (p = .074, Cohen's d = .36). Conclusions: Findings from this study suggest that HIV infection is not associated with a disproportionate effect on time- versus event-based ProM. Whether such comparable deficits reflect a common dysregulation of strategic monitoring and retrieval processes or separate underlying mechanisms remains to be determined. In addition to their theoretical value, such investigations are of clinical importance because HIV-associated ProM deficits are strongly linked to everyday functioning outcomes, such as medication non-adherence.
NEUROPSYCHOLOGICAL DOMAINS: EXECUTIVE FUNCTIONS
The Relationship between Wechsler Adult Intelligence Scale-Fourth Edition Full Scale IQ and Neuropsychological Test Performance
Objective: The purpose of the present study was to generate data on the relationship between intelligence, as measured by the new Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) FSIQ, and a variety of commonly used neuropsychological tests as a replication of earlier studies using earlier versions of the test. Method: The sample consisted of 30 individuals (14 males). The mean age of the sample was 32.86 years (SD = 13.89) and the mean education was 12.78 years (SD = 2.32). Correlations were run between the WAIS-IV Full Scale IQ (FSIQ) and the Indices of the Wechsler Memory Scale-Fourth Edition (WMS-IV), the Stroop Color-Word Test, the Trail Making Test, the Wisconsin Card Sorting Test, the Category Test, Finger Tapping Test, and the Tactual Performance Test (TPT). Results: Significant correlations (df = 28) were found between the WAIS-IV FSIQ and the WMS-IV Auditory Memory Index (r = .52), Visual Memory Index (r = .65), Visual Working Memory Index (r = .71), Immediate Memory Index (r = .77), Delayed Memory Index (r = .56), Stroop Color (r = .42), Stroop Color-Word (r = .48), Trails A (r = .46), Trails B (r = .51), Category Test (r = .56), TPT-Dominant Hand (r = .48), TPT-Non-Dominant Hand (r = .59), TPT-Both (r = .60), and TPT-Location (r = .48). All correlations were significant at the p < .05 level. Conclusion: Results revealed significant correlations between the WAIS-IV FSIQ and measures of memory, concentration, set-shifting, cognitive flexibility, non-verbal concept formation, and sensory and motor functions. These results are comparable to studies using earlier versions of the WAIS.
Anxiety and Cognitive Performance: A Neuropsychological Assessment of Patients Undergoing Coronary Artery Bypass Graft Surgery
Since the advent of coronary artery bypass graft (CABG) surgery, neurological complications, including strokes, seizures, and cognitive impairments, have been associated with the procedure. Recent studies have indicated that certain characteristics of patients pre-operatively may predict post-operative complications (Keith, Puente, Malcolmson, Tartt, Coleman, & Marks, 2002; Morrill, Richardson, Keith, & Puente, 2006). Based on these findings, it was hypothesized that pre-operative anxiety may put patients at a higher risk of post-operative cognitive impairments. Participants were assessed pre- and post-operatively to measure cognitive function and level of anxiety. Tests of cognitive function included the Stroop Color and Word Test, Trail Making Test Parts A and B, and the Symbol Digit Modalities Test. The State Trait Anxiety Inventory was used to assess anxiety. Results indicated that participants did not experience significant cognitive decline from pre- to post-surgery. Furthermore, although situational state anxiety did not correlate significantly with performance on any neuropsychological tests, general trait anxiety showed a significant negative relationship with performance, indicating that higher general anxiety leads to poorer performance on neurocognitive tests. The second part of the study involved comparing scores on the State Trait Anxiety Inventory to cortisol levels from saliva samples obtained once testing sessions had been completed. The purpose of this part of the study was to (a) examine correlations between a self-report and physiological measure of anxiety and (b) review the literature to examine which technique would provide a more accurate reading of anxiety. Results indicated that neither state nor trait anxiety scores correlated significantly with salivary cortisol levels.
Executive Functioning as a Potential Link between Attention-deficit/Hyperactivity Disorder and Developmental Dyslexia
Objective: The purpose of this study was to examine potential differences in executive functioning (EF) among children with Attention-deficit/Hyperactivity Disorder-Predominately Inattentive type (ADHD-PI), ADHD-Combined type (ADHD-C), and developmental dyslexia (DD). While deficits in EF are not commonly associated with DD, some literature suggests they may have executive dysfunction and, thus, EF may be a potential source of comorbidity between DD and ADHD. Method: Participants included 146 children, aged 8–12 years, with ADHD-PI (n = 28), ADHD-C (n = 19), DD (n = 35), comorbid ADHD/DD (n = 17), and controls (n = 47). Groups were equated on age, gender, ethnicity/race, and non-verbal IQ (Test of Nonverbal Intelligence-Third Edition; TONI-3). They performed several measures as part of a university-based, NIH/NICHD-funded project (R03 HD048752) including the Wechsler Intelligence Scale for Children, Wisconsin Card Sorting Test, and NEPSY Design Fluency and Tower. Results: Initial statistics compared the five groups on EF measures using multivariate analysis of variance (MANOVA). ADHD-PI and ADHD-C performed highly comparable to each other; thus, 2 (ADHD or not) × 2 (DD or not) MANOVA was used in order to determine if there was an interaction between ADHD and DD. No interactions were found. Children with DD performed worse on NEPSY Design Fluency (F(1, 142) = 10.23, p = .002), Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) Letter-Number Sequencing (F(1, 82) = 7.66, p = .007), total number of categories achieved on the WCST (F(1, 139) = 6.97, p = .009), and WISC Digit Span Forward (F(1, 141) = 6.88, p = .010) and Digit Span Backward (F(1, 141) = 7.05, p = .009) than those without it. The ADHD group tended to perform worse than those without it on Design Fluency (F(1, 142) = 3.80, p = .053). Groups did not differ on the NEPSY Tower. Conclusions: Our study suggests that executive dysfunction may contribute to the problems seen in children with DD.
Executive Functioning and Blood Glucose Levels of Adolescents with Type 2 Diabetes
Objective: This pilot study examines the relationship among executive functioning and blood glucose levels in adolescents with type 2 diabetes. Method: Participants for this study were recruited from a large pediatric hospital in an urban setting. The total sample of participants was 9. The participants had a mean age of 14.3 years (SD = 1.7). The sample included predominantly females (66%) and was predominantly Hispanic (77%). Adolescents with type 2 diabetes completed the Behavior Rating Inventory of Executive Function (BRIEF) Self Report, whereas their parents completed the BRIEF-Parent Form (BRIEF-Parent Form). Participants completed the BRIEF during their regular outpatient visit to the Diabetes Clinic at this pediatric hospital. The participant's glycosylated hemoglobin (HbA1c)—the average blood glucose over the last 2–3-month period—was used as a measure of metabolic control. Spearman rank correlation was calculated to examine the correlation between executive functioning and metabolic control. The eight individual indices of the BRIEF, the two broader indices, and the composite score were examined in relation to the HbA1c levels. Results: A statistically significant correlation (p = .048) was found between parent rating of planning/organization and HbA1c. No other significant correlations were found on any of the other indices assessed as reported by the adolescents or their parents. Conclusions: Adolescents' self-rating of executive functioning was not related to level of metabolic control. Interestingly, parent's report of the adolescent's ability to manage current and future-oriented task demands within the situational context was significantly correlated with a measure of average blood glucose levels over the past 3 months.
Predictive Ability of Executive Functions on Full Scale IQ
Objective: The current study attempted to evaluate the ability of executive functions to predict Full Scale IQ (FSIQ) in individuals with average to superior intelligence. Method: In a sample of 165 normal volunteer participants, there were 87 participants in the average FSIQ range and 79 participants in the above average to superior range of intelligence. Executive functioning was measured using the total time to complete part B of the Trail Making Test (TMT), the total number of perseverative errors on the Wisconsin Card Sorting Test (WCST), and the total number of trials to complete the WCST. Intelligence was assessed using the prorated Full Scale IQ score on the Wechsler Adult Intelligence Scale-3rd Edition. A linear regression was conducted for each group of FSIQ scores. Results: The regression indicated that 6.3% (r = .25, p > .05) of the variance was accounted for by executive functions, particularly time to complete TMT part B in participants with above average to superior intelligence.The second regression indicated that 13.7% (r = .37, p < .05) of the variance was accounted for by executive functions in participants with average intelligence. Conclusion: Executive functioning was thought to predict FSIQ in all individuals; however, it appears that it is less likely to predict FSIQ in individuals with above average to superior intelligence. These effects may be accounted for by differences in processing speed. Processing speed is probably higher in individuals with higher IQ scores. Overall executive functions were significant in predicting FSIQ only in the participants with average intelligence.
A Meta-Analytic Review: Verbal Fluency as a Measure of Executive Function in Individuals with Autism Spectrum Disorders
Objective: Research has suggested that deficits in executive function (EF) are exhibited by individuals with autism spectrum disorders (ASDs). The purpose of this meta-analysis was to provide a review of the literature on tasks that assess verbal fluency as a measure of EF in individuals with ASDs. Data selection: Searches on Medline and PsychInfo with keywords including “verbal fluency,” “executive function,” and “Autism Spectrum Disorders” identified the studies for the analysis. Additional references were generated from the review of the cited articles. Only articles that could be obtained in English and that indicated the use of a measure of verbal fluency in the assessment of ASDs were included in the analysis. Data synthesis: Cohen's d effect size was calculated for each verbal fluency variable used. Results indicated that generativity attributes of individuals with ASDs are not consistent across verbal fluency tasks. Effect sizes, on average, were medium, but differences in effect sizes appeared between semantic verbal fluency tasks and phonemic verbal fluency tasks. Effect sizes were larger when individuals with ASD were compared with age- and ability-matched control groups. Conclusions: The findings of the analysis suggest that impairments in executive function in individuals with ASDs can be measured by verbal fluency tasks taking into consideration the task and the composition of the comparison group. Measures of verbal fluency are recommended as part of a comprehensive assessment for individuals with ASDs.
Psychological Impact of Emotions in Chess Players' Cognitive Performance
Objective: Schwarz et al. (2002) analyzed tournament chess players who reported their emotional states after each move and found that feelings of hopelessness and helplessness correlated with high heart rate variability. The impact of one's emotional state on chess-playing ability, however, is less studied. The goals of this study were to correlate emotions with chess performance and to examine the impact of personality traits on how chess players perform. It is hypothesized that mistakes associated with changes in chess players' emotional states will be of greater magnitude than mistakes that are not associated with changes in their emotional states. Also, players who have maladaptive personality traits are likely to make more mistakes than will players with adaptive personality traits. Method: Twenty participants (19 males and 1 female, aged 16–65) with U.S. Chess Federation ratings were matched against each other via the Internet Chess Club. Time control was 45 min for each side, with a 45-s increment. After playing each move, participants completed the International Positive and Negative Affect Schedule Short-Form (I-PANAS-SF). Participants submit the game online, and their moves were then analyzed using the Rybka 3 computer chess engine at a fixed search depth of 12 plies. The participants also completed the PsychEval Personality Questionnaire (PEPQ). Results: Chess players with adaptive personality characteristics and low levels of anxiety made fewer errors than did their counterparts who exhibited reactive personality characteristics and high levels of anxiety. Conclusions: Chess players must learn to manage stress effectively in order to improve their cognitive performance.
Negative Emotional Distracters Impair Set Maintenance in a Switching Task
Objective: Emotional distracters have been shown to alter performances on various cognitive measures, including task switching (Wang & Guo, 2008). The present study investigated the effects of emotional distracters on set maintenance and switching costs in a spatial and a verbal version of a switching task. Method: Two hundred and nineteen college-age students were recruited from undergraduate psychology classes. Participants completed two switching tasks, one requiring that they switch between classifying stimuli as vowels/consonants versus capital/lower case letters, and one requiring that they switch between classifying locations of stimuli on the screen along a diagonal versus vertical axis. Each stimulus consisted of a letter of the alphabet superimposed over a grayscale image with smiling (positive) or crying (negative) facial expressions. Switching costs and set maintenance costs were computed by subtracting baseline performances from switch and set maintenance trials. Results: A repeated-measures analysis of variance (ANOVA) using (a) response latencies as dependent variables and (b) distracter type (positive vs. negative), cost type (switch vs. set loss), and task type (verbal vs. spatial) as within-subjects factors yielded a significant three-way interaction between task type, distracter type, and cost type (F(1, 218) = 77.48, p < .001), such that only negative (but not positive) distracters had deleterious effects, which were evident only on set maintenance (not switch) costs and only for the spatial task (t(1, 211) = 12.05, p < .001). Conclusions: Negative emotional distracters may occupy attentional resources in the right hemisphere that are needed for adequate set maintenance during performance on spatial tasks.
A Meta-Analytic Review of the Use of the Wisconsin Card Sorting Test with Individuals with Autism Spectrum Disorders
Objective: Research suggests that deficits in executive functioning including strategic planning, organized searching, set shifting, goal attainment, and inhibition are common to both Attention-deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorders (ASD). The purpose of this meta-analysis is to provide a review of the extant ASD literature with regard to tasks frequently used in the assessment of ADHD, namely the Wisconsin Card Sorting Test (WCST), and to lend support to the notion that measures traditionally used in the assessment of ADHD may also be effective in the diagnosis of ASD. Data selection: Studies included in the meta-analysis were identified through a search of PsychInfo and Medline. Search terms included “autism,” “Asperger,” and “pervasive developmental disorder.” From the generated search and subsequent review of cited articles, only those that could be obtained in English and contained data for more than one group were included in the analysis. Data synthesis: Cohen's d was calculated for each reported variable (categories achieved, trials, errors, and perseverative errors) based on the information provided in each article. Results indicate moderate-to-large average effect sizes on the reported variables. Conclusion: Although traditionally used to assess ADHD, the WCST is also sensitive to the executive functioning deficits found in ASD and can effectively discriminate between individuals with ASD and normal controls. Based on the available studies, the use of the WCST as part of a comprehensive assessment of individuals with suspected ASD is recommended.
Relationships between Executive Functioning and Behavioral Rating Inventory of Executive Function (BRIEF) Scores in a Pediatric Epilepsy Sample
Objective: The Behavioral Rating Inventory of Executive Function (BRIEF) is a questionnaire that assesses “real-world” executive functioning in children and adolescents. Although the relationship between BRIEF scores and executive functioning test performance has not been consistently borne out in a variety of pediatric neurological subgroups, a prior study in a pediatric epilepsy sample demonstrated this link (Parrish et al., 2006). In an effort to replicate this finding, the current study investigated the relationship between BRIEF scores and performance on executive functioning tasks in children diagnosed with partial or generalized epilepsy. It was hypothesized that scores on BRIEF clinical scales would predict neuropsychological performance across selected executive functioning tasks. Method: Participants included 25 children (mean age = 11.36; 14 females and 11 males) consecutively evaluated children with partial or generalized epilepsy. Mean age of epilepsy onset was 6.18 (SD = 4.40). Mean number of AEDs was 1.52 (SD = 0.87). Variables included all BRIEF clinical scales and performance on Trail-making, Digit Span (forward and backward), and Tower of London. Pearson product–moment correlations between neuropsychological performance and BRIEF clinical scales (standard scores) were completed. Results: The working memory clinical scale was correlated with Digits Backward (r = −.491, p = .013), although no other clinical scales correlated with performance on other neuropsychological tests. Conclusion(s): Despite common assumption that parent-reported executive functioning and neuropsychological test performance are linked, results suggest that some behavioral and cognitive measures of executive functioning in children diagnosed with epilepsy are not strongly related and thus are likely separable constructs.
Clinical Utility of the Biber Cognitive Estimation Test in a Pediatric Epilepsy Sample
Objective: Cognitive estimation tests involve generating reasonable answers to questions for which certain facts, but not definitive answers, are available. Executive functions (EFs) including planning, working memory, mental control, and self-monitoring are required for successful completion of these tasks. This study assesses cognitive estimations in childhood epilepsy and examines its relationship with intellectual functioning and tests of EFs. Method: Twenty-five children with epilepsy (mean age = 11.36, mean age at seizure onset = 6.18) were administered the Biber Cognitive Estimations Test (BCET), which assesses estimation of quantity, time, weight, and distance. Measures of intellectual functioning, the Tower of London, and the Trail Making Test were also administered. Correlational analyses examined the relationship between the BCET, epilepsy variables, and the other cognitive measures. Results: Quantity and weight estimation were impaired in 36% and 40% of participants, respectively, when compared with normative means. Time and distance estimation were less impaired (19% and 16%, respectively). Forty-four percent had impaired BCET total scores. BCET total score was significantly correlated with age of seizure onset (r = .438, p = .029); other epilepsy variables were non-significant. BCET was also correlated with overall intellectual functioning (r = .715, p < .001), Digit Span Forward (r = .438, p = .029), and Backward (r = .551, p = .004). Other EF tests were non-significant. Conclusions: Cognitive estimation ability is impaired in childhood epilepsy and appears to be related to age of onset and intellectual functioning. The BCET correlates to several, but not all EF tests with well-established validity, reliability, and utility in this population, suggesting that the BCET may be tapping a unique construct not assessed by other EF tests.
A Meta-Analytic Review of the Use of Tower Test with Autism Spectrum Disorder
Objective: Executive function deficits are one of the most frequently reported symptoms of autism spectrum disorders (ASD). The tower tasks are a widely used measure of executive functioning. In relation to tower tasks, the problem-solving process requires executive functioning include goal-focused behavior, the ability to plan and carry out organized sequence of steps, and the ability to form a mental representation of a task. The purpose of this meta-analysis is to provide a review of the existing ASD literature with regard to the discriminating power of the tower tasks in measuring executive functioning between individuals with autism spectrum disorder and a control group. Data selection: Studies for inclusion were identified through a search of PsychInfo, Medline, and EBSCO with the task names “Tower of London” or “Tower of Hanoi” in combination with the terms “Autism,” “Aspergers,” and “High Functioning Autism.” The resulted articles that could be obtained in English and contained data for more than one group were included in the analysis. Data synthesis: Cohen's d was calculated for each reported variable (execution time, decision time, number of trials, rule violation, time violation, and total scores) on the information provided in each article. Results indicate moderate-to-large effect sizes on the reported variable. Conclusion: Widely used to assess executive functioning in ASD, tower tests are sensitive in detecting executive functioning deficits in autism and has discriminating power between individuals with ASD and normal control groups.
NEUROPSYCHOLOGICAL DOMAINS: MEMORY AND AMNESIA
Normative Data for Logical Memory Story A in Alzheimer's Disease and Normal Controls
Objective: Story A from the Logical Memory (LM) subtest of the Wechsler Memory Scale-R/III (WMS-R/WMS-III) is sometimes administered in isolation for screening or research purposes. Cutoffs for impairment have been proposed for Story A, but no data have been presented demonstrating the equivalence of Story A and the standard version. Method: Three hundred and eighty participants with Alzheimer's disease (AD) and 152 healthy controls of similar age and education were administered either Story A or the full version of the WMS-R/III LM I and II subtests as part of a larger neuropsychological battery. Individual story scores and retention rates were compared across groups with analysis of variance (ANOVA). Results: Controls demonstrated significantly better Story A delayed recall (13.3 vs. 11.8) and percent retention (91.7% vs. 77.7%, p < .05) when administered Story A alone compared with those who were administered the full LM subtest. A similar pattern for retention rates was seen in the AD sample (41.4% vs. 31.8%), but was not significant. Conclusion: LM Story A delayed recall and retention rates were lower when Story A was administered along with Story B in the standard format compared with Story A alone in older controls and Ss with AD, suggesting interference effects related to Story B. As such, impairment cutoffs (e.g., 1 SD below M) need to be adjusted when Story A is administered in isolation (e.g., <9 vs. <7). These results highlight the impact changes in administration procedures can have on test performance.
The Benton Visual Retention Test and Mediating Learning Variables: Distinguishing Item Sophistication
Objective: Intelligence combined with age and education was found to influence performance on varied neuropsychological tests, however the extent to which these learning variables mediate memory is not clearly established within the Benton Visual Retention Test (BVRT). The purpose of the study is to elucidate the role of the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) (Verbal Comprehension Index/VCI, Working Memory Index/WMI, Perceptual Organization Index/POI), age, and years of formal education on the BVRT. Method: U.S. veterans within the Palo Alto VA Healthcare System were randomly and consecutively referred for neuropsychological assessment. No exclusion criteria were used. These veteran patients exhibited mixed medical and neuropsychiatric diagnoses. They were administered the WAIS-III and the BVRT; factor scales were composed. To clarify the influence of age and education on memory, the WAIS-III was removed from the analyses. Results: The analyses revealed that VCI, WMI, and education factored together, whereas age negatively correlated with items 3–10 on the BVRT. POI factored together with both verbal and non-verbal items on the BVRT. Age was found to be uniquely related to BVRT items 3–10 (non-verbally mediated/memory) and had a mild influence on items 1 and 2 (verbally mediated/memory). Consequently, education influenced items 1 and 2 on the BVRT. Conclusion: The results, in this sample, suggested that education mediated the verbal learning strategy on items 1 and 2 and that the latter items do not adhere to this construct. Furthermore, the BVRT items 3–10 have a sophisticated crystallized component, as POI contributed to an age-related non-verbal learning intellectual strategy, which describes a more complex memory structure.
Relationship of Working Memory When Compared to Memory Indices Measuring a Related Concept
Objective: The authors studied the relationship between Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) and Wechsler Memory Scale-Fourth Edition (WMS-IV) measures of working memory. Method: Participants consisted of 20 adults aged 19–68 years (M = 34.20, SD = 13.87) from a clinically referred population. The sample was 65.0% females, 60.0% Caucasian, and had an average education level of M = 13.38 years (SD = 2.06). Index scores from the WMS-IV including Visual Working Memory, Visual Memory, and Auditory Memory (AMI) and WAIS-IV including Working Memory (WMI) were utilized in analyses. Results: Moderate positive linear relationships were found between WMS-IV Visual Working memory and WMS-IV Visual Memory (r(20) = .572) and WAIS-IV Working Memory and WMS-IV Visual Working Memory (r(20) = .686). There were no significant correlations between the AMI and the WAIS WMI. Conclusions: The authors of the new revisions of the Wechsler Memory and Intelligence scales have indicated that the Working Memory subtests were divided between the two tests because the WAIS was supposed to measure Auditory Working Memory, whereas the WMS was supposed to measure Visual Working Memory. It was hypothesized that these processes should relate to their counterpart memory tests the Auditory Memory Index and the Visual Memory Index of the WMS-IV. The hypothesis was partially supported. Significant correlations were noted between the VWMI and the VMI, but there was no significant correlations between the AMI and the WAIS WMI. It was initially thought that the processes involving working memory should relate because they are involved in the client's initial ability to consolidate memory, but this was not found.
Relations of Depression Factors in Encoding Strategies and Verbal Memory
Objective: Little research has examined the relationship between factors of depression and their relationship to encoding strategies and verbal memory performance. Depression factors created through a factor analysis will be examined to determine what aspects of depression predict deficits of encoding and verbal memory ability. Methods: Forty-five depressed patients and 41 healthy control adults participated in the study. The 24-item Hamilton Depression Rating Scale (HDRS) was used to measure depression severity, and the California Verbal Learning Test-Second Edition (CVLT-II) was used to measure encoding strategies (semantic, subjective, and serial clustering) and verbal memory performance (CVLT-II Trials 1–5). Results: Based on preliminary results, six factors were created from the HDRS through factor analysis, which explained 75.6% of the variance. Correlations between the depression factors and the verbal memory and encoding scores indicated that only the sleep/cognitive factor was consistently related to these CVLT-II scores. A multiple regression with the sleep/cognitive factor and the three encoding strategies significantly explained 54% of the variance for verbal memory. The sleep/cognitive factor was partially mediated by encoding strategies in predicting verbal memory. This depression factor (Beta = −.162), semantic clustering (Beta = .703), and serial clustering (Beta = .445) were found to be unique predictors (p < .05). Subjective clustering (Beta = .470) did not have significant unique contributions to the regression model (Beta = .191, p = .19). Conclusions: Only one of the six factors of depression (specifically sleep/cognitive) predicted encoding strategies and verbal memory performance. These findings suggest that depression is not a unitary construct and that only specific depression symptoms affect a patient's ability to encode and remember verbal information.
Factor Analysis between Wechsler Adult Intelligence Scale-Third Edition and California Verbal Learning Test-Second Edition Show Common Working Memory Pathways in Adult Brain Functions
The California Verbal Learning Test-Second Edition (CVLT-II) is a widely used test that measures different measures of memory encoding and retrieval. This study looks at a quantitative and qualitative, comprehensive comparison of the primary CVLT-II factors: verbal comprehension (verbal attention without attention span), perceptual organization (non-verbal intellectual ability), and speed/attention/concentration (freedom of distractibility). When the main components of this test were analyzed using factor analyses, it was found that memory retrieval factors correlated highly between primacy and serial variables, education with verbal comprehension and ability, perceptual organization with age, and freedom from distractibility combined to explain 77.37% of the variance. When these factors were juxtaposed with Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) variables, it was found that there is an overlap with 77.7% of the variables explaining variance. There appears to be a working memory component that is shared by the CVLT-II and WAIS-III variables when both primacy and serial processing are included in the factor analyses. As the CVLT-II is primarily a verbal attention and retention task, there is no clear separation between how many words are recalled in order to distinguish what is primarily identified as “primacy,” or “recency.” The related factors of attention and working memory played a key role in determining how accurately the patient recalled words from the CVLT-II.
Memory Profile Patterns Across Developing Youth: An Examination of the Test of Memory and Learning
Objective: In order to understand atypical memory patterns in children and adolescents today, it is crucial to first understand normative memory development patterns. The current study examined raw scores of the Test of Memory and Learning's (TOMAL) standardization sample in order to ascertain how and when memory components progress across children and adolescents. Method: Participants included 1,121 youth between 5 and 19 years of age selected from the TOMAL standardization sample. Subtest raw scores were analyzed in an exploratory two-step cluster analysis to determine age-segregated clusters. Descriptives of these clusters then served as a base to run a series of bootstrap discriminant function analyses. Classification rates were compared to establish the age ranges that best captured differential memory patterns. Results: The two-step analysis extracted three clusters that differed on age (p > .01) but not on gender or ethnicity. Clusters had mean ages of 7.1 (SD = 1.8), 11.1 (SD = 2.7), and 13.5 (SD = 2.9). Repeated discriminant function analyses indicated that age ranges between 5 and 8 years, 9 and 11 years, and 12 and 19 years best represented differential memory development patterns across age with an overall 77.1% classification rate. The cutoff ages of 9 and 12 concord with existing theory, and inspection of raw subtest scores suggest that several subtests of both visual and verbal modality improve markedly at these age points. Discussion: Results provide preliminary evidence that overall normative memory development progresses rapidly between 5 and 8 years of age, somewhat more slowly between 9 and 11 years of age, and levels off between 12 and 19 years of age.
Assessment of Memory: Utility of the Mini-mental State Examination Three-Word Recall Task
Objective: This study examined patients on a geriatric psychiatric unit who passed the Mini-mental State Examination (MMSE) (total score greater than 24), but achieved scores on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) delayed memory index which suggested memory impairment. The MMSE three-word recall task was examined to determine if performance on this task helped identify the memory impaired individuals. Data selection: Participants were 76 senior adults (mean age = 76.13, SD = 8.9; mean education = 11.94, SD = 2.3) hospitalized on a rural geriatric psychiatry unit and earning an MMSE Total Score greater than 24 at admission. Patient's scores on the RBANS Delayed Memory Index were examined using independent sample t-tests for differences relative to their MMSE three-word recall task score. Patients scoring a 0 comprised group 1 and patients scoring a 3 comprised group 2. Data synthesis: Patients scoring a 0 on the MMSE three-word recall task scored on average more than 3 SD below the mean on the RBANS Delayed Memory Index (M = 61.81). Patients scoring a 3 were on average 1 SD below the mean on this index (M = 81.27). This mean difference was statistically significant (t = −3.901, df = 74, p < .0001). Conclusions: In a hospitalized geriatric population, approximately 40% of the patients passing the MMSE have impaired short-term memory. The MMSE three-word recall score helps to identify these patients. This study suggests that the MMSE is most useful if individual domains are examined and not just the total score.
Improved Memory Functioning Subsequent to Diffuse Bilateral Hippocampal Damage from Predominantly CA1 Involvement: A Case Study
Objective: The relationship between hippocampal function and memory has long been a cornerstone of neuropsychological investigation. Anoxia is a well-known cause of hippocampal damage, and bilateral hippocampal damage has been associated with enduring memory impairment. However, there exist relatively few cases of documented bilateral hippocampal damage in patients who have not suffered traumatic brain injury or other progressive neurological disease, and who have demonstrated improvement of function. Method: We report the case of a 56-year-old woman who presented with initial retrograde and anterograde amnesia as a result of attempted suicide by drug overdose that resulted in bilateral hippocampal damage from hypotension and anoxia. Patient Mrs. K was assessed at bedside during her initial hospitalization, followed by a full neuropsychological evaluation as an outpatient 2 months later, with a short follow-up visit completed at 5 months. MRI and neurological information were also available. Results: In the hospital, personally relevant autobiographical and public memory related to events within the past few years was impaired. Mrs. K was unable to learn new verbal information and did not appear to benefit from repetition or priming. MRI showed evidence of bilateral diffuse hippocampal infarction predominantly involving CA1. At 2 months, Mrs. K evidenced improvement but still deficient verbal memory performance. She now appeared to benefit from repetition and priming, and evidenced low-average to average intelligence with relatively preserved verbal abilities. Five months after initial evaluation, Mrs. K continued to show general improvement. Conclusion: This case provides evidence that limited recovery of memory function is possible after bilateral hippocampal damage.
Refining the Clinical Interpretation of Memory Assessment on the Wechsler Memory Scale-Fourth Edition (WMS-IV): Base Rates of Low Demographically Adjusted Memory Scores
Demographically adjusted normative data are used to improve the accuracy of clinical inferences relating to acquired memory deficits. The purpose of this study was to present the prevalence of low demographically adjusted scores on the Wechsler Memory Scale-Fourth Edition (WMS-IV; Wechsler, 2009) for healthy adults. Participants included 686 healthy adults (16–69 years of age) who were part of the WMS-IV standardization sample and had demographically adjusted normative scores (i.e., adjusted for sex, age, education, and ethnicity). The WMS-IV contains four tests of learning and memory (logical memory, verbal paired associates, designs, and visual reproduction) that provide eight scaled scores. Base rate analyses involved consideration of these subtest scores simultaneously, stratified by Test of Premorbid Functioning (TOPF)-demographic predicted intelligence. Considering below the 10th percentile as a cutoff (SS ≤ 6), one or more low demographically adjusted WMS-IV scores occurs in 64.7% with unusually low, 37.0% with low average, 36.7% with average, 29.7% with high average, and 20.0% with superior/very superior predicted intelligence. When considering only delayed memory scores, one or more scores <10th percentile is found in 35.3% with unusually low, 30.1% with low average, 28.1% with average, 22.9% with high average, and 20.0% with superior/very superior predicted intelligence. Using demographically adjusted normative data essentially eliminates the role of age, sex, and education, and lessens the moderating effects of intelligence, on memory test scores. These results have important implications for identifying memory impairment using existing diagnostic criteria.
Using Virtual Reality to Study Prospective Memory and Executive Functioning in Healthy Adults
Traditional neuropsychological assessment is presently known for its weakness in diagnosing executive disorders such as those we can see in daily life. In response to this criticism, some researchers have used virtual reality to develop assessment protocols for prospective memory or executive function disorders (McGeorge et al., 2001; Sweeney et al., 2009). In the same manner, this poster presentation aimed to demonstrate how virtual reality can be complementary to traditional neuropsychological tools in the assessment of prospective memory. In order to attain this objective, we have assessed 94 healthy adults who have accomplished prospective memory tasks both in a virtual apartment and in laboratory conditions. The surprising results obtained after the first experiment showed no correlation between laboratory and virtual reality tasks. In order to determine the best method for interpreting this finding, we have conducted a PAF analysis. This method has revealed the presence of two different factors that makes the distinction between virtual and laboratory measuring. Our second experiment aims to understand where the differences between these two measurements are. We have assessed 52 healthy adults in conditions similar to those of experiment 1 with the variable being the elimination of the ongoing task. The results have demonstrated that our virtual reality protocol can assess multitasking capacities much in the same way as a Multiple-Errands Test (Shallice & Burgess, 1996). Finally, one drawback in the experiment is the ease with which the prospective memory tasks can be accomplished. One advantage to this assessment is its ecological value and capacity to detect subtle executive problems.
PROFESSIONAL ISSUES: TEST DEVELOPMENT AND METHODS
Neuropsychological Evaluation Outcomes for Children and Adolescents with Learning Disabilities
Objective: This study investigates academic, social, and emotional functioning in children with learning disabilities following neuropsychological evaluations (NEs). Method: Participants are parents of school-aged children completing NEs for learning disabilities at a private practice. Fifteen parents completed surveys at intake and 28 completed surveys following NEs. Children's functioning was measured using the Achenbach Child Behavior Checklist (CBCL) and a newly constructed Academic Scale. Parents were asked about their satisfaction, adherence to recommendations, and how well they understood their child's needs. Data collection is still underway; final results will include a longitudinal sample comparing data from the same parents at intake and following NEs. Results: Preliminary factor analysis of the academic scale indicates three factors: academic skills (reading, writing, math), attention/executive functioning, and social skills. No differences were found between academic scale scores at intake versus follow-up. Parents at follow-up more often reported that they “definitely” understood their child's academic/learning needs (43%) than parents at intake (13%). Similarly, parents at follow-up more often reported that they “definitely” understood their child's behavior (39%) than at intake (13%). CBCL scales indicated greater concerns about children's emotional functioning at intake. At follow-up, parents reported that they were “very satisfied” (82%) or “mostly satisfied” (18%) with the evaluation and that they followed recommendations (82%). Conclusions: Longitudinal data from a larger sample are currently being collected to address research questions. Preliminary results indicate that parents of children who completed NEs report a better understanding of their child's needs and report fewer emotional symptoms than parents just beginning the evaluation process.
Abbreviated Category Fluency: 30 Seconds is All You Need
Objective: Because patients often generate most of their responses early in verbal fluency tests, we assessed the comparability of a shortened measure of category fluency. Participants and methods: Using scores from the traditional 1-min animal fluency test, we studied 30- and 60-s scores in 447 SS with Alzheimer's disease divided into two groups (a training group [N = 223] and validation group [N = 224]). Using a regression model and the data from the training group, initial 30-s scores were used to predict 1-min total scores; the regression weights from the training set were then applied to the validation group. Both estimates were then compared with the actual total score in both groups. Results: The training and validation groups were similar in age, education, age at onset of illness, and Mini-mental Status Examination (MMSE). Estimated and obtained total scores in the training set were highly correlated (r = .938) and had high agreement (ICC = .936) with the means for the estimated and obtained scores of 10.06 and standard deviations of 4.99 and 5.32, respectively. When the weights from the training group regression model were used to estimate scores in the validation group, results were identical, with high correlations (r = .937), agreement (ICC = .937), and equality (t = −1.35, p = .1793) with means for the estimated and obtained scores in this validation group 10.13 (SD = 4.95) and 9.97 (SD = 5.04), respectively. Conclusion: We found high agreement between the score for the first 30 s and 1 min on animal fluency, suggesting that in dementia patients, using the first 30 s provides a reasonable assessment of category fluency.
Older Adults' Learning, Memory, and Copy Performance on the Rey-Osterrieth and Modified Taylor Complex Figures
Objective: The Rey-Osterrieth (ROCF) and modified Taylor (MTCF) complex figures generally produce comparable accuracy scores on learning, memory, and copy in adults, although Hubley (2010) raises questions about the comparability of copy scores in older adults. The purpose of this study was to examine, in older adults, whether the two figures show comparable (a) accuracy scores on learning, memory, and copy, (b) performance by gender, and (c) correlations between accuracy scores and both age and education. Method: The sample consisted of 86 adults (18 men, 68 women), aged 55–78 with 8–21 years of education, recruited from the general community. A between-groups design was used wherein participants received either the ROCF or the MTCF. An intentional memory procedure (four learning trials, delayed recall, and copy) was employed. Figures were scored using the standard accuracy scoring systems (see Lezak et al., 2004). Results: Independent sample t-tests and Mann–Whitney U-tests (as appropriate depending on the normality of the data) indicated that there were no significant differences between (a) the ROCF and MTCF on learning, memory, or copy trials, or (b) men and women on any trial for either figure. Correlations between age and accuracy scores were low (r = −.09 to −.39) and correlations between education and accuracy scores were low to moderate (r = .28 to .51). Using Fisher's Z-test, there were no significant differences between the two figures in these correlations. Conclusions: The results of this study support the comparability of learning, memory, and copy accuracy scores on the ROCF and MTCF in older adults.
Exploration of the Validity of the Neuropsychological Symptom Inventory in a Sample of Renal Patients
Objective: The Neuropsychological Symptom Inventory (NSI; Dean, 1989) is a self-report measure of neurological and psychiatric symptoms. The present study seeks to provide evidence for the validity of this instrument as a measure of neuropsychological impairment by evaluating its ability to predict scores on the L, F, and K scales of the Minnesota Multiphasic Personality Inventory (MMPI) (Hathaway & Mckinley, 1967). Method: The sample consisted of 61 adults with renal disease. This sample was selected because renal patients are known to exhibit neuropsychological deficits (Brown & Brown, 1995). Patients completed the MMPI and the NSI. Linear regression analyses were conducted to evaluate the relationship between the severity of neuropsychological symptoms as measured by the NSI and scores produced on the L, F, and K scales of the MMPI. Note that lower scores on the NSI indicate greater impairement. Results: Linear regression analysis revealed that NSI scores accounted for 38% of the variance in scores on the F scale (B = −.140, p < .001), 36% of the variance in scores on K scale (B = .124, p < .001), and 28% of the variance in scores on the L scale (B = −.130, p < .001). Conclusions: These findings suggest that as the severity of symptoms reported on the NSI increase, so do scores on the MMPI's F scale. This lends credence to the NSI as a measure of psychological symptomatology. Significance of the relationship between the NSI and the L and K scales will also be discussed, as will future research considerations and clinical applications of the NSI.
An Examination of the Factor Structure of Responses to the Center for Epidemiological Studies Depression Scale (CES-D) in Chronic Kidney Disease Patients
Objective: Chronic kidney disease (CKD) is an increasingly common illness among middle-aged and older adults, and is associated with cognitive decline and depression. The Center for Epidemiological Studies Depression Scale (CES-D) is a widely used self-report screening measure on which responses generally conform to a four-factor structure, with each factor loading onto a higher-order depression factor. The current study examines whether this structure is supported among CKD patients. Method: CKD patients (n = 225; ages 19–89) and healthy controls (n = 230; ages 19–91) were recruited from Vancouver General Hospital and the community. Inclusion criteria were English fluency and a minimum of a 6th grade education. Exclusion criteria included psychosis, acute illness, neurological disorder, or other organ failure. Results: Confirmatory factor analytic models were computed for CKD and control participants. Results support the four-factor structure of CES-D responses in CKD (χ2[df = 155] = 196.25, p = .01, power = .99) and control participants (χ2[df = 162] = 199.67, p < .05, power = .99). The hierarchical structure of CES-D responses also appears invariant between groups (χ2[df = 318] = 401.72; CFI = .97; SRMR = .044; RMSEA = .024, .016 < RMSEA CL90 < .031). Factor structure was similar between groups; only for depressive affect was the strength of association for the second-order factor greater among CKD than control participants (Δχ2[Δdf = 1] = 5.43, p > .05; CFI = .96; SRMR = .054; RMSEA = .030, .023 < RMSEA CL90 < .036). Conclusions: Findings support the similarity of CES-D factor structures between CKD and non-kidney disease participants. Results also suggest that the CES-D's four factors contribute to measurement of a higher-order depression factor in both groups. Furthermore, three of the four factors appear invariant between groups. Results suggest that the CES-D may be used confidently with CKD patients.
10-Year Publication Trends in the Archives: Moving Toward a Positive Neuropsychology?
Objective: The field of positive psychology—emphasizing strengths and aptitudes to promote mental health—has gained considerable momentum recently. Despite tremendous growth in the neuropsychology literature over the past 10 years, few studies address positive neuropsychology (PNP)—the study, promotion, and enhancement of cognitive health. The present study aimed to examine 10-year publication trends in Archives of Clinical Neuropsychology to determine whether there has been a noticeable shift in publication of PNP-oriented manuscripts. Data selection: Titles and abstracts from all empirical papers published in the Archives in 1999, 2004, and 2009 (N = 145) were reviewed and classified into categories based on primary study aims. Primary manuscript categories included deficit characterization, symptom validity testing, new/existing measure validation, general methodological research, examination of normative cognitive functioning, neuroimaging, diversity, intervention effects on cognition, and cognitive rehabilitation in normal and patient groups. Data synthesis: Review of Archive papers across the sampled years indicated a predominant focus on characterizing deficits in neurological conditions (31%), validating new neuropsychological measures (31%), validating symptom validity measures and procedures (13%), and statistical/methodological issues (9%). Although there was a trend toward increased publication of normative cognitive functioning studies, there was no other increase in PNP-related publications in the 10-year period sampled here. Conclusions: There is minimal evidence that the field is moving toward promotion of cognitive health as gleaned from Archive publication trends over the past 10 years. Future directions to promote a shift from a focus on characterization of pathological brain–behavior relationships toward a PNP focus are discussed.
Part-Whole Stability of Performance on a Controlled Oral Word Association Task
This study examined the relationship of productivity during 15-s intervals on a controlled oral word association task in a sample of 126 participants referred for neuropsychological assessment. The correlations among the productivity during the first through fourth 15-s interval and overall productivity (range = .794 to .885) and correlations among intervals (range = .620 to .852) were consistently high. The productivity during the second (R = .787, SEE = 2.116) and third (R = .752, SEE = 1.956) intervals were significantly related to the productivity during the other intervals, even when the effects of demographic variables were controlled. Although the productivity during the first interval was significantly related to productivity during the other intervals (R = .739, SEE = 2.659), productivity on the fourth interval did not make a significant contribution. Similarly, productivity during the fourth interval was significantly related to productivity during the second and third intervals (R = .703, SEE = 2.185) but the contribution of productivity during the first interval was not significant. This suggested that performance on the first and final trials was determined in a different manner than productivity during the second and third intervals. The effects of the demographic variables included in this study were similar to those reported by other researchers. That is, age and education had a significant impact on overall productivity, whereas gender had only a modest association with productivity. Overall, these analyses indicated that part-scores share a similar basis and that differences among them might be clinically significant.
Factor Structure of the Maternal Perinatal Scale
Objective: Although the rate of infant mortality has dropped over the past century, the most recent figure has not changed significantly in the last 10 years, maintaining a steady rate of approximately 6.71 deaths per 1,000 live births (MacDorman & Mathews, 2008). The lack of success that decreases infant death warrants additional research in the area of prenatal assessment to positively influence the trend in infant mortality. The Maternal Perinatal Scale (MPS; Dean & Gray, 1985) is a 28-item self-report measure that was developed to ascertain the risk that perinatal complications carry on poor developmental outcomes. Previous factor analyses on the MPS yielded 10 factors, not improving the ease of interpretation as the original scale has only 28 items. The purpose of this paper was to create a more interpretable factor structure to allow for future studies to implement scoring criteria to increase interpretability of the scale. Method: Archival data from 714 participants were used. The mean age of mother was 34.50 years (SD = 9.72; median = 33). The age of the child in question was no more than 5 years old at the time of evaluation. Results: The seven-factor solution accounted for some 43.98% of the total variability, a slightly simpler solution than the aforementioned. Implications: This structure allows for more strategic scoring criteria to increase the utilization of the MPS in clinical practice. By adding scoring criteria to each item, validated by factor cutoff scores, this measure has a potential to be even more useful in clinical practice.
Factor Analysis of the Personality Assessment Inventory in a Neuropsychological Population
Objective: Research has investigated the use of the Personality Assessment Inventory (PAI) within specific clinical populations, such as eating disorders and alcohol dependence. The studies have replicated the normative four-factor structure of the PAI (Boyle & Lennon, 1994; Schinka, 1995). However, no research has examined the factor structure of the PAI in neuropsychological populations, which the current study was designed to do. Method: Participants included consecutive referrals for comprehensive neuropsychological evaluations in either an outpatient multispecialty practice or a university training clinic who completed the PAI. Participants were 45% males and 55% females, with a mean age of 43.8 years (SD = 15.1) and mean education of 13.4 years (SD = 2.3). The sample was 88% Caucasian, 3% African American, and 9% from other racial backgrounds, with 75% clinical referrals and 25% forensic referrals. Results: Exploratory factor analytic results indicate a five-factor solution when all PAI scales were analyzed, with factors labeled distress, egocentricity, social detachment, substance abuse, and profile validity. When the validity scales were removed, validity factor was not found. Using only clinical scales, results indicated a two-factor solution. All analyses were consistent with a general distress factor, which accounted for approximately 40%–50% of the variance. Conclusions: Results essentially replicated the normative factor structure with slight differences. Specifically, differences in the five-factor solution included separate social detachment and substance abuse factors. The two-factor solution found only the distress factor and a combined egocentricity/substance abuse factor, whereas the four- and five-factor solutions were similar except for the lack of a validity factor in the four-factor solution.
Clinical Use of the Geriatric Depression Scale (GDS-15) in Young and Middle-aged Adults with Bipolar Disorder
Objective: The 15-item Geriatric Depression Scale (GDS-15) yields self-ratings of depression severity. It is brief, easy to read, and well-validated for use with older individuals as well as young and middle-aged adults. The aim of this study was to determine whether the GDS-15 is also suitable for clinical use with young and middle-aged adults with bipolar disorder. Method: We administered the GDS-15 to a community sample of adults and to participants in a study of work disability in bipolar disorder. Each participant completed either a structured psychiatric interview or a combined protocol including the Mini International Neuropsychiatric Interview Short-Version, Montgomery-Asberg Depression Rating Scale and Young Mania Scale. We then compared 96 young or middle-aged, healthy, non-depressed participants (controls) from the community sample with 72 individuals who met DSM-IV diagnostic criteria for bipolar disorder. Mean ages were 45 and 44, respectively. Results: With a cut-off score of 5 or more on the GDS-15, we used discriminant and receiver operating characteristic (ROC) analyses to distinguish between bipolar and non-depressed participants. This cut-off correctly classified 100% of individuals with bipolar disorder who were experiencing a depressed/mixed state at the time of assessment, while also correctly classifying 95% of controls as non-depressed. Of those with bipolar disorder, 81% in partial remission and 41% in full remission were correctly classified, as were 99% of controls in both instances. Conclusions: In addition to being appropriate for use in young and middle-aged adults with depression, the GDS-15 shows very good diagnostic sensitivity and specificity for individuals with active symptoms of bipolar disorder.
Measurement Invariance of the Geriatric Depression Scale-15 (GDS-15): Does Gender, Age, or Education Bias One's Scores?
Objective: The 15-item Geriatric Depression Scale (GDS-15) is commonly used to screen for depression across a wide age range in clinical and community settings. The purpose of this study was to examine the measurement invariance of the 15-item Geriatric Depression Scale (GDS-15) across gender, age, and educational levels. Method: The sample consisted of 896 community dwelling adults (418 men, 478 women), ages 16 to 94 with 2 to 21 years of education, who completed the GDS-15. A series of multi-group confirmatory factor analyses (MG-CFA) using Robust Maximum Likelihood estimation were conducted on these data to test for measurement invariance. Results: The GDS-15 showed measurement invariance across gender. This means that, all other things being equal, men and women with the same latent (true) level of depression obtained the same observed score on the GDS-15. This was not the case for age and education, however. That is, all other things being equal, individuals with the same latent (true) level of depression scored differently on the GDS-15 only because of (a) their age or (b) their educational status. Conclusions: The presence of measurement invariance for gender means that men and women can be meaningfully compared using the GDS-15 and that gender alone does not bias one's scores. The lack of measurement invariance across age and education in the GDS-15, however, may lead to reported differences in depressive status that do not represent true differences in depression but rather individuals’ membership in an age or educational group.
The Relationship between the NEO Personality Inventory-Revised (NEO PI-R), Beck Depression Inventory Fast Screen for Medical Patients (BDI-FS), and the Beck Anxiety Inventory (BAI): An Instrument Validity Study in an Acute Rehabilitation Hospital
Objective: To find the correlation between the facet scale scores of depression and anxiety in the personality inventory, Revised NEO Personality Inventory (NEO-PI-R; Costa & McCrae, 1992) with the Beck Depression Inventory Fast Screen for Medical Patients (BDI-FS; Beck et al., 2000) and the Beck Anxiety Inventory (BAI; Beck, Epstein, Brown, & Steer, 1988). Method: The BDI-FS, the BAI, and the NEO-PI-R were administered to 52 individuals on the Spinal Cord Injury unit of an acute rehabilitation hospital. The patients invited to the study included those with traumatic spinal cord injuries, neurological disorders, and spinal stenosis and/or back procedures. The participants were a cross-sectional random selection of patients admitted to the SCI unit. They were recruited by the researchers upon admission. Results: The Anxiety subscale of the NEO-PI-R had a moderate correlation with the BAI (r (n=52)=.31, p=.024), with a 95% confidence interval of 0.045 to 0.54. The Depression subscale of the NEO-PI-R also had a moderate correlation with the BDI-FS (r(n=52)=.557, p<.000), with a 95% confidence interval of 0.336 to 0.72. Conclusions: The results of our analysis show support for the instrument validity of the BDI-FS and the BAI in an acute rehabilitation hospital setting. Further research with a larger sample size is required to find stronger support for the instrument validity of the BDI-FS and the BAI by using their correlation with the facet scale scores of the NEO-PI-R.
Poster Session D
DEVELOPMENTAL AND PEDIATRIC: ATTENTION-DEFICIT/HYPERACTIVITY DISORDER
Cross-Cultural Comparison of Attention, Mood, and Behavior Problems: Japanese and U.S. College Students
Objective: The purposes of this study were to compare levels of Attention-deficit/Hyperactivity Disorder (ADHD) symptoms of Japanese college students to U.S. peers, to estimate prevalence rates in both populations, and to examine the relationship between ADHD symptoms and other behavioral and mood problems. There is little cross-national research in this area, and these results are among the first to identify such problems in Japanese college students. Method: Participants included 271 U.S. and 712 Japanese college students who completed a rating scale assessing the 18 Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition-Text Revision (DSM-IV-TR) symptoms of ADHD as well as a measure of other behavior and mood problems (Achenbach Adult Self-Report or Youth Self-Report). Results: Japanese students reported higher levels of childhood (F(1, 957) = 30.64, p < .001) and current (F(1, 959) = 37.11, p < .001) problems with inattention resulting in higher levels of overall ADHD symptoms (childhood F(1, 949) = 6.17, p = .01); current F(1, 948) = 17.15, p < .001). Using DSM-IV-TR symptom thresholds, 5.70% of U.S. students and 6.26% of Japanese students reported enough symptoms to meet the cutoff for inattentive, hyperactive/impulsive, or combined type during childhood; 2.66% of U.S. students and 4.52% of Japanese students reported enough symptoms to meet the cutoff for one of the three subtypes currently. ADHD symptoms were significantly correlated with mood and other behavioral problems in both groups of students. Conclusions: These rates are consistent with expectations based on previous research and indicate that it is possible to assess and identify ADHD symptoms in Japanese college students. Higher self-report of problems by Japanese students was unexpected.
Cross-Cultural Invariance of Attention-deficit/Hyperactivity Disorder Factors
Objectives: Prior research with children generally supports the two-dimensional structure of Attention-deficit/Hyperactivity Disorder (ADHD) symptoms (I and H/I factors) in the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition-Text Revision (DSM-IV-TR) and that this structure is invariant across cultures. Research with adults supports either a two-factor or three-factor structure depending on reporting source. However, research with adults is limited and there are few studies addressing cross-cultural invariance in adults. The purposes of this study were to (1) assess relative fit of two- versus three-factor solutions for self-report of recent ADHD symptoms in adults and (2) further establish cross-cultural invariance of factors. Method: Participants included 271 U.S. and 712 Japanese college students who completed a rating scale assessing the 18 DSM-IV-TR ADHD symptoms. Confirmatory factor analysis using Mplus (Version 6) and the mean and variance-adjusted weighted least-squares (WLSMV) procedure were used to test invariance of two- and three-factor models across U.S. and Japanese samples. Results: The two- and three-factor models showed similar fit indices (two-factor CFI = .929, TLI = .936, RMSEA = .079, WRMR = 3.976; three-factor CFI = .929, TLI = .936, RMSEA = .079, WRMR = 4.002). The same model seems to hold for U.S. and Japanese participants. Conclusions: Neither a two-factor nor a three-factor model was clearly superior. The two-factor model is more parsimonious and consistent with current theory. The study supports cross-cultural invariance of factors and is consistent with prior research with Australian, Brazilian, German, Malaysian, Puerto Rican, Spanish, and Taiwanese children as well as Chinese and New Zealand adults. Collectively, this research supports the use of current ADHD diagnostic criteria internationally.
Differential Cognitive Performance in Children with a Primary Diagnosis of Attention-deficit/Hyperactivity Disorder (ADHD) or Traumatic Brain Injury (TBI)
Introduction: Attention-deficit/hyperactivity disorder (ADHD) and traumatic brain injury (TBI) are two of the most common childhood disorders and can be difficult to distinguish one from another due to similar clinical and behavioral manifestations. The purpose of the current study was to investigate and differentiate cognitive processing differences in children with ADHD and TBIs according to the Cattell–Horn–Carroll (CHC, i.e., Carroll, 1993) cognitive processing theory. Methodology: The current study examined 129 children; 59 ADHD and 70 TBI (mean age = 11.26, SD = 3.36) who had been referred for a neuropsychological assessment and were given a primary diagnosis of ADHD or TBI. Each participant completed, as part of a comprehensive battery, 14 cognitive subtests that were selected from the Woodcock–Johnson Psycho-Educational Battery-Third Edition (WJ-III; Woodcock, McGrew, & Mather, 2001). Results and summary: The results of a multivariate analysis of variance (MANOVA) indicated that cognitive differences on subtests did indeed exist between the two groups (Wilks' Lambda = .761, F(13, 128) = 2.780, p = .002). Overall, the group with ADHD performed at a higher level than did the group with TBI in cognitive tasks. The group with ADHD performed significantly better on 5 of the 13 subtests administered including: sound blending, visual matching, numbers reversed, memory for words, and pair cancellation. Findings suggest differences in the areas of processing speed (Gs), auditory processing (Ga), and short-term memory (Gsm).
Risk Factors for Neurodevelopmental Disorders
Objective: Pediatric neuropsychological evaluations often involve children who have many early life risk factors for Attention-deficit/Hyperactivity Disorder (ADHD), learning disorders (LD), or intellectual disabilities. Some early risk factors may negatively affect brain development and subsequent cognitive functioning and behavioral regulation. Low birth weight, early life abuse/neglect, and preschool developmental disorders are associated with later occurring academic and behavioral problems. Our research hypothesis is that abuse/neglect, birth weight, birth hypoxia, and preschool developmental disorders (in speech and motor function) are significantly associated with later occurring ADHD, LDs, and diagnosed behavioral and emotional problems. Method: This study involved 22 (15 boys, 7 girls) consecutive neuropsychological evaluations with mean age = 11.6 years, mean birth weight = 7.9 pounds, and mean Full Scale IQ (Wechsler Intelligence Scale for Children-Fourth Edition; WISC-IV) = 88. Variables measured include: birth weight, apgar scores, birth hypoxia, preschool developmental delay (Devdelay: speech or motor function), history of abuse or neglect, current diagnoses involving ADHD, LD, behavioral or emotional disorder (affective disorder, oppositional defiant disorder, conduct disorder, disruptive behavior disorder). Results: The strongest correlations included: abuse/neglect and later behavioral disorder (r = .52), birth hypoxia and devdelay (r = .39), Devdelay and ADHD (r = .33), and Devdelay and FSIQ (r = −.31). Birth weight had a weak correlation with other variables. Fifty-five percent of those who had developmental delays developed ADHD, but only 10% developed LDs. Using analysis of variance (ANOVA), those who suffered abuse/neglect were more likely to be diagnosed with behavioral/emotional disorders (F(1, 21) = 7.3, p < .05). Early life abuse is associated with a high incidence of behavioral problems, but has less of an effect on FSIQ, ADHD, or LD. Developmental delays appear to be a very strong risk factor for ADHD, but not for LD.
DEVELOPMENTAL AND PEDIATRIC: OTHER
Sequelae of Viral Meningitis: A Pediatric Case Study
Objective: This poster presentation will highlight a case study in which a child who contracted viral meningitis experienced debilitating sequelae, including ataxia and expressive aphasia. Prevalent neuropsychological research focuses on bacterial meningitis, given the greater cognitive and functional consequences of this form, including death in some cases. While viral meningitis is more common, significant sequelae are unusual, and literature on its neuropsychological impact is sparse. Method: This previously healthy, typically functioning 3-year-old initially presented to the Emergency Department with vague symptoms of the common cold, which rapidly progressed to an altered mental status. An initial MRI revealed increased signal in the cerebellar white matter, and viral meningitis was eventually diagnosed. Upon her transfer to an inpatient rehabilitation hospital, she received intensive physical, occupational, and speech therapies, as well as a neuropsychological evaluation. Results: During her 2-month inpatient stay, this patient made remarkable progress. At discharge, she was ambulating with supervision and her aphasia was improving. Neuropsychological evaluation conducted prior to discharge revealed largely intact cognitive skills in concept development and expressive and receptive vocabulary. Consistent with known neuropsychological sequelae of bacterial meningitis, this child revealed relative weaknesses in visual-motor integration and construction skills, reasoning, and fine motor coordination. Conclusions: This case study reflects an important and unique contribution to the literature on meningitis, as it documents the existence, albeit transient, of debilitating effects subsequent to viral meningitis. In addition, this neuropsychological evaluation highlights consistencies with cognitive deficits implicated in bacterial meningitis, suggesting that viral meningitis can also have significant neuropsychological effects.
Neuropsychological Outcome Following Admission to Pediatric Intensive Care
Objectives: The study aimed to explore neuropsychological function in children 3–6 months following hospital discharge from pediatric intensive care (PICU). Methods: A prospective study of children aged 5–16 years admitted to PICUs in the London area and healthy controls recruited from the general community. Children with previous conditions likely to have an impact on neuropsychological function were excluded. Recruitment of participants is ongoing. Currently, 65 children (41 boys and 24 girls) admitted to PICU (mean age: 9.97 years; SEM .43) and 61 matched controls have been recruited. The PICU group consists of 16 patients admitted with meningo-encephalitis, 15 with septicaemia, and 33 with other critical illnesses. Children's neuropsychological function was assessed using the Cambridge Neuropsychological Test Automated Battery (CANTAB) and the Children's Memory Scale (CMS), focusing on the domains of visual and verbal memory and attention. Results: Preliminary analysis revealed the PICU group underperformed the controls. Specifically, the PICU group performed worse on measures of pattern recognition memory (p = .07; p = .05), spatial working memory (p = .03; p < .01), spatial span (p = .07), visual sustained attention (p = .02), verbal recall memory (p = .05; p = .01), and verbal recognition memory (p < .01). Exploratory analysis indicated that these main effects were driven by poor performance in the children admitted to PICU with meningo-encephalitis and septicemia. Conclusion: Our results suggest impaired neuropsychological function in children following severe pediatric illness, with particular incidence in children with meningo-encephalitis and septicemia.
Neuropsychological Deficits Following Lesion in the Left Dorsomedial Thalamic Region: A Pediatric Case Study
Objective: Thalamic tumors are commonly associated with several neurocognitive deficits, including sensory loss, muscle weakness, decreased intellect, vision problems, and emotional dysregulation, as most sensory input is first relayed through the thalamus. The age of diagnosis, gender, histology, and type of treatment affect prognosis (Pathy, 2002). Thalamic tumors are rare and account for 2%–5% of pediatric brain tumors with no clear direction on optimal treatment (Crimmins, 2007). Method: Neuropsychological testing was administered on a 16-year-old Caucasian male, diagnosed with a left, dorsomedial thalamic tumor 1 year prior. He presented with academic, emotional, and motor difficulties. Due to the deep, central placement of the tumor, resection has not been undertaken; instead, close monitoring has been instituted. Results: Neuropsychological testing revealed average verbal intelligence and below-average non-verbal intelligence, with low-average working memory and below-average processing speed. Average reading and written language skills were found with below-average math skills. Contrasting intelligence test results, neuropsychological testing displayed stronger non-verbal than verbal learning and memory, with strengths in visuospatial, visuomotor, and motor domains. Weaknesses were found in attention, executive functioning, verbal fluency, phonological and auditory processing, expressive language, and emotional regulation. The individual endorsed many symptoms associated with depression and anxiety. Conclusion: Neuropsychological deficits consistent with processes mediated by left dorsomedial thalamus, including deficits in attention, organization, abstract thinking, memory, and mood. Language deficits are consistent with lesion in the dominant hemisphere. The importance of close monitoring and regular neuropsychological evaluation is discussed.
Asperger's Disorder Versus Non-Verbal Learning Disabilities: A Diagnostic Conundrum
Objective: The purpose of this study was to evaluate consistency of diagnosis for children with Asperger's Disorder (AS) or Non-verbal learning disabilities (NLD) in a group of children referred for a neuropsychological study of social competence. Method: Thirty-six children previously diagnosed with NLD and 27 children diagnosed with AS prior to entry in the study were evaluated using the Autism Diagnostic Interview-Revised (ADI-R) structured parent interview, IQ screening, and selected neuropsychological measures. The criteria for NLD were adapted from existing research protocols. To meet criteria for AS, each child needed to meet Diagnostic and Statistical Manual-Fourth Edition-Text Revision (DSM-IV-TR) criteria as well as to be below the cutoff for autism on the ADI-R parent interview but within the logarithm for AS on this interview and to show stereotyped interests but not language delay. Criteria for NLD varied across clinicians but in no child previously diagnosed with NLD had the ADI-R been completed. For children with AS, the ADI-R had been completed in less than 20% of the sample. Results: Of the 36 children in this study previously diagnosed with NLD, 18 were diagnosed with AS or another disorder. In the AS group, all diagnoses were confirmed. Review of the record found that the children previously classified as NLD had been diagnosed based on a verbal-performance IQ split of 15 or more standard score points (14) or based on parent report of a social skills deficit (2). Conclusion: This paper presents evidence in support of the use of a structured parent interview to rule out autistic spectrum disorders in children being evaluated for a possible non-verbal learning disability.
Analysis of Motor Functioning in Children with Pervasive Developmental Disorders
Objective: The present study examined neuropsychological differences in motor performance between children with a Pervasive Developmental Disorder (PDD) diagnosis and their normal counterparts. Methods: Participants in the PDD group were 49 children (mean age = 9.90, SD = 3.31) who had a primary diagnosis of pervasive developmental disorder NOS, autistic disorder, or Asperger's disorder (N = 49). All of the diagnoses were classified according to the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV, 1994) and the International Classification of Diseases, Ninth Revision (ICD-9, 1998). Participants in the normal group were 52 children (mean age = 10.78, SD = 4.00) who had no history of neurologic or psychiatric diagnosis. All of the children were administered the subtests of the Dean–Woodcock Sensory Motor Battery (DWSMB). The examiners were graduate-level students, who underwent training and supervision in the areas of neuropsychological, cognitive, and psychological assessment. Results: The results of a nominal regression analysis indicated significant differences in motor functioning between normal children and children with a PDD. Specifically, the two differed on expressive speech and grip strength. There was no statistical difference in the other motor areas (i.e., construction, coordination, gait and station, Romberg, mime movements, left–right movements, finger tapping). Conclusions: In this study, children with PDD presented with impaired expressive speech and grip strength. While expressive speech difficulties were expected, the grip strength impairment is a novel finding. Moreover, the results suggest that motor functioning should be included in standard pediatric neuropsychological examination.
Neuropsychological Findings in a Girl with Encephalitis Lethargica
Objective: Encephalitis lethargica (EL) describes an encephalitis with psychiatric, sleep, and movement disorders. The absence of viral antigens, the benefit of immunotherapies, and the presence of anti-neuronal antibodies and Cerebral Spinal Fluid (CSF) oligoclonal bands suggests it is an autoimmune disease. EL often remains undiagnosed and therefore untreated. We report initial neuropsychological findings of a girl who remained encephalopathic for two years until immunotherapy was begun. Method: A 12-yr-old previously healthy girl presented at age nine with headache and dyskinesias. Within one week she experienced visual hallucinations, then lost speech and ambulation. On the 12th day she was resuscitated for respiratory cardiac arrest, later requiring tracheostomy. CSF was inflammatory but demonstrated no viral antigens. EEG showed slowing but no electrographic seizures. Serial brain MRIs were negative. She showed no response to one course of immunoglobulin and steroids. Two years later the patient had not regained speech or ambulation. Re-examination of CSF showed oligoclonal bands and antiphospholipid antibodies. She underwent monthly immunoglobulin and pulse steroid treatments for six months. During treatment, the patient began speaking, walking, and performing daily living skills. Results: Preliminary neuropsychological testing performed six months after beginning treatment showed: Peabody Picture Vocabulary Test (PPVT) Receptive Speech SS of 67 (90% CI: 61–74) at the 1%tile with age equivalent of 7 yr-1mo. Weschler Abbreviated Scale of Intelligence (WASI) Full Scale IQ was 55 (90% CI: 52–62) at the 0.1 %tile with Verbal IQ at 55 (90% CI: 52–64) at the 0.1 %tile and Performance IQ of 61 (90% CI: 58–69) at the 0.5 %tile. She slowly completed Trails A & B. Conclusions: Significant neuropsychological sequelae follow dramatic improvement in autoimmune EL.
NEUROLOGICAL AND NEUROPSYCHIATRIC DISORDERS: OTHER
Case Report: Neurocognitive Findings in an Adult with Hypothalamic Hamartoma and History of Helastic Seizures Undergoing Presurgical Neuropsychological Evaluation
Objective: Hypothalamic hamartoma (HH) is a rare developmental malformation which commonly presents in young children with gelastic seizures and is highly pharmacoresistant, usually requiring resection. Our aim is to report the neurocognitive findings of an adult with epilepsy with a previously undiagnosed HH. Given that initial diagnosis in adulthood is less common, this study will contribute to our knowledge of the neuropsychological profile of patients with HH. Method: Neuropsychological test results were obtained from a 37-year-old, right-handed male as part of a presurgical evaluation. The patient's premorbid intelligence was estimated to be in the high-average range. He had just been terminated from his employment as a senior librarian due to anger outbursts. Results: Assessed verbal intelligence was average (Wechsler Adult Intelligence Scale-Fourth Edition [WAIS-IV] VCI = 100) and non-verbal intelligence was borderline (WAIS-IV PRI = 75). Working memory was borderline (6th percentile) and processing speed was low average (5th percentile). Verbal and visual memory, visual scanning, and motor speed were average (WMS-IV, California Verbal Learning Test-Second Edition [CVLT-II], Rey Complex Figure Test [RCFT], and Delis-Kaplan Executive Function System [D-KEFS Trails]). Impairments were noted in non-verbal problem-solving and mental flexibility (category test at 6th percentile), rapid semantic and phonemic retrieval (animal fluency at 1st percentile; Controlled Oral Word Association Test; COWA at 14th percentile) and confrontation naming (Boston Naming Test [BNT] at <1st percentile). Sequencing and switching on the D-KEFS Trails were low average. A relative weakness in non-dominant (left hand) motor performance and relatively greater right peripheral sensory deficits were observed. Conclusions: In contrast to published reports of memory deficits in patients with HH, this patient demonstrated intact memory in the context of executive deficits, suppressed IQ (VCI>PRI), and sensorimotor deficits.
Quality of Life and Driving Behaviors in Multiple Sclerosis
Objective: This study examined the relationship between quality of life (QOL) and driving behaviors in multiple sclerosis (MS). Driving behaviors were hypothesized to have moderate effects in the relationships between QOL and fatigue and QOL and depression, two well-established predictors of QOL in the MS literature. Methods: The current study is a subcomponent of a larger prospective study. All data were collected in an outpatient research setting and an outpatient driver rehabilitation program. Participants were 64 community-dwelling, licensed individuals with clinically defined MS between the ages of 23 and 56. Self-report questionnaires assessing driving frequency in days per week, change in driving status, fatigue, depression, and quality of life were administered. Results: Multiple regressions revealed fatigue and depression to be strong independent predictors of quality of life in MS (p < .001), consistent with the literature. Driving frequency (days per week) had significant independent predictive value in the fatigue (p = .05) and depression (p = .01) models, and change in driving status demonstrated significant independent effects in the depression model (p < .01). The driving behaviors measured did not have moderate effects on the relationships between QOL and fatigue and QOL and depression. Conclusions: Driving behaviors are valuable predictors of QOL in MS; however, the behaviors measured in this study did not serve as moderators in the relationships between QOL and fatigue and QOL and depression in our sample. The results suggest that fatigue and depression are primary predictors of QOL in MS, even when an important independent activity such as driving is accounted for.
Impact Types of Multiple Sclerosis (MS) on the Oral Symbol Digit Modalities Test
Objectives: This study examined the impact of different proportions of types of patients with multiple sclerosis (MS) using discrepancies from predicted performance on the oral version of the Symbol Digit Modalities Test (OSDMT). Method: The proportion of patients with Secondary-Progressive (SP), Progressive-Remitting and Progressive-Relapsing (PR&PR), Primary-Progressive and Chronic-Progressive (PP&CP), and Relapsing-Remitting (RR) types of MS was recorded for 61 sample means (n = 3,116 patients with MS). Data from healthy control participants (n of groups = 234, n of participants = 32,397) were used to develop predictive equations based on selected demographic variables. Scores on the OSDMT could be predicted using age, education, square and cubed transformations of discrepancies of age from the aggregated mean of age, prior assessment using the written SDMT, and proportion of male participants (R = .773, p < .001). Results: Overall, the means of OSDMT for patients with MS fell below their predicted levels (observed/expected = .785, range = .461 to 1.007). As the proportion of patients with RR increased, so did means of OSDMT and correspondingly the discrepancy between the observed and expected score decreased (Rxy = −.438, df = 49, p < .01). In contrast, as the proportion of patients with PR&PR increased, the discrepancy between the observed and expected score increased (Rxy = .611, df = 48, p < .01). Conclusion: Although many studies failed to report complete data, these results indicate that impact of the differing proportion of types of MS can affect the neuropsychological tests results.
Does Duration of Diagnosis Predict Cognitive Impairment in Multiple Sclerosis?
Objective: Multiple sclerosis (MS) is a debilitating neurological condition that has been thought to primarily result in white matter dysfunction. However, recent research has suggested that the disease pathology is also associated with cortical impairment, which accounts for the depth and breadth of cognitive impairment seen in patients with MS. The purpose of this study was to investigate the relationship between duration of diagnosis of MS and cognitive processing. Method: Participants were 33 patients with MS (mean age of 45.61 years, SD = 8.71 years). The mean duration of diagnosis was 7.15 years with an SD of 7.89 years. Most of the participants (75.8%) had relapsing-remitting MS. All participants completed the Wechsler Abbreviated Scale of Intelligence and the Repeatable Battery for the Assessment of Neuropsychological Status as part of a clinical battery. Results: Although group deficits in attention, immediate memory, and delayed memory were observed, the sample's mean FSIQ, VIQ, and PIQ scores were in the average range. Duration of diagnosis was not a significant predictor of verbal intelligence (R2 = .000; p = .95), but was a significant predictor of fluid intelligence (R2 = .138; p = .034). Conclusions: Duration of diagnosis has been shown to be a mixed predictor of cognitive impairment for patients with MS. The results of this study suggest that crystallized intelligence is more sensitive to disease progression. The implications will be discussed for practitioners and researchers.
Misophonia and Attention Disturbance Following Right Orbital Brain Injury
Objective: The objective of this study is to explore the relationship between misophonia (i.e., pathological aversion to sounds) and orbital-frontal lesion, as well as the impact on attention. Misophonia is an aversion or decreased tolerance to sounds that is thought to be the result of heightened autonomic/limbic responses triggered by the auditory system. However, little is known about the neuroanatomical and pathological causes of misphonia. Method: A 41-year-old, right-handed male who fell 10 feet from a ladder striking his head on some railing, resulting in a right orbital-frontal fracture. The individual presented with a diagnosis of misophonia, as confirmed by an audiology specialty clinic. Medical history otherwise includes a right parietal brain abscess that was removed 16 years earlier without apparent complication or cognitive sequelae. He had been high functioning until the fall, and subsequently has been unable to function in environments where he cannot control the sounds. Evaluation procedures included administration, scoring, and interpretation of comprehensive quantitative and qualitative measures. Results: Neuropsychological testing revealed average to above-average cognitive functioning with exception to poor attentional vigilance and organization of information. Emotional indices showed a relatively well-adjusted individual without significant depression, despite an otherwise clear pattern of panic attacks triggered by sounds. Results were used to guide psychotherapeutic interventions, including compensatory strategies and biofeedback aimed at desensitization. Conclusion: Misophonia may be the result of orbital-frontal lesion affecting anterior limbic structure, and neuropsychological testing is beneficial in ruling out processing and emotional disturbances that may contribute to an aversion to sounds.
Borderline Intellectual Functioning in Adults with Physical and Psychiatric Disorders
Objective: This study examined differential relationships between demographic and empirical variables in two clinical groups of adults with and without borderline intellectual functioning. Method: In an outpatient service principally designed for providing vocational rehabilitation, records from 1,014 adults who had undergone assessment were examined. Four hundred and fifteen were used in this study. Two hundred and twenty-six (54.5%) had exclusive referral diagnoses of physical impairment, whereas 189 (45.5%) had affective psychiatric disorders as their principal diagnosis making them eligible for the service. Results: Twenty-four and 8/10th percent of the sample had Full Scale IQ (FSIQ) scores between 71 and 84, potentially reflective of borderline intellectual functioning. Mean education level for the full sample was 11.66 years (SD = 1.98). Regardless of area of disability (physical or psychiatric) those with borderline intellectual functioning had the least years of education (mean 10.82) and lowest performance on cognitive measures. Based on multivariate analysis of variance (MANOVA), neurocognitive performance and academic achievement were explained significantly more fully by borderline intellectual functioning than referral diagnoses or any other subject variable (F(1, 411) = 27.97, p < .0001). Discussion: Despite the fact that it is only a potential V-code in Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) diagnosis and usually does not drive any form of funding or service eligibility, borderline intellectual functioning is often reflective of significant disability characterized by elevated risk and potentially poor functional outcomes. This study revealed that borderline intellectual functioning was a more salient risk factor than affective psychiatric disorder in predicting educational and vocational outcomes in adults. Neuropsychologists are in a key position to recognize and evaluate this potential area of disability and provide meaningful assistance. Implications of the results for clinical practice are discussed.
Differential Effects of Treatment on Cognitive Functioning in Primary Central Nervous System Lymphoma
Objective: In the cancer literature, quality of life has recently increased in salience in treatment planning, as an important aspect of functional outcome. In a primary brain cancer population, such as primary central nervous system lymphoma (PCNSL), both disease- and treatment-related changes in neurocognitive function (NCF) commonly render significant adverse effects on quality of life. Because of its low incidence and sparse research, little is known about treatment-related changes in NCF in PCNSL. The present study investigated the differential effects of chemotherapy with and without concurrent radiation on NCF in the treatment of PCNSL. Method: Cognition was assessed using specific subtests (Block Design, Similarities, Digit Span, Digit Symbol) from the Wechsler Adult Intelligence Scale-Third Edition, Controlled Oral Word Association task, and the Hopkin's Verbal Learning Test. Twelve PCNSL patients participated (mean age = 50 years, male = 50%, right-handed = 91.6%, mean years of education = 13). There were no significant differences between groups in sex, age, handedness, or years of education. Six independent sample t-test analyses were performed. Results: Performance on tasks of auditory attention and working memory, visuospatial construction skill, immediate verbal memory, and learning efficiency was significantly better in patients treated with chemotherapy alone than in those undergoing chemoradiation. Conclusions: Although both chemotherapy and radiation are known to have some effects on cognition, chemotherapy alone appears to be associated with better cognitive performance than chemoradiation. Further investigation on common neuropsychological effects of both of these treatments may help to further inform treatment plans for patients with PCNSL.
Multiple System Atrophy: A Case Study
Objective: The objective of this single case study is to explore multiple system atrophy (MSA). MSA is a progressive neurodegenerative disorder characterized by symptoms of autonomic nervous system failure combined with tremor, rigidity, bradykinesia, and ataxia; three types are recognized based on symptom presentation: a Parkinson's, autonomic, and cerebellar type. MSA is associated with the degeneration of nerve cells in specific areas of the brain causing problems with movement, balance, and automatic functions of the body. Although cognitive dysfunction may appear minimal in the early stages, most patients experience frontal system impairment and many develop dementia later in the course of the disease. This case will discuss a patient diagnosed with MSA by his neurologist. Method: A 67-year-old African American male was assessed in a hospital setting. Patient has a 4-year history of progressive changes in gait, bilateral tremor, incomplete bladder emptying progressed to urinary incontinence, erectile disorder, peripheral neuropathy, orthrostatic hypotension, and a new onset of sleep apnea and restless leg syndrome. The patient has noted slowed processing speed and mild word-finding difficulties with intact memory. Archival neuropsychological data, de-identified history, physician report, and neuroimaging will be organized and presented in a single study case summary. Evaluation procedures included administration, scoring, and interpretation of comprehensive quantitative and qualitative measures. Results: Assessment revealed several areas of impairment, including tremor, rigidity, bradykinesia, and ataxia. Deficits were noted in verbal fluency, inhibition, cognitive flexibility, and problem-solving. Memory was intact. Conclusion: The patient presented with deficits consistent with MSA.
Neuropsychological Assessment of Frontal Temporal Dementia: A Case Study
Objective: Recent research has identified a frontal temporal dementia (FTD) syndrome that impairs executive functioning in middle age and progresses rapidly. There have been few clinical reports of neuropsychological assessment with such FTD patients. This poster describes the neuropsychological assessment of an FTD female in order to demonstrate the value of neuropsychological assessment in diagnosing FTD patients. Method: The patient was a 50-year-old, divorced, African American right-handed female, who had a 2-year history of problems with short-term memory and poor judgment that were becoming worse. The patient had difficulty fulfilling her job duties in a security agency to the point she was retired, had been swindled out of thousands of dollars by various scams, and gained 50 pounds in the last 2 years due to overeating. In addition, there were concerns about the patient driving at high speeds in the patient's car. A comprehensive batt